摘要
目的探讨快速康复外科理念对腹腔镜下行胰十二指肠切除术胰头癌患者术后应激因子及预后的影响。方法选取2016年10月至2019年10月在淮南新华医疗集团新华医院接受治疗的60例胰头癌患者,随机分为对照组和观察组,每组30例。两组均接受腹腔镜下胰十二指肠切除术,在手术期间及术后,对照组给予临床常规治疗措施,观察组采用快速康复外科理念指导围手术期诊疗,观察并比较两组患者治疗前后的皮质醇(CO)、肾上腺素(AD)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)应激因子水平,比较两组患者汉密顿焦虑量表(HAMA)评分,比较两组患者的临床疗效(术后肛门排气时间、引流管拔除时间、住院时间)及术后并发症发生情况,并于术后随访6个月,记录并比较随访期间两组患者的二次手术率及病死情况,行统计学分析。结果术前两组患者的应激因子(CO、AD、IL-6及TNF-α)比较差异无统计学意义(P>0.05),术后2 d,观察组的血清CO、AD、IL-6、TNF-α水平及HAMA评分均低于对照组(P<0.05);观察组的并发症发生率(33.33%)低于对照组(73.33%),且观察组患者的术后肛门排气时间、引流管拔除时间和住院时间较对照组均明显缩短(P<0.05),观察组的二次手术率及病死率均明显低于对照组(P<0.05)。结论快速康复外科理念应用于腹腔镜下胰十二指肠切除术患者具有较好的临床疗效,可大幅度减轻患者术后的应激反应,降低并发症的发生率,同时还起到缩短治疗时间、减轻患者创伤的效果,利于患者术后快速恢复。
Objective To investigate the effect of rapid rehabilitation surgery on the stress factors and prognosis of patients undergoing laparoscopic pancreatic duodenal resection for pancreatic head cancer.Methods Sixty patients with pancreatic head cancer who were treated in Xinhua Hospital of Huainan Xinhua Medical Group from October 2016 to October 2019 were selected as the research subjects.Randomly divided into two groups:control group and observation group,30 cases in each group.Patients in both groups underwent laparoscopic pancreaticoduodenectomy for pancreatic head cancer.The control group was given routine clinical treatment during and after the operation.The observation group used the concept of rapid rehabilitation surgery to guide perioperative diagnosis and treatment.Observe and compare the levels of cortisol(CO),adrenaline(AD),IL-6 and TNF-α stress factors of the two groups of patients before and after treatment,and compare the Hamilton Anxiety Scale(HAMA)of the two groups of patients Scoring,comparing the clinical efficacy of the two groups of patients(postoperative anal exhaust time,drainage tube removal time,hospitalization time)and postoperative complications.Followed up for 6 months postoperatively,the secondary operation rate and mortality of the two groups of patients were recorded and compared during the follow-up period for statistical analysis.Results There was no statistically significant difference in stress factors between the two groups of patients before surgery(P>0.05).Two days after surgery,the levels of serum CO,AD,IL-6 and TNF-α in the observation group were significantly lower than those in the control group;the HAMA score was lower than that in the control group(P<0.05);Incidence of complications in the observation group were significantly lower than those in the control group(33.33%vs.73.33%),and the postoperative anal exhaust time,drainage tube removal time and hospitalization time of the observation group were significantly shorter than that of the control group(P<0.05).And the secondary surgery rate and mortality in the control group were significantly higher than those in the observation group(P<0.05).Conclusions The concept of rapid rehabilitation surgery applied to patients undergoing pancreaticoduodenectomy for pancreatic head cancer under laparoscopy has a good clinical effect,which can greatly reduce the postoperative stress response and reduce the incidence of complications.It also has the effect of shortening the treatment time and reducing the trauma of the patient,which is beneficial to the rapid recovery of the patient after the operation.
作者
顾亚奇
余红东
周茂旭
王成
黄强
GU Yaqi;YU Hongdong;ZHOU Maoxu;WANG Cheng;HUANG Qiang(Department of General Surgery,Xinhua Hospital,Huainan Xinhua Medical Group,Huainan 232052,China;Department of General Surgery,First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)
出处
《中国肿瘤外科杂志》
CAS
2020年第5期425-428,共4页
Chinese Journal of Surgical Oncology
关键词
快速康复外科
腹腔镜
胰头癌
胰十二指肠切除术
应激因子
Rapid rehabilitation surgery
Laparoscopic
Pancreatic head cancer
Pancreaticoduodenectomy
Stress factor
