郝晉 1,2,3 , 楊廷翰 1,2,4 , 蒲怡 1,2,4 , 楊光超 1,2,4 , 汪曉東 1,2 , 李立 1,2
  • 1.四川大學(xué)華西醫(yī)院胃腸外科中心(成都 610041);;
  • 2.四川大學(xué)華西醫(yī)院MCQ團(tuán)隊(duì)(成都 610041);;
  • 3.四川大學(xué)華西口腔醫(yī)學(xué)院(成都 610041);;
  • 4.四川大學(xué)華西臨床醫(yī)學(xué)院(成都 610041);

目的 探討快速流程應(yīng)用于梗阻型結(jié)直腸癌外科治療的臨床安全性與可行性。方法 回顧性分析2008年2月至2009年2月期間四川大學(xué)華西醫(yī)院胃腸外科中心結(jié)直腸外科專(zhuān)業(yè)組收治的157例梗阻型結(jié)直腸癌患者的臨床資料,其中接受快速流程管理模式者59例(快速流程組),未接受者98例(傳統(tǒng)組)。研究不同管理模式下患者早期恢復(fù)情況及并發(fā)癥發(fā)生情況。結(jié)果 從術(shù)后早期康復(fù)指標(biāo)來(lái)看,快速流程組患者的首次排氣時(shí)間、首次經(jīng)口進(jìn)食時(shí)間和術(shù)后住院時(shí)間均短于傳統(tǒng)組患者,差異有統(tǒng)計(jì)學(xué)意義(P lt;0.05); 而2組間首次下床活動(dòng)時(shí)間及首次拔除胃管、尿管和引流管時(shí)間的差異則沒(méi)有統(tǒng)計(jì)學(xué)意義(P gt;0.05)。2組間術(shù)后并發(fā)癥發(fā)生率的差異沒(méi)有統(tǒng)計(jì)學(xué)意義(P gt;0.05)。結(jié)論 梗阻型結(jié)直腸癌外科治療中采用快速流程管理模式具有良好的安全性,能夠縮短該類(lèi)患者住院時(shí)間,促進(jìn)術(shù)后康復(fù),改善其生活質(zhì)量。

引用本文: 郝晉,楊廷翰,蒲怡,楊光超,汪曉東,李立. 梗阻型結(jié)直腸癌外科治療中運(yùn)用快速流程的安全性△. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1314-1317. doi: 復(fù)制

1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
2. Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
3. 汪曉東, 謝堯, 肖軍, 等. 快速流程在結(jié)直腸外科手術(shù)后管理中的應(yīng)用 [J]. 中國(guó)普通外科雜志, 2008; 17(4): 394-396.
4. 李立, 汪曉東, 舒曄, 等. 四川大學(xué)華西醫(yī)院肛腸外科·結(jié)直腸外科快速流程臨床指南 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5-8): 413, 493-494, 581, 671.
5. 賴(lài)瑋婧, 汪曉東, 陳海燕, 等. 梗阻型中下段直腸癌一期吻合手術(shù)的臨床效果 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(11): 918-921.
6. Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care [J]. Dis Colon Rectum, 2004; 47(3): 271-277.
7. Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [J]. ANZ J Surg, 2002; 72(6): 421-425.
8. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 45-54.
9. 羅超蘭, 楊向東. 直腸癌的手術(shù)治療進(jìn)展 [J]. 結(jié)直腸肛門(mén)外科, 2008; 14(1): 72-74..
10. 王振軍, 馬華崇. 直腸癌合并急性腸梗阻的外科處理策略 [J]. 中國(guó)實(shí)用外科雜志, 2007; 27(6): 455-457..
11. 彭愛(ài)國(guó), 金小順, 趙懷輝. 結(jié)腸癌并發(fā)急性腸梗阻的外科治療 [J]. 安徽醫(yī)學(xué), 2010; 31(6): 610-611..
12. de Aguilar-Nascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240-245..
13. Durán Giménez-Rico H, Abril Vega C, Herreros Rodríguez J, et al. Hartmann’s procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery [J]. Clin Transl Oncol, 2005; 7(7): 306-313.
14. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon [J]. Am J Surg, 2005; 189(4): 384-387.
15. Omejc M, Stor Z, Jelenc F, et al. Outcome after emergency subtotal/total colectomy compared to elective resection in patients with left-sided colorectal carcinoma [J]. Int Surg, 1998; 83(3): 241-244.
16. 黃勇, 陳志棠. 結(jié)、直腸癌并發(fā)急性腸梗阻的外科治療 [J]. 國(guó)際醫(yī)藥衛(wèi)生導(dǎo)報(bào), 2007; 13(1): 22-23.
17. Vukovic' M, Moljevic' N. Total colectomy-options in management of acute obstruction of the left-side colon [J]. Med Pregl, 2008; 61(1-2): 43-47.
18. 汪曉東, 賴(lài)瑋婧, 肖凌, 等. 結(jié)直腸外科術(shù)前快速腸道準(zhǔn)備研究進(jìn)展 [J]. 結(jié)直腸肛門(mén)外科, 2009; 15(5): 365-368.
19. Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
20. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466-477.
21. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.
22. Fleshman JW, Fry RD, Birnbaum EH, et al. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome [J]. Dis Colon Rectum, 1996; 39(1): 15-22.
23. Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50.
24. 周寅, 楊廷翰, 汪曉東, 等. 早期經(jīng)口進(jìn)食在結(jié)直腸癌術(shù)后快速流程模式中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(5): 500-503.
25. 楊廷翰, 周寅, 余曦, 等. 低位/超低位直腸癌快速流程模式的效果探討 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(6): 618-621.
26. Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark [J]. Arch Orthop Trauma Surg, 2010; 130(2): 263-268.
27. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
28. 肖凌, 李蔚, 麥玲, 等. 快速流程模式下術(shù)后限制補(bǔ)液對(duì)不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190-194.
29. 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 239-242.
  1. 1. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
  2. 2. Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793.
  3. 3. 汪曉東, 謝堯, 肖軍, 等. 快速流程在結(jié)直腸外科手術(shù)后管理中的應(yīng)用 [J]. 中國(guó)普通外科雜志, 2008; 17(4): 394-396.
  4. 4. 李立, 汪曉東, 舒曄, 等. 四川大學(xué)華西醫(yī)院肛腸外科·結(jié)直腸外科快速流程臨床指南 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(5-8): 413, 493-494, 581, 671.
  5. 5. 賴(lài)瑋婧, 汪曉東, 陳海燕, 等. 梗阻型中下段直腸癌一期吻合手術(shù)的臨床效果 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009; 16(11): 918-921.
  6. 6. Basse L, Thorbl JE, Lssl K, et al. Colonic surgery with accelerated rehabilitation or conventional care [J]. Dis Colon Rectum, 2004; 47(3): 271-277.
  7. 7. Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [J]. ANZ J Surg, 2002; 72(6): 421-425.
  8. 8. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 45-54.
  9. 9. 羅超蘭, 楊向東. 直腸癌的手術(shù)治療進(jìn)展 [J]. 結(jié)直腸肛門(mén)外科, 2008; 14(1): 72-74..
  10. 10. 王振軍, 馬華崇. 直腸癌合并急性腸梗阻的外科處理策略 [J]. 中國(guó)實(shí)用外科雜志, 2007; 27(6): 455-457..
  11. 11. 彭愛(ài)國(guó), 金小順, 趙懷輝. 結(jié)腸癌并發(fā)急性腸梗阻的外科治療 [J]. 安徽醫(yī)學(xué), 2010; 31(6): 610-611..
  12. 12. de Aguilar-Nascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240-245..
  13. 13. Durán Giménez-Rico H, Abril Vega C, Herreros Rodríguez J, et al. Hartmann’s procedure for obstructive carcinoma of the left colon and rectum: a comparative study with one-stage surgery [J]. Clin Transl Oncol, 2005; 7(7): 306-313.
  14. 14. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon [J]. Am J Surg, 2005; 189(4): 384-387.
  15. 15. Omejc M, Stor Z, Jelenc F, et al. Outcome after emergency subtotal/total colectomy compared to elective resection in patients with left-sided colorectal carcinoma [J]. Int Surg, 1998; 83(3): 241-244.
  16. 16. 黃勇, 陳志棠. 結(jié)、直腸癌并發(fā)急性腸梗阻的外科治療 [J]. 國(guó)際醫(yī)藥衛(wèi)生導(dǎo)報(bào), 2007; 13(1): 22-23.
  17. 17. Vukovic' M, Moljevic' N. Total colectomy-options in management of acute obstruction of the left-side colon [J]. Med Pregl, 2008; 61(1-2): 43-47.
  18. 18. 汪曉東, 賴(lài)瑋婧, 肖凌, 等. 結(jié)直腸外科術(shù)前快速腸道準(zhǔn)備研究進(jìn)展 [J]. 結(jié)直腸肛門(mén)外科, 2009; 15(5): 365-368.
  19. 19. Hasenberg T, Keese M, Lngle F, et al. ‘Fast-track’ colonic surgery in Austria and Germany-results from the survey on patterns in current perioperative practice [J]. Colorectal Dis, 2009; 11(2): 162-167.
  20. 20. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection [J]. Clin Nutr, 2005; 24(3): 466-477.
  21. 21. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.
  22. 22. Fleshman JW, Fry RD, Birnbaum EH, et al. Laparoscopic-assisted and minilaparotomy approaches to colorectal diseases are similar in early outcome [J]. Dis Colon Rectum, 1996; 39(1): 15-22.
  23. 23. Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50.
  24. 24. 周寅, 楊廷翰, 汪曉東, 等. 早期經(jīng)口進(jìn)食在結(jié)直腸癌術(shù)后快速流程模式中的應(yīng)用 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(5): 500-503.
  25. 25. 楊廷翰, 周寅, 余曦, 等. 低位/超低位直腸癌快速流程模式的效果探討 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(6): 618-621.
  26. 26. Husted H, Hansen HC, Holm G, et al. What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark [J]. Arch Orthop Trauma Surg, 2010; 130(2): 263-268.
  27. 27. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
  28. 28. 肖凌, 李蔚, 麥玲, 等. 快速流程模式下術(shù)后限制補(bǔ)液對(duì)不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190-194.
  29. 29. 劉展, 汪曉東, 李立. 多學(xué)科協(xié)作診治模式下的結(jié)直腸外科快速康復(fù)流程 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2007; 14(2): 239-242.