楊廷翰 1,2,3 , 蒲怡 1,2,3 , 楊光超 1,2,3 , 彭安嬌 1,2,3 , 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團隊(成都 610041);;
  • 3.四川大學(xué)華西臨床醫(yī)學(xué)院(成都 610041);

目的 探討快速流程完成率對結(jié)直腸癌根治術(shù)術(shù)后管理的影響。方法 回顧性分析2010年2~5月期間四川大學(xué)華西醫(yī)院胃腸外科中心結(jié)直腸外科專業(yè)組收治的100例結(jié)直腸癌患者(2010年組)及2008年2~5月期間收治的76例結(jié)直腸癌患者(2008年組)的臨床資料,比較2組患者術(shù)后康復(fù)情況、并發(fā)癥發(fā)生情況及快速流程完成情況。結(jié)果 快速流程各主要環(huán)節(jié)中,2010年組液體限制、早期下床活動、早期經(jīng)口進食、胃管管理和引流管管理完成率均高于2008年組,其差異有統(tǒng)計學(xué)意義(P lt;0.05); 而2008年組尿管管理的完成率則明顯高于2010年組,其差異也有統(tǒng)計學(xué)意義(P lt;0.05)。術(shù)后康復(fù)方面,2010年組術(shù)后首次排氣時間〔(3.86±1.05) d比(4.28±1.22) d〕明顯早于2008年組,其差異有統(tǒng)計學(xué)意義(P lt;0.05),而2組術(shù)后住院時間之間的差異沒有統(tǒng)計學(xué)意義(P gt;0.05)。同時,2組患者并發(fā)癥總發(fā)生率及各項并發(fā)癥的發(fā)生率之間的差異均無統(tǒng)計學(xué)意義(P gt;0.05)。結(jié)論 隨著對快速流程理念接受程度的增高,快速流程各環(huán)節(jié)的完成率明顯提高,越來越多的環(huán)節(jié)成為常規(guī)管理方式,患者早期康復(fù)也更好,但發(fā)揮快速流程最大優(yōu)勢尚需加強多學(xué)科合作及克服本土化的困難。

引用本文: 楊廷翰,蒲怡,楊光超,彭安嬌,汪曉東,李立. 快速流程完成率對結(jié)直腸癌根治術(shù)術(shù)后管理的影響. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(11): 1203-1206. doi: 復(fù)制

1. Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793, PMID: 18328911.
2. 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]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(6): 618-621.
3. 楊廷翰, 蒲怡, 趙娜, 等. 高齡結(jié)直腸癌患者快速流程的隨機對照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(9): 983-988.
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(一) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 413.
5. 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(二) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(6): 493-494.
6. 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(三) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 581.
7. 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(四) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(8): 671.
8. 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, PMID: 18462237.
9. 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, PMID: 15896435.
10. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695, PMID: 10773121.
11. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928, PMID: 14667752.
12. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416-423, PMID: 15729063.
13. Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection [J]. Br J Surg, 2000; 87(11): 1540-1545, PMID: 11091243.
14. King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300-308, PMID: 16363014.
15. Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial) [J]. BMC Surg, 2006; 6: 16, PMID: 17134506.
16. Tsikitis VL, Holubar SD, Dozois EJ, et al. Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer [J]. Surg Endosc, 2010; 24(8): 1911-1916, PMID: 20108142.
17. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fast-track surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408-412, PMID: 19245924.
18. 肖凌, 李蔚, 麥玲, 等. 快速流程模式下術(shù)后限制補液對不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190-194.
19. Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review [J]. J Clin Nurs, 2006; 15(6): 696-709, PMID: 16684165.
20. 周寅, 楊廷翰, 汪曉東, 等. 早期經(jīng)口進食在結(jié)直腸癌術(shù)后快速流程模式中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(5): 500-503.
21. 李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新(一) [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1): 106-109.
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, PMID: 8601351.
23. Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50, PMID: 15972171.
24. White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care [J]. Anesth Analg, 2007; 104(6): 1380-1396, PMID: 17513630.
25. White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? [J]. Anesthesiology, 2010; 112(1): 220-225, PMID: 20010418.
  1. 1. Kehlet H. Fast-track colorectal surgery [J]. Lancet, 2008; 371(9615): 791-793, PMID: 18328911.
  2. 2. 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]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(6): 618-621.
  3. 3. 楊廷翰, 蒲怡, 趙娜, 等. 高齡結(jié)直腸癌患者快速流程的隨機對照研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(9): 983-988.
  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(一) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5): 413.
  5. 5. 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(二) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(6): 493-494.
  6. 6. 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(三) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 581.
  7. 7. 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(四) [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(8): 671.
  8. 8. 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, PMID: 18462237.
  9. 9. 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, PMID: 15896435.
  10. 10. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695, PMID: 10773121.
  11. 11. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928, PMID: 14667752.
  12. 12. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416-423, PMID: 15729063.
  13. 13. Bardram L, Funch-Jensen P, Kehlet H. Rapid rehabilitation in elderly patients after laparoscopic colonic resection [J]. Br J Surg, 2000; 87(11): 1540-1545, PMID: 11091243.
  14. 14. King PM, Blazeby JM, Ewings P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme [J]. Br J Surg, 2006; 93(3): 300-308, PMID: 16363014.
  15. 15. Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial) [J]. BMC Surg, 2006; 6: 16, PMID: 17134506.
  16. 16. Tsikitis VL, Holubar SD, Dozois EJ, et al. Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer [J]. Surg Endosc, 2010; 24(8): 1911-1916, PMID: 20108142.
  17. 17. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fast-track surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408-412, PMID: 19245924.
  18. 18. 肖凌, 李蔚, 麥玲, 等. 快速流程模式下術(shù)后限制補液對不同手術(shù)方案直腸癌患者康復(fù)情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(2): 190-194.
  19. 19. Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review [J]. J Clin Nurs, 2006; 15(6): 696-709, PMID: 16684165.
  20. 20. 周寅, 楊廷翰, 汪曉東, 等. 早期經(jīng)口進食在結(jié)直腸癌術(shù)后快速流程模式中的應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010; 17(5): 500-503.
  21. 21. 李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新(一) [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1): 106-109.
  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, PMID: 8601351.
  23. 23. Hsu TC. Feasibility of colectomy with mini-incision [J]. Am J Surg, 2005; 190(1): 48-50, PMID: 15972171.
  24. 24. White PF, Kehlet H, Neal JM, et al. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care [J]. Anesth Analg, 2007; 104(6): 1380-1396, PMID: 17513630.
  25. 25. White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues? [J]. Anesthesiology, 2010; 112(1): 220-225, PMID: 20010418.