本文關(guān)鍵詞： 加速康復(fù)外科 腔鏡輔助下 進展期胃癌　出處：《青海大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討腹腔鏡輔助下進展期胃癌根治術(shù)圍手術(shù)期經(jīng)加速康復(fù)外科處理的安全性、有效性。方法:收集并整理2015年5月至2016年11月期間,到青海大學(xué)附屬醫(yī)院胃腸外科就醫(yī)的,行腹腔鏡輔助下進展期胃癌根治手術(shù)的60例病例資料行回顧性病例分析,其中圍手術(shù)期經(jīng)加速康復(fù)外科處理的病例資料30例為試驗組,經(jīng)傳統(tǒng)圍手術(shù)期處理方法的病例資料30例為對照組。通過兩組術(shù)前(性別、年齡)、術(shù)中(手術(shù)方式、手術(shù)時間、術(shù)中出血量、清掃淋巴結(jié)個數(shù))、術(shù)后(p TNM分期、術(shù)后下床時間及通氣時間、拔管時間、經(jīng)口進流食時間、術(shù)后住院天數(shù)、住院總費用、并發(fā)癥發(fā)生率)三方面進行安全性及有效性的對比。結(jié)果:通過試驗組與對照組的對比,可見二者在一般臨床資料(年齡、性別、手術(shù)方式、手術(shù)時間、術(shù)中出血量、清掃淋巴結(jié)個數(shù)、p TNM分期)之間無差異(P0.05),具有可比性。二者在下床時間及通氣時間、拔管時間、經(jīng)口進流食時間、術(shù)后住院天數(shù)和住院總費用之間分別對比存在差異(P0.05)。此中,加速組較傳統(tǒng)組的術(shù)后下床時間(16.07±4.41 vs.49.10±15.25)、通氣時間(46.10±16.69 vs.86.33±19.14)、拔尿管時間(1.13±0.35 vs.3.27±0.58)、拔胃管時間(2.63±0.76 vs.6.17±1.74)、拔腹腔引流管時間(7.10±2.55 vs.9.93±3.70)、經(jīng)口進流食時間(2.60±0.93 vs.7.73±1.91)、術(shù)后住院天數(shù)(9.80±1.32 vs.15.87±4.87)均縮短,住院費用(65088.02±10451.94 vs.71145.16±14165.37)較之減少;二者在術(shù)后并發(fā)癥方面差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:在手術(shù)后并發(fā)癥未提高的前提下,應(yīng)用加速康復(fù)處理的腹腔鏡輔助下進展期胃癌患者,下床時間提前,通氣時間也提前,拔管時間比之縮短,經(jīng)口進流食時間提前,手術(shù)以后的住院時間減少,住院總花費卻較之降低。一定程度上證實了,其在臨床工作中的安全性及有效性,故建議推廣加速康復(fù)外科在腔鏡輔助下進展期胃癌患者中的應(yīng)用。
[Abstract]:Objective: to investigate the safety and efficacy of laparoscopic assisted radical gastrectomy for advanced gastric cancer during the perioperative period of accelerated rehabilitation surgery. Methods: from May 2015 to November 2016. A retrospective analysis of 60 cases of laparoscopic assisted radical gastrectomy for gastric cancer was performed in the department of gastrointestinal surgery in the affiliated hospital of Qinghai University. Among them, 30 cases were treated by accelerated rehabilitation surgery in perioperative period as experimental group, 30 cases by traditional perioperative method as control group, and 30 cases were treated by pre-operation (sex, age) in two groups. Intraoperative (mode of operation, time of operation, amount of blood lost during operation, number of lymph nodes dissected, TNM stage after operation, time of getting out of bed, time of ventilation, time of extubation, time of feeding through mouth). Results: through the comparison between the trial group and the control group, we can see that the two in general clinical data (age, sex). There was no significant difference between operation mode, operation time, intraoperative bleeding volume and lymph node dissection TNM stage (P 0.05), the two were comparable in the time of getting out of bed, time of ventilation and time of extubation. There were significant differences in the time of feeding through the mouth, the days of hospitalization and the total cost of hospitalization. The time of getting out of bed was 16.07 鹵4.41 vs.49.10 鹵15.25 in accelerated group than in traditional group. The time of ventilation was 46.10 鹵16.69 vs.86.33 鹵19.14 vs.86.33, and the time of extubation was 1.13 鹵0.35 vs.3.27 鹵0.58). The time of gastric tube extraction was 2.63 鹵0.76 vs.6.17 鹵1.74 vs.6.17, and that of abdominal drainage tube was 7.10 鹵2.55 vs.9.93 鹵3.70). The feeding time was 2.60 鹵0.93 vs.7.73 鹵1.91 vs.7.73 and the postoperative hospitalization time was 9.80 鹵1.32 vs.15.87 鹵4.87). The cost of hospitalization was 65088.02 鹵10451.94 vs.71145.16 鹵14165.37). There was no significant difference in postoperative complications between the two groups (P 0.05). Conclusion: under the premise of no improvement of postoperative complications, laparoscopic assisted treatment with accelerated rehabilitation is used in patients with advanced gastric cancer. The time of getting out of bed was earlier, the time of ventilation was earlier, the time of extubation was shorter than that of extubation, the time of feeding through the mouth was earlier, the time of hospitalization after operation was reduced, but the total cost of hospitalization was lower than that of others. It is suggested to promote the application of accelerated rehabilitation surgery in patients with advanced gastric cancer assisted by endoscopy.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

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