本文關(guān)鍵詞： 結(jié)直腸腫瘤 NOSE 手術(shù) ERAS 腹腔鏡　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景及目的:目前結(jié)直腸癌的治療方法包括手術(shù)、放療、化療等,而手術(shù)切除腫物是目前結(jié)直腸癌根治性治療的首選治療方法,隨著外科技術(shù)和手術(shù)器械的不斷發(fā)展,腹腔鏡微創(chuàng)手術(shù)成為外科治療的主流方式,得到廣泛開展。NOTES手術(shù)比腹腔鏡手術(shù)更加微創(chuàng),幾乎達(dá)到了體表“無疤”的最高境界,仍而其尚有許多關(guān)鍵的問題未能很好解決,腹腔鏡手術(shù)與NOTES手術(shù)各有優(yōu)缺點(diǎn),對(duì)此,NOSE手術(shù)的出現(xiàn)是腹腔鏡手術(shù)的操作優(yōu)勢(shì)和NOTES手術(shù)的微創(chuàng)理念相結(jié)合的產(chǎn)物,可以說是“完美結(jié)合”,達(dá)到經(jīng)自然腔道取標(biāo)本的腹壁無輔助切口手術(shù),較傳統(tǒng)腹腔鏡創(chuàng)傷小,術(shù)后恢復(fù)更快。在另一方面,ERAS理念通過優(yōu)化圍手術(shù)期措施,包括術(shù)前、術(shù)中及術(shù)后處理等一系列的圍手術(shù)期治療干預(yù)措施,減少患者機(jī)體內(nèi)平衡的干擾,減少各種應(yīng)激反應(yīng),提高患者手術(shù)療效及降低術(shù)后并發(fā)癥,加快術(shù)后康復(fù),縮短住院時(shí)間。腹腔鏡手術(shù)、NOSE手術(shù)及ERAS理念都是以減少患者術(shù)后應(yīng)激、提高患者臨床治療效果、加速患者康復(fù)為目的。那么,NOSE手術(shù)聯(lián)合加速康復(fù)外科理念在結(jié)直腸癌患者中的應(yīng)用效果如何?本研究探討經(jīng)自然腔道標(biāo)本取出(NOSE)手術(shù)聯(lián)合快速康復(fù)外科(ERAS)理念在乙狀結(jié)腸及直腸上段癌治療中的應(yīng)用。對(duì)象與方法:本研究通過選取2013年10月至2016年2月間南方醫(yī)科大學(xué)附屬珠江醫(yī)院普外科收治的90例乙狀結(jié)腸癌和直腸上段癌患者隨機(jī)分為:傳統(tǒng)護(hù)理對(duì)照組(腹腔鏡手術(shù)加傳統(tǒng)護(hù)理方案)、腹腔鏡對(duì)照組(傳統(tǒng)腹腔鏡手術(shù)加ERAS方案)和NOSE組(NOSE手術(shù)加ERAS方案),行隨機(jī)對(duì)照研究比較3組患者術(shù)中及術(shù)后情況及疼痛評(píng)分。結(jié)果:3組患者手術(shù)均順利完成,無患者死亡,患者麻醉時(shí)間、手術(shù)時(shí)間和術(shù)中出血量差異無統(tǒng)計(jì)學(xué)意義(均P0.05);腹腔鏡對(duì)照組術(shù)后首次排氣時(shí)間、術(shù)后首次排糞時(shí)間、術(shù)后住院時(shí)間、平均住院費(fèi)用及術(shù)后并發(fā)癥發(fā)生率低于傳統(tǒng)護(hù)理對(duì)照組,NOSE組術(shù)后首次排氣時(shí)間、術(shù)后首次排糞時(shí)間、術(shù)后住院時(shí)間、平均住院費(fèi)用及術(shù)后第三天的CRP、IL-6、皮質(zhì)醇指標(biāo)及均低于其他兩組,各差異均有統(tǒng)計(jì)學(xué)意義(均P0.05);腹腔鏡對(duì)照組患者術(shù)后疼痛評(píng)分優(yōu)于傳統(tǒng)護(hù)理對(duì)照組患者,而NOSE組患者術(shù)后疼痛評(píng)分優(yōu)于其他兩組,差異均具有統(tǒng)計(jì)學(xué)意義(均P0.05)。結(jié)論:采用NOSE手術(shù)聯(lián)合ERAS方案治療乙狀結(jié)腸及直腸上段癌患者,較傳統(tǒng)腹腔鏡治療及其聯(lián)合ERAS方案更有優(yōu)勢(shì)。
[Abstract]:Background and objective: at present, the treatment of colorectal cancer includes surgery, radiotherapy, chemotherapy and so on. Surgical resection of tumor is the first choice of treatment for colorectal cancer. With the continuous development of surgical techniques and instruments, laparoscopic minimally invasive surgery has become the mainstream of surgical treatment, and has been widely developed. NOTES surgery is more minimally invasive than laparoscopic surgery. Almost reached the highest level of "no scar" on the body surface, but there are still many key problems to be solved. Laparoscopic surgery and NOTES surgery have their own advantages and disadvantages. The appearance of NOSE surgery is the result of the combination of the advantages of laparoscopic surgery and the idea of minimally invasive NOTES surgery, which can be said to be a "perfect combination". The abdominal wall without assistant incisions through the natural cavity is less traumatic than the traditional laparoscopic surgery, and the postoperative recovery is faster. On the other hand, the ERAS idea is to optimize the perioperative measures, including preoperative. During and after a series of perioperative treatment intervention measures to reduce the interference of the balance of patients, reduce all kinds of stress reactions, improve the effectiveness of surgery and reduce postoperative complications, accelerate postoperative rehabilitation. The purpose of laparoscopic surgery and ERAS is to reduce postoperative stress, improve the clinical effect of patients, and accelerate the recovery of patients. How effective is NOSE surgery combined with accelerated rehabilitation surgery in patients with colorectal cancer? The purpose of this study was to investigate the combination of the removal of the specimens from the natural canal and the rapid rehabilitation surgery (ERASS). Application of the concept in the treatment of sigmoid and upper rectal cancer. Objects and methods:. From October 2013 to February 2016, 90 patients with sigmoid and upper rectal cancer were randomly divided into:. Traditional nursing control group (. Laparoscopic surgery plus traditional nursing protocols). Laparoscopic control group (traditional laparoscopic operation plus ERAS regimen) and NOSE group with no operation plus ERAS regimen). A randomized controlled study was conducted to compare the intraoperative and postoperative conditions and pain scores in the three groups. Results all the patients in the 3 groups were successfully operated without death and anesthesia time. There was no significant difference in the time of operation and the amount of blood loss during operation (all P 0.05). The time of first exhaust after operation, the time of first excrement, the time of hospitalization, the average cost of hospitalization and the incidence of postoperative complications in the laparoscopic control group were lower than those in the traditional nursing control group. The time of first defecation postoperative hospitalization average hospitalization cost and CRP IL-6 on the third day after operation were lower than those in the other two groups. All the differences were statistically significant (P 0.05). The postoperative pain score of the patients in the laparoscopic control group was better than that in the traditional nursing control group, while the postoperative pain score in the NOSE group was better than that in the other two groups. The difference was statistically significant (P0.050.Conclusion: NOSE combined with ERAS regimen was used to treat cancer of sigmoid colon and upper rectum. Compared with traditional laparoscopic therapy and combined with ERAS regimen has more advantages.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 朱江帆;;腹壁無瘢痕手術(shù):從NOTES到TUES[J];中國(guó)微創(chuàng)外科雜志;2007年09期

2 ;Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy[J];World Journal of Gastroenterology;2006年15期

3 蔡明;;擇期手術(shù)患者術(shù)前禁食、禁飲的現(xiàn)狀與進(jìn)展[J];解放軍護(hù)理雜志;2006年12期

4 曹月敏;;NOTES的發(fā)展史、現(xiàn)狀與前景[J];中國(guó)微創(chuàng)外科雜志;2010年01期

5 席兆華;;經(jīng)自然孔道內(nèi)鏡外科的研究進(jìn)展[J];肝膽外科雜志;2010年01期

6 張曉紅;邵衛(wèi)玲;;快速康復(fù)外科理念在腹腔鏡直腸癌圍術(shù)期的應(yīng)用[J];實(shí)用臨床醫(yī)藥雜志;2014年22期

7 王錫山;;結(jié)直腸腫瘤類-NOTES手術(shù)實(shí)踐與關(guān)鍵技術(shù)[J];中華普外科手術(shù)學(xué)雜志(電子版);2016年02期

，

本文編號(hào)：1468618