林建安 杜佳斌 钟文进 叶凯 许建华

[摘要] 目的 分析加速康復外科理念在腹腔镜下胃癌根治术中的应用。方法 收集福建医科大学附属第二医院胃肠外科 2018年1月至2020年12月收治的120例胃癌患者以1∶2随机分为对照组和 ERAS组，对照组40例，ERAS组80例，对照组行常规腹腔镜手术治疗，ERAS组行加速康复外科理念联合腹腔镜手术治疗。比较两组术前 1 d 和术后 3 d 各项指标、患者术后恢复情况及术后并发症发生情况。结果 术前1 d两组患者白细胞、C-反应蛋白和血清白蛋白比较，差异无统计学意义（P>0.05）;术后3 d，ERAS组患者白细胞[（9.16±1.95）×109/L vs.（10.25±2.07）×109/L]、C-反应蛋白[（21.30±4.27）mg/L vs.（30.70±5.28）mg/L]均低于对照组，差异有统计学意义（P<0.01）;ERAS组患者的血清白蛋白[（35.20±3.23）g/L vs.（31.60±3.07）g/L]高于对照组，差异有统计学意义（P<0.01）;患者术后肠道功能恢复时间[（21.31±4.70）h vs.（26.11±5.29）h]、首次排气时间[（28.51±4.97）h vs.（33.19±5.11）h]、首次进食时间[（26.68±5.09）h vs.（40.31±6.02）h]以及住院时间[（8.09±1.27）d vs.（10.71±1.58）d]均短于对照组，差异有统计学意义（P<0.01）;ERAS组术后伤口感染率（2.50% vs. 12.50%）低于对照组，差异有统计学意义（P<0.05）。 结论 腹腔镜联合加速康复外科理念（ERAS）行胃癌根治术疗效佳，患者康复更快、应激减轻及缩短住院时间，值得临床推广应用。

[关键词] 加速康复外科;腹腔镜;胃癌;应激反应

[中图分类号] R735.2          [文献标识码] B          [文章编号] 1673-9701（2021）33-0066-04

[Abstract] Objective To analyze the application of enhanced recovery after surgery in laparoscopic radical gastrectomy. Methods A total of 120 patients with gastric cancer admitted to the Department of Gastrointestinal Surgery of the Fujian Medical University， 2nd Affiliated Hospital from January 2018 to December 2020 were randomly divided into control group （n=40） and ERAS group （n=80） at a ratio of 1∶2. The control group received routine laparoscopic surgery. The ERAS group received enhanced recovery after surgery combined with laparoscopic surgery. The indicators 1 day before surgery and 3 days after surgery， postoperative recovery and postoperative complications were compared between the two groups. Results There was no significant difference in white blood cell， C-reactive protein， and serum albumin 1 day before operation between the two groups （P>0.05）. Three days after the operation， the white blood cells [（9.16±1.95）×109/L vs. （10.25±2.07）×109/L] and C-reactive protein [（21.30±4.27）mg/L vs. （30.70±5.28）mg/L] of patients in the RAS group were lower than those in the control group， and the difference had statistical significance（P<0.01）. Serum albumin [（35.20±3.23）g/L vs.（31.60±3.07）g/L] in the ERAS group was higher than that in the control group， and the difference was statistically significant （P<0.01）. The postoperative intestinal function recovery time [（21.31±4.70）h vs. （26.11±5.29）h]， first exhaust time [（28.51±4.97）h vs.（33.19±5.11）h]， first feeding time [（26.68±5.09）h vs. （40.31±6.02）h]， and hospital stay[（8.09±1.27）d vs. （10.71±1.58）d] in ERAS group were lower than those in the control group， and the differences were statistically significant（P<0.01）. The postoperative wound infection rate （2.50% vs. 12.50%） in the ERAS group was lower than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion Laparoscopy combined with enhanced recovery after surgery（ERAS） is effective in radical gastrectomy， with the advantages of faster recovery， less stress， and shorter hospital stay. It is worthy of being widely popularized in clinical application.

[Key words] Enhanced recovery after surgery; Laparoscopy; Gastric cancer; Stress response

胃癌为我国发病率最高的消化道肿瘤，尽管胃癌的治疗方法有很多，如放疗、化疗、免疫治疗等，手术切除是提高胃癌患者生存率的唯一合适的治疗方法，因手术复杂，所需手术时间较长，麻醉时间较长，术后应激反应及并发症将影响患者术后康复[1]，然而，腹腔镜手术以其“出血少、创伤小、恢复快”的特点在胃癌的应用越来越得到广泛认可，但仍有围术期相对较长及术后并发症多等问题一直困扰着广大临床医生[2]。术后加速康复（Enhanced recovery after surgery，ERAS）是指通过多学科的协作，遵循基于循证医学证据的围术期医疗理念，对常规临床和护理措施进行优化和改良，从而加速术后患者快速康复的重要理念[3]，ERAS的安全性及有效性在世界各地得到了广泛应用，为探讨其理念在胃癌手术中的应用优越性。本研……