• 武漢市第八醫(yī)院肛腸外科（湖北武漢 430010）;

目的探討快速流程模式(FT)和傳統(tǒng)模式(TC)對行不同手術(shù)方式的直腸癌患者圍手術(shù)期的影響。方法回顧性分析2009年1月至2010年1月期間武漢市第八醫(yī)院肛腸外科收治的285例直腸癌患者的臨床資料，患者接受FT或TC處理以及直腸癌高位前切除術(shù)(HAR)或低位/超低位前切除術(shù)(LAR)，從而分為FT+HAR組(n=39)、FT+LAR組(n=17)、TC+HAR組(n=151)及TC+LAR組(n=78)，分析比較在FT和TC處理下不同手術(shù)方式對患者術(shù)中情況和術(shù)后康復(fù)的影響。結(jié)果①手術(shù)時間和出血量4組間總體比較差異均無統(tǒng)計學(xué)意義(P gt;0.05)。②術(shù)后共發(fā)生吻合口漏3例、傷口感染13例和腸梗阻4例，4組間總體比較差異無統(tǒng)計學(xué)意義(P gt;0.05)。③術(shù)后首次排便和排氣時間的總體差異無統(tǒng)計學(xué)意義(P gt;0.05)，而在拔除鼻胃管、引流管和尿管、首次進食、下床活動以及術(shù)后住院時間方面的總體差異均有統(tǒng)計學(xué)意義(P lt;0.05)。與TC+HAR組和TC+LAR組比較，F(xiàn)T+HAR組和FT+LAR組患者在拔除鼻胃管、引流管和尿管、首次進食以及下床活動時間均較短，且FT+LAR組患者術(shù)后住院時間明顯比TC+HAR組和TC+LAR組短，差異均有統(tǒng)計學(xué)意義(P lt;0.05)。結(jié)論對于接受不同手術(shù)方案的直腸癌患者，F(xiàn)T能加快患者術(shù)后康復(fù)，但在減少并發(fā)癥方面并未顯示出優(yōu)勢。

引用本文： 徐俊,陳超,熊非,陳繼貴. 快速流程模式對直腸癌不同手術(shù)方案的臨床療效影響. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(9): 961-965. doi: 復(fù)制

1. 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.
2. 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.
3. 楊廷翰, 蒲怡, 楊光超, 等. 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 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(11): 12031206, 1212.
4. Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery [J]. Br J Surg, 2006, 93(7): 800809.
5. MacKay G, Molloy RG, O’Dwyer PJ. Fasttrack colorectal surgery and perioperative outcomes [J]. Semin Colon Rectal Surg, 2008, 19(1): 1619.
6. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review [J]. Dig Surg, 2008, 25(2): 148157.
7. 李立, 汪曉東, 舒曄, 等. 四川大學(xué)華西醫(yī)院·結(jié)直腸癌手術(shù)治療指南(二) [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(11): 861862.
8. Donohoe CL, Nguyen M, Cook J, et al. Fasttrack protocols in colorectal surgery [J]. Surgeon, 2011, 9(2): 95103.
9. 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.
10. 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]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(2): 239242.
11. 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]. 中國普通外科雜志, 2008, 17(4): 394396.
12. 王道榮, 魚海峰, 趙建國, 等. 中間入路腹腔鏡下直腸癌高位前切除術(shù)回顧分析 [J/CD]. 中華腔鏡外科雜志(電子版), 2010, 3(2): 189192.
13. 顧晉, 李明. 直腸癌前切除超低位吻合術(shù) [J]. 中華胃腸外科雜志, 2006, 9(2): 102103.
14. 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.
15. Schwenk W, Raue W, Haase O, et al. “Fasttrack” colonic surgeryfirst experience with a clinical procedure for accelerating postoperative recovery [J]. Chirurg, 2004, 75(5): 508514.
16. 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.
17. 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.
18. 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.
19. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer [J]. Ann Surg, 2007, 245(6): 867872.
20. 楊廷翰, 吳凡, 唐之韻, 等. 結(jié)直腸癌患者腹腔鏡手術(shù)與應(yīng)用快速流程的開腹手術(shù)術(shù)后短期康復(fù)效果的對比研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10971101.
21. Kuhl PK,Stevens E, Hayashi A, et al. Infants show a facilitation effect for native language phonetic perception between 6 and 12 months [J]. Dev Sci, 2006, 9(2): F13F21.
22. 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.
23. Wichmann MW, Eben R, Angele MK, et al. Fasttrack rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological singlecentre study [J]. ANZ J Surg, 2007, 77(7): 502507.
24. Nygren J, Hausel J, Kehlet H, et al. A comparison in five european centres of case mix, clinical management and outcomes following either conventional or fasttrack perioperative care in colorectal surgery [J]. Clin Nutr, 2005, 24(3): 455461.
25. Kehlet H, Wilmore DW. Evidencebased surgical care and the evolution of fasttrack surgery [J]. Ann Surg, 2008, 248(2): 189198.
  1. 1. 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.
  2. 2. 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.
  3. 3. 楊廷翰, 蒲怡, 楊光超, 等. 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 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(11): 12031206, 1212.
  4. 4. Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery [J]. Br J Surg, 2006, 93(7): 800809.
  5. 5. MacKay G, Molloy RG, O’Dwyer PJ. Fasttrack colorectal surgery and perioperative outcomes [J]. Semin Colon Rectal Surg, 2008, 19(1): 1619.
  6. 6. Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review [J]. Dig Surg, 2008, 25(2): 148157.
  7. 7. 李立, 汪曉東, 舒曄, 等. 四川大學(xué)華西醫(yī)院·結(jié)直腸癌手術(shù)治療指南(二) [J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(11): 861862.
  8. 8. Donohoe CL, Nguyen M, Cook J, et al. Fasttrack protocols in colorectal surgery [J]. Surgeon, 2011, 9(2): 95103.
  9. 9. 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.
  10. 10. 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]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(2): 239242.
  11. 11. 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]. 中國普通外科雜志, 2008, 17(4): 394396.
  12. 12. 王道榮, 魚海峰, 趙建國, 等. 中間入路腹腔鏡下直腸癌高位前切除術(shù)回顧分析 [J/CD]. 中華腔鏡外科雜志(電子版), 2010, 3(2): 189192.
  13. 13. 顧晉, 李明. 直腸癌前切除超低位吻合術(shù) [J]. 中華胃腸外科雜志, 2006, 9(2): 102103.
  14. 14. 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.
  15. 15. Schwenk W, Raue W, Haase O, et al. “Fasttrack” colonic surgeryfirst experience with a clinical procedure for accelerating postoperative recovery [J]. Chirurg, 2004, 75(5): 508514.
  16. 16. 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.
  17. 17. 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.
  18. 18. 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.
  19. 19. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer [J]. Ann Surg, 2007, 245(6): 867872.
  20. 20. 楊廷翰, 吳凡, 唐之韻, 等. 結(jié)直腸癌患者腹腔鏡手術(shù)與應(yīng)用快速流程的開腹手術(shù)術(shù)后短期康復(fù)效果的對比研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 10971101.
  21. 21. Kuhl PK,Stevens E, Hayashi A, et al. Infants show a facilitation effect for native language phonetic perception between 6 and 12 months [J]. Dev Sci, 2006, 9(2): F13F21.
  22. 22. 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.
  23. 23. Wichmann MW, Eben R, Angele MK, et al. Fasttrack rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological singlecentre study [J]. ANZ J Surg, 2007, 77(7): 502507.
  24. 24. Nygren J, Hausel J, Kehlet H, et al. A comparison in five european centres of case mix, clinical management and outcomes following either conventional or fasttrack perioperative care in colorectal surgery [J]. Clin Nutr, 2005, 24(3): 455461.
  25. 25. Kehlet H, Wilmore DW. Evidencebased surgical care and the evolution of fasttrack surgery [J]. Ann Surg, 2008, 248(2): 189198.