楊廷翰 1,2,3 , 周寅 1,2,3 , 余曦 1,2,3 , 郝晉 1,2,4 , 汪曉東 1,2 , 李立 1,2
  • 1.四川大學華西醫(yī)院胃腸外科中心（成都 610041）;;
  • 2.四川大學華西醫(yī)院MCQ團隊（成都 610041）;;
  • 3.四川大學華西臨床醫(yī)學院/華西醫(yī)院（成都 610041）;;
  • 4.四川大學華西口腔醫(yī)學院（成都 610041）;

目的  初步探討低位/超低位直腸癌快速流程模式的臨床效果。方法  回顧性研究2007年10月至2008年12月期間四川大學華西醫(yī)院胃腸外科中心結(jié)直腸外科專業(yè)組收治的行未造口的根治性切除術(shù)的120例低位/超低位直腸癌患者的病例資料，分析快速流程管理模式下（快速流程組）與傳統(tǒng)管理模式下（傳統(tǒng)組）患者早期恢復情況。結(jié)果  從術(shù)后早期康復指標來看，快速流程組的首次排氣時間、首次下床活動時間、首次經(jīng)口進食時間、首次拔除尿管時間及術(shù)后住院時間均短于傳統(tǒng)組，差異有統(tǒng)計學意義（P lt;0.05）； 而2組首次拔除胃管和引流管時間的差異則沒有統(tǒng)計學意義（P gt;0.05）。2組患者術(shù)后并發(fā)癥發(fā)生率的差異亦沒有統(tǒng)計學意義（P gt;0.05）。 結(jié)論  低位/超低位直腸癌快速流程模式具有良好的安全性，能夠促進患者早期康復、縮短住院時間。

引用本文： 楊廷翰,周寅,余曦,郝晉,汪曉東,李立. 低位/超低位直腸癌快速流程模式的效果探討. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(6): 618-621. doi: 復制

1. Kehlet H. Fast-track colorectal surgery [J]. Lancet， 2008; 371(9615): 791-793.
2. 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.
3. 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.
4. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection [J]. Dis Colon Rectum, 2003; 46(7): 851-859.
5. Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J]. Br J Surg, 2003; 90(12): 1497-1504.
6. 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.
7. 李立, 汪曉東, 舒曄, 等. 四川大學華西醫(yī)院肛腸外科·結(jié)直腸外科快速流程臨床指南 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5-8): 413, 493-494, 581, 671.
8. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
9. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
10. 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情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志， 2010； 17（2）： 190-194.
11. 李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新（四） [J]. 中國普外基礎(chǔ)與臨床雜志， 2006； 13（4）： 461-468.
12. 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.
13. 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.
14. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007; (3): CD004929.
15. Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses [J]. Ann Surg, 2004; 240(6): 1074-1084.
16. Nygren J, Soop M, Thorell A, et al. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients [J]. Dis Colon Rectum, 2009; 52(5): 978-985.
17. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
18. Gatt M, Anderson AD, Reddy BS, et al. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection [J]. Br J Surg, 2005; 92(11): 1354-1362.
19. Raue W, Haase O, Junghans T, et al. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation [J]. Surg Endosc, 2004; 18(10): 1463-1468.
20. Bradshaw BG, Liu SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery [J]. J Am Coll Surg, 1998; 186(5): 501-506.
21. 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.
22. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.
  1. 1. Kehlet H. Fast-track colorectal surgery [J]. Lancet， 2008; 371(9615): 791-793.
  2. 2. 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.
  3. 3. 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.
  4. 4. Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection [J]. Dis Colon Rectum, 2003; 46(7): 851-859.
  5. 5. Anderson AD, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J]. Br J Surg, 2003; 90(12): 1497-1504.
  6. 6. 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.
  7. 7. 李立, 汪曉東, 舒曄, 等. 四川大學華西醫(yī)院肛腸外科·結(jié)直腸外科快速流程臨床指南 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(5-8): 413, 493-494, 581, 671.
  8. 8. Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery [J]. Lancet, 2003; 362(9399): 1921-1928.
  9. 9. Maessen JM, Dejong CH, Kessels AG, et al. Length of stay: an inappropriate readout of the success of enhanced recovery programs [J]. World J Surg, 2008; 32(6): 971-975.
  10. 10. 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情況的影響 [J]. 中國普外基礎(chǔ)與臨床雜志， 2010； 17（2）： 190-194.
  11. 11. 李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新（四） [J]. 中國普外基礎(chǔ)與臨床雜志， 2006； 13（4）： 461-468.
  12. 12. 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.
  13. 13. 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.
  14. 14. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery[J]. Cochrane Database Syst Rev, 2007; (3): CD004929.
  15. 15. Petrowsky H, Demartines N, Rousson V, et al. Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses [J]. Ann Surg, 2004; 240(6): 1074-1084.
  16. 16. Nygren J, Soop M, Thorell A, et al. An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients [J]. Dis Colon Rectum, 2009; 52(5): 978-985.
  17. 17. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome [J]. Am J Surg, 2002; 183(6): 630-641.
  18. 18. Gatt M, Anderson AD, Reddy BS, et al. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection [J]. Br J Surg, 2005; 92(11): 1354-1362.
  19. 19. Raue W, Haase O, Junghans T, et al. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation [J]. Surg Endosc, 2004; 18(10): 1463-1468.
  20. 20. Bradshaw BG, Liu SS, Thirlby RC. Standardized perioperative care protocols and reduced length of stay after colon surgery [J]. J Am Coll Surg, 1998; 186(5): 501-506.
  21. 21. 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.
  22. 22. Kehlet H. Manipulation of the metabolic response in clinical practice [J]. World J Surg, 2000; 24(6): 690-695.