肖凌 1,2,3 , 李蔚 1,2,3 , 麥玲 1,2 , 汪曉東 1 , 李立 1
  • 1.四川大學(xué)華西醫(yī)院胃腸外科中心（成都 610041）;;
  • 2.四川大學(xué)華西醫(yī)院MCQ團(tuán)隊(duì)（成都 610041）;;
  • 3.四川大學(xué)華西口腔醫(yī)學(xué)院（成都 610041）;

目的  比較快速流程模式下不同手術(shù)方案聯(lián)合術(shù)后限制補(bǔ)液策略對直腸癌患者術(shù)后康復(fù)情況的影響。
方法  回顧性研究2008年1月至2009年1月期間四川大學(xué)華西醫(yī)院肛腸外科專業(yè)組收治的直腸癌患者的臨床資料，分析比較術(shù)后不同補(bǔ)液策略聯(lián)合不同手術(shù)方案〔高位前切除術(shù)（HAR）、低位/超低位前切除術(shù)（LAR）〕綜合治療的直腸癌患者術(shù)后康復(fù)情況。
結(jié)果  從術(shù)后康復(fù)指標(biāo)看，常規(guī)補(bǔ)液組的術(shù)后排氣、排便、進(jìn)食及下床活動(dòng)時(shí)間均長于限制補(bǔ)液組（P lt;0.05）； 常規(guī)補(bǔ)液組中LAR組的術(shù)后排氣、排便及進(jìn)食時(shí)間均長于HAR組（P lt;0.05）； 限制補(bǔ)液組中LAR組與HAR組其術(shù)后早期恢復(fù)指標(biāo)間的差異則無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。 從術(shù)后并發(fā)癥的發(fā)生率上看，常規(guī)補(bǔ)液組的肺部感染、傷口感染和腸梗阻發(fā)生率均高于限制補(bǔ)液組（P lt;0.05）； 常規(guī)補(bǔ)液組中LAR和HAR組間的術(shù)后并發(fā)癥發(fā)生率差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）； 限制補(bǔ)液組中LAR和HAR組間的術(shù)后早期恢復(fù)和并發(fā)癥發(fā)生率的差異無統(tǒng)計(jì)學(xué)意義(P gt;0.05)。
結(jié)論  不同部位的直腸癌切除術(shù)后采取限制補(bǔ)液策略是可行的，能促使患者的早期康復(fù)。

引用本文： 肖凌,李蔚,麥玲,汪曉東,李立. 快速流程模式下術(shù)后限制補(bǔ)液對不同手術(shù)方案直腸癌患者康復(fù)情況的影響. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(2): 190-194. doi: 復(fù)制

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2. 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.
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4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. The danish study group on perioperative fluid therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg， 2003; 238(5): 641648.
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8. 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.
9. 呂東昊， 汪曉東，陽川華， 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713716.
10. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3)： 355360.
11. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
12. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
13. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg， 2005; 101(2): 601605.
14. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
15. 肖凌， 汪曉東， 李立. 術(shù)后液體管理在結(jié)直腸外科快速流程中的應(yīng)用進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 593596.
16. Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
17. MacKay G, Fearon K, McConnachie A, et al . Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 14691474.
18. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
19. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
20. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
21. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med， 1997; 23(3): 276281.
25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.
  1. 1. Schwenk W, Haase O, Raue W, et al. Establishing “fasttrack” colonic surgery in the clinical routine [J]. Zentralbl Chir, 2004; 129 (6): 502509.
  2. 2. 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.
  3. 3. Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial [J]. Lancet, 2002; 359(9320): 18121818.
  4. 4. Brandstrup B, Tnnesen H, BeierHolgersen R, et al. The danish study group on perioperative fluid therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens. A randomized assessor blinded multi centre trial [J]. Ann Surg， 2003; 238(5): 641648.
  5. 5. 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.
  6. 6. 吳在德, 吳肇漢. 外科學(xué) [M]. 第7版. 北京: 人民衛(wèi)生出版社, 2008： 66.
  7. 7. Dukes C. The classification of cancer of the rectum [J]. J Pathol Bacteriol, 1932; 35(3): 323332.
  8. 8. 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.
  9. 9. 呂東昊， 汪曉東，陽川華， 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(6): 713716.
  10. 10. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit [J]. Br J Surg, 1991; 78(3)： 355360.
  11. 11. Mayor S. New approach to surgical care aims to improve recovery and reduce length of hospital stay [J]. BMJ, 2007; 334(7598): 816817.
  12. 12. Gan TJ, Soppitt A, Maroof M, et al. Goaldirected intraoperative fluid administration reduces length of hospital stay after major surgery [J]. Anesthesiology, 2002; 97(4): 820826.
  13. 13. Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery [J]. Anesth Analg， 2005; 101(2): 601605.
  14. 14. Mecray PM, Barden RP, Ravdin IS. Nutritional edema: it’s effect on the gastric emptying time before and after gastric operations. 1937 [J]. Nutrition, 1990; 6(4): 278290.
  15. 15. 肖凌， 汪曉東， 李立. 術(shù)后液體管理在結(jié)直腸外科快速流程中的應(yīng)用進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(7): 593596.
  16. 16. Moller AM, Pedersen T, Svenden PE, et al. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance [J]. Eur J Anaesthesiol, 2002; 19(1): 5762.
  17. 17. MacKay G, Fearon K, McConnachie A, et al . Randomized clinical trial of the effect of postoperative intravenous fluid restriction on recovery after elective colorectal surgery [J]. Br J Surg, 2006; 93(12): 14691474.
  18. 18. Holte K, Jensen P, Kehlet H. Physiologic effects of intravenous fluid administration in healthy volunteers [J]. Anesth Analg, 2003; 96(5): 15041509.
  19. 19. Lang K, Boldt J, Suttner S, et al. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery [J]. Anesth Analg, 2001; 93(2): 405409.
  20. 20. von Heymann C, Grebe D, Schwenk W, et al. The influence of intraoperative fluid therapy on the postoperative outcome in “fast track” colon surgery [J]. Anasthesiol Intensivmed Notfallmed Schmerzther, 2006; 41(6): E1E7.
  21. 21. Boldt J. Fluid management of patients undergoing abdominal surgerymore questions than answers [J]. Eur J Anaesthesiol, 2006; 23(8): 631640.
  22. 22. Noblett SE, Snowden CP, Shenton BK, et al. Randomized clinical trial assessing the effect of Doppleroptimized fluid management on outcome after elective colorectal resection [J]. Br J Surg， 2006; 93(9): 10691076.
  23. 23. Matthay MA, Fukuda N, Frank J, et al. Alveolar epithelial barrier: role in lung fluid balance in clinical lung injury [J]. Clin Chest Med, 2000; 21(3): 477490.
  24. 24. HamiltonDavies C, Mythen MG, Salmon JB, et al. Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry [J]. Intensive Care Med， 1997; 23(3): 276281.
  25. 25. Rahbari NN, Zimmermann JB, Schmidt T, et al. Metaanalysis of standard, restrictive and supplemental fluid administration in colorectal surgery [J]. Br J Surg, 2009; 96(4): 331341.