劉展 1,2 , 楊廷翰 1,3,4 , 余曦 1,3,4 , 李蔚 1,3,5 , 汪曉東 1,3 , 李立 1,3
  • 1.四川大學(xué)華西醫(yī)院胃腸外科中心（成都 610041）;;
  • 2.成都市第三人民醫(yī)院普外科（成都 610031）;;
  • 3.四川大學(xué)華西醫(yī)院MCQ團(tuán)隊（成都 610041）;;
  • 4.四川大學(xué)華西臨床醫(yī)學(xué)院（成都 610041）;;
  • 5.四川大學(xué)華西口腔醫(yī)學(xué)院（成都 610041）;

目的 評價在非微創(chuàng)手術(shù)條件下快速流程（fasttrack,FT）圍手術(shù)期臨床管理對結(jié)直腸癌圍手術(shù)期炎性反應(yīng)的影響。方法 將55例擇期結(jié)直腸癌手術(shù)患者隨機(jī)分為2組，分別接受FT圍手術(shù)期管理（FT組，n=29）和傳統(tǒng)圍手術(shù)期管理（傳統(tǒng)組，n=26），均接受常規(guī)非微創(chuàng)開腹手術(shù)，檢測2組患者術(shù)前24 h及術(shù)后24 h、72 h和7 d共4個截點的血漿C反應(yīng)蛋白（CRP）和血漿淀粉樣蛋白（SAA）濃度并作統(tǒng)計學(xué)分析。
結(jié)果 2組患者均無影響實驗結(jié)果的并發(fā)癥發(fā)生，均無手術(shù)死亡。2組內(nèi)患者的CRP和SAA濃度變化趨勢一致。FT組患者CRP和SAA濃度在術(shù)后24 h即達(dá)到峰值〔CRP: (72.36±60.94) mg/L; SAA: (328.97±267.20) mg/L〕，傳統(tǒng)組峰值推后，出現(xiàn)于術(shù)后72 h 〔CRP: (112.71±63.92) mg/L; SAA: (524.18±331.03) mg/L〕; 術(shù)后72 h時FT組CRP 和SAA濃度已經(jīng)開始下降〔CRP: (57.21±30.42) mg/L; SAA: (237.43±215.66) mg/L〕; FT組CRP及SAA峰值均明顯低于傳統(tǒng)組(P lt;0.001); 術(shù)后72 h時FT組CRP和SAA濃度明顯低于傳統(tǒng)組(P lt;0.001)。術(shù)后7 d，2組患者CRP和SAA濃度進(jìn)一步下降，組間比較差異無統(tǒng)計學(xué)意義（P gt;0.05）; 且均低于各組內(nèi)術(shù)后24 h 及72 h時的CRP和SAA值（P lt;0.001），但均高于各組內(nèi)術(shù)前24 h的CRP和SAA值（P lt;0.001）。
結(jié)論 在非微創(chuàng)手術(shù)條件下，快速流程圍手術(shù)期臨床管理可顯著減輕結(jié)直腸癌手術(shù)的炎性反應(yīng)，科學(xué)的臨床管理也是促進(jìn)患者快速康復(fù)的重要手段。

引用本文： 劉展 ,楊廷翰,余曦,李蔚,汪曉東,李立. 快速流程圍手術(shù)期臨床管理降低結(jié)直腸癌手術(shù)炎性反應(yīng)的隨機(jī)臨床研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(8): 855-859下轉(zhuǎn)864. doi: 復(fù)制

1. 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241.
2. 許劍民, 鐘蕓詩, 朱德祥, 等. 促進(jìn)術(shù)后恢復(fù)綜合方案在結(jié)直腸癌根治術(shù)中的應(yīng)用 [J]. 中華胃腸外科雜志, 2007; 10(3): 238244.
3. 劉展， 汪曉東， 李立. 結(jié)直腸外科快速流程內(nèi)容及依據(jù) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(4): 469473.
4. Kehlet H. Surgical stress response: does endoscopic surgery confer an advantage? [J]. World J Surg, 1999; 23(8): 801807.
5. Nakagoe T, Tsuji T, Sawai T, et al. Minilaparotomy may be independently associated with reduction in inflammatory responses after resection for colorectal cancer [J]. Eur Surg Res, 2003; 35(6): 477485.
6. 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.
7. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acutephase reactant for clinical practice [J]. Eur J Clin Invest, 1996; 26(6): 427435.
8. Adlouni A, Ghalim N, Sale R, et al. Beneficial effect on serum apo AI, apo B and Lp AI levels of Ramadan fasting [J]. Clin Chim Acta, 1998; 271(2): 179189.
9. Reismann M, von Kampen M, Laupichler B, et al. Fasttrack surgery in infants and children [J]. J Pediatr Surg, 2007; 42(1): 234238.
10. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fasttrack surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408412.
11. Feo CV, Lanzara S, Sortini D, et al. Fast track postoperative management after elective colorectal surgery: a controlled trial [J]. Am Surg, 2009; 75(12): 12471251.
12. 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.
13. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet, 2007; 370(9605): 21122117.
14. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
15. PenaSoria MJ, Mayol JM, Anula R, et al. Singleblinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis [J]. J Gastrointest Surg, 2008; 12(12): 21032109.
16. Pineda CE, Shelton AA, HernandezBoussard T, et al. Mechanical bowel preparation in intestinal surgery: a metaanalysis and review of the literature [J]. J Gastrointest Surg, 2008;12(11): 20372044.
17. Cheatham ML, Chapman WC, Key SP, et al. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy [J]. Ann Surg, 1995; 221(5): 469478.
18. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and metaanalysis [J]. Ann Surg, 1999; 229(2): 174180.
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. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus [J]. World J Surg, 2006; 30(8): 13821391.
21. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operationis it evidencebased? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 4554.
22. Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery [J]. Proc Nutr Soc, 2003; 62(4): 807811.
23. Kuzma J. Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioidsparing analgesia versus traditional care after open appendectomy [J]. Clin Nutr, 2008; 27(5): 694699.
24. HanGuerts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery [J]. Br J Surg, 2007; 94(5): 555561.
25. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416423.
26. 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.
27. Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335343.
  1. 1. 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241.
  2. 2. 許劍民, 鐘蕓詩, 朱德祥, 等. 促進(jìn)術(shù)后恢復(fù)綜合方案在結(jié)直腸癌根治術(shù)中的應(yīng)用 [J]. 中華胃腸外科雜志, 2007; 10(3): 238244.
  3. 3. 劉展， 汪曉東， 李立. 結(jié)直腸外科快速流程內(nèi)容及依據(jù) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(4): 469473.
  4. 4. Kehlet H. Surgical stress response: does endoscopic surgery confer an advantage? [J]. World J Surg, 1999; 23(8): 801807.
  5. 5. Nakagoe T, Tsuji T, Sawai T, et al. Minilaparotomy may be independently associated with reduction in inflammatory responses after resection for colorectal cancer [J]. Eur Surg Res, 2003; 35(6): 477485.
  6. 6. 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.
  7. 7. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acutephase reactant for clinical practice [J]. Eur J Clin Invest, 1996; 26(6): 427435.
  8. 8. Adlouni A, Ghalim N, Sale R, et al. Beneficial effect on serum apo AI, apo B and Lp AI levels of Ramadan fasting [J]. Clin Chim Acta, 1998; 271(2): 179189.
  9. 9. Reismann M, von Kampen M, Laupichler B, et al. Fasttrack surgery in infants and children [J]. J Pediatr Surg, 2007; 42(1): 234238.
  10. 10. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fasttrack surgery: what can be expected? [J]. Am J Surg, 2009; 197(3): 408412.
  11. 11. Feo CV, Lanzara S, Sortini D, et al. Fast track postoperative management after elective colorectal surgery: a controlled trial [J]. Am Surg, 2009; 75(12): 12471251.
  12. 12. 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.
  13. 13. Contant CM, Hop WC, van’t Sant HP, et al. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial [J]. Lancet, 2007; 370(9605): 21122117.
  14. 14. Kehlet H. Fasttrack colorectal surgery [J]. Lancet, 2008; 371(9615): 791793.
  15. 15. PenaSoria MJ, Mayol JM, Anula R, et al. Singleblinded randomized trial of mechanical bowel preparation for colon surgery with primary intraperitoneal anastomosis [J]. J Gastrointest Surg, 2008; 12(12): 21032109.
  16. 16. Pineda CE, Shelton AA, HernandezBoussard T, et al. Mechanical bowel preparation in intestinal surgery: a metaanalysis and review of the literature [J]. J Gastrointest Surg, 2008;12(11): 20372044.
  17. 17. Cheatham ML, Chapman WC, Key SP, et al. A metaanalysis of selective versus routine nasogastric decompression after elective laparotomy [J]. Ann Surg, 1995; 221(5): 469478.
  18. 18. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and metaanalysis [J]. Ann Surg, 1999; 229(2): 174180.
  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. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus [J]. World J Surg, 2006; 30(8): 13821391.
  21. 21. Kehlet H, Büchler MW, Beart RW Jr, et al. Care after colonic operationis it evidencebased? Results from a multinational survey in Europe and the United States [J]. J Am Coll Surg, 2006; 202(1): 4554.
  22. 22. Fearon KC, Luff R. The nutritional management of surgical patients: enhanced recovery after surgery [J]. Proc Nutr Soc, 2003; 62(4): 807811.
  23. 23. Kuzma J. Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioidsparing analgesia versus traditional care after open appendectomy [J]. Clin Nutr, 2008; 27(5): 694699.
  24. 24. HanGuerts IJ, Hop WC, Kok NF, et al. Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery [J]. Br J Surg, 2007; 94(5): 555561.
  25. 25. Basse L, Jakobsen DH, Bardram L, et al. Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study [J]. Ann Surg, 2005; 241(3): 416423.
  26. 26. 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.
  27. 27. Vlug MS, Wind J, van der Zaag E, et al. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme [J]. Colorectal Dis, 2009; 11(4): 335343.