ObjectiveTo investigate the effect of fasttrack (FT) and traditional care (TC) on patients with rectal cancer underwent different surgical strategies in perioperative period. MethodsThe clinical data of 285 patients with rectal cancer from January 2009 to January 2010 in this hospital were retrospectively analyzed. These patients underwent high anterior resection (HAR) or lower/super lower anterior resection (LAR) under FT and TC were divided into four groups: FT+HAR (n=39), FT+LAR (n=17), TC+HAR (n=151), and TC+LAR (n=78), and intraoperative conditions and postoperative rehabilitation were analyzed. ResultsThe baselines characteristics of four groups were basically identical (Pgt;0.05). ①The operative time and blood loss of patients in four groups were not statistically significant (Pgt;0.05). ②Anastomotic leakage occurred in three cases, wound infection in 13 cases, and intestinal obstruction in four cases after operation, and the difference was not significant in four groups (Pgt;0.05). ③The time of first defecation and first flatus of four groups were not statistically significant (Pgt;0.05), but there were significant differences in the time with drainage tube, nasogastric tube, and catheter tube, the time of first intake and first ambulation, and length of stay among four groups (Plt;0.05). Compared with TC+HAR and TC+LAR group, the time with drainage tube, nasogastric tube, and catheter tube, and the time of first intake and first ambulation of patients were shorter in FT+HAR and FT+LAR group, and the length of stay of patients in FT+LAR group was shorter than that in TC+HAR group and TC+LAR group (Plt;0.05). ConclusionsFT can promote postoperative rehabilitation of rectal cancer patients underwent different surgical strategies, but which does not demonstrate the superiority of reducing postoperative complications.
ObjectiveTo explain the latest concepts of colorectal surgery, and predict the future direction of it. MethodsA review and summary based on the clinical experience of our hospitals and theses over the past years and new advances on the researches in home and abroad were performed. ResultsDoctors should attach more importance to anal preserving operation; and there should be more usage of fast track in colorectal surgery. Besides, predicting low risk of postoperative complications and digitizing colorectal surgery also needed more attention. ConclusionThose aspects of colorectal surgery in the result need further development.
Objective To explore the clinical effects of postoperative restrict rehydration on different body mass index (BMI) of patients with colorectal cancer. Methods From January 2008 to January 2009, the patients diagnosed definitely as colorectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different BMI (underweight group, normal group, overweight group).Results The first defecation time, aerofluxus time and ambulation time of the fluid restriction group were significantly earlier than those of the tradition therapy group (Plt;0.05), and postoperative in-hospital time was also less (Plt;0.05). However, the differences of early postoperative rehabilitation among underweight group, normal group and overweight group in the tradition therapy group and fluid restriction group had no statistical significance (Pgt;0.05). The complications such as pulmonary infection, anastomotic leakage, intestinal obstruction and wound dehiscence in the fluid restriction group were significantly lower than those in the tradition therapy group (Plt;0.05). In the tradition therapy group, the incidences of anastomotic leakage and wound dehiscence in overweight group were significantly higher than those in the underweight and normal group (Plt;0.05). The rate of postoperative complications among underweight group, normal group and overweight group in the fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Postoperative restrict rehydration for overweight colorectal cancer patients has a good clinical effect, which can promote the early postoperative rehabilitation.
1背景早在1987年英国爱丁堡皇家医院就开始着手研究快速的治疗流程分类系统给心肌梗塞的患者所带来的时间经济效益，就此对快速流程的研究正式拉开了序幕。到了20世纪90年代初，欧洲部分医院的急诊科首先从科室角度开始迅速推广快速流程； 同时涉及麻醉方面的流程效率改革和创新逐步兴起。20世纪90年代末麻醉专业从门诊麻醉模式、手术及麻醉前干预上，开始逐步提升快速流程的综合管理能力。正是在20世纪90年代末，快速流程的理念被正式提出，在当时它还有一个名称叫做多模式康复流程。这种理念随之在欧美国家流行起来，大量的临床实践不断在进行。1994年，美国Engelman等就提出了冠状动脉旁路“fast-track recovery”的概念，并建立了一套相应的快速康复程序，通过实践发现其的确能够加快患者的术后康复、缩短住院时间。至此快速流程作为一项高效的临床运作模式被正式纳入临床具体病种的应用中。从2001年至今，心脏外科及结直肠外科的快速流程已趋于成熟，并已成功地渗透到外科领域的多个环节……
Objective To explore the value and clinical safety of low-dose dexamethasone used after operation of anastomotic colorectal resection with fast-track surgery in patients with colorectal cancer. Methods Between January 2008 and December 2009, 470 patients undergoing anastomotic colorectal resection were analyzed retrospectively, who were divided into dexamethasone group and control group according to the use of low-dose dexamethasone treatment or not after operation. Postoperative adverse effect, complications, and early rehabilitations were studied. Results There was no statistical significance in postoperative incidence of adverse effect or complications between two groups (Pgt;0.05). In early rehabilitation, first ambulation of patients in the dexamethasone group was significantly earlier than that in the control group (Plt;0.05), while there was no statistical significance in first time of passing flatus, stool, and oral intake, the retain time of nasogastric tubes, urinary catheter, and drains, and postoperative hospital stay (Pgt;0.05). Conclusion Using low-dose dexamethasone after operation anastomotic colorectal resection in patients with colorectal cancer is safe and may have potential to enhance recovery after operation.
Objective To discuss the safety of fast track surgery for patients with obstructive colorectal cancer. Methods Between February 2008 and February 2009, 157 cases of obstructive colorectal cancer were analyzed retrospectively, 59 in fast track (FT) group and 98 in traditional group. Postoperative early rehabilitations and complications were studied and compared. Results The first time of passing flatus, oral intake and postoperative hospital stay in FT group were significantly earlier or less than those in traditional group （Plt;0.05）, while there were no significant differences in time of first ambulation, time with use of nasogastric tubes, urinary catheter, and drains between the 2 groups （Pgt;0.05）. There was also no statistically significant difference in postoperative complications rate between the 2 groups （Pgt;0.05）. Conclusion Fast track surgery for patients with obstructive colorectal cancer is safe and can accelerate recovery with decreasing length of hospital stay and improving life quality of the patients.
Objective To compare the clinical effect of different strategies for surgical treatment combined with restrict rehydration on rehabilitation of rectal cancer patients in fast-track. Methods From January 2008 to January 2009, the patients diagnosed definitely as rectal cancer were analyzed retrospectively. The postoperative early rehabilitations were studied and compared in different fluid therapy with different surgical programs 〔high anterior resection (HAR), low anterior resection (LAR)〕. Results The difference of first aerofluxus, first defecation, postoperative first eating and first ambulation between fluid restriction group and tradition therapy group was statistically significant (Plt;0.05). And the difference of first aerofluxus, first defecation and post-operative first eating between HAR group and LAR group in tradition therapy group was statistically significant (Plt;0.05). Regarding to the overall incidence of postoperative complications, the incidence of pulmonary infection, wound infection and intestinal obstruction in tradition therapy group were higher than that in fluid restriction group (Plt;0.05). And in tradition therapy group, the difference in the incidence of intestinal obstruction between LAR group and HAR group was not statistically significant (Pgt;0.05). The difference of early recovery and postoperative complications between HAR group and LAR group in fluid restriction group had no statistical significance (Pgt;0.05). Conclusion Different strategies for surgical treatment of rectal cancer patients combined with restrict rehydration in fasttrack is feasible and can promote early rehabilitation of patients.
Objective To discuss the clinical outcome of fast-track surgery for low/super-low rectal cancer. Methods Between October 2007 and December 2008, 120 patients underwent low/super-low rectal cancer resection without formation of stoma in the West China Hospital were analyzed retrospectively. Postoperative early rehabilitations were compared between fast-track group and traditional group. Results In early rehabilitations, time of first passing flatus, ambulation, oral intake, and pulling out urinary catheter and the hospital stay in fast-track group were significantly earlier than those in traditional group （Plt;0.05）, while there was no significant difference in time of using nasogastric tubes or drains （Pgt;0.05）. There was also no significant difference in postoperative morbidity of complications between the 2 groups （Pgt;0.05）. Conclusion Fast-track surgery for low/super-low rectal cancer is safe and can accelerate recovery with decreased length of hospital stay.