无肠道准备对胸腔镜肺癌根治术后患者康复及肠道功能的影响

doi:10.3760/cma.j.issn.1007-1245.2024.02.020

摘要/Abstract

摘要：

目的　观察无肠道准备对胸腔镜肺癌根治术后患者康复情况及肠道功能的影响。方法　本文为随机对照试验，病例纳入南阳医学高等专科学校第一附属医院2021年1月至2023年3月收治的122例肺癌患者，采用随机数字表法对入组患者进行分组，分别列为常规组（61例）和试验组（61例）。常规组中男40例，女21例，年龄48～72（60.32±5.25）岁；试验组中男41例，女20例，年龄50～70（61.42±5.31）岁。所有患者均行胸腔镜下肺癌根治术治疗，常规组术前服用复方聚乙二醇电解质散进行肠道准备，试验组不采取术前肠道准备措施。比较两组患者术后恢复情况，术后胃肠功能、炎症指标变化情况，胃肠道不良反应发生情况及手术安全性。用χ²检验、t检验。结果　在不同治疗方案下，试验组的手术时间为（170.44±20.35）min、略长于常规组（167.35±20.46）min，差异无统计学意义（P>0.05）；试验组的术后排气时间、排便时间、住院时间分别为（20.25±5.14）h、（23.36±5.42）h、（8.76±2.47）d，均短于常规组［（23.77±5.18）h、（26.62±5.41）h、（10.36±3.22）d］，差异均有统计学意义（均P<0.05）。术前，两组患者的胃肠功能指标差异均无统计学意义（均P>0.05）；在不同治疗方案下，试验组术后的胃泌素（GAS）、胃动素（MLT）分别为（70.22±10.37）ng/L、（78.45±10.27）ng/L，均低于常规组［（75.45±10.26）ng/L、（86.33±10.28）ng/L］，差异均有统计学意义（均P<0.05）。治疗前，两组患者的炎症指标差异均无统计学意义（均P>0.05）；在不同治疗方案下，试验组术后的C-反应蛋白（CRP）、白细胞介素-6（IL-6）水平分别为（15.45±4.49）mg/L、（12.33±3.47）ng/L，均低于常规组［（18.77±4.18）mg/L、（15.66±4.14）ng/L］，差异均有统计学意义（均P<0.05）。在不同治疗方案下，试验组的胃肠道不良反应发生率为8.20%（5/61），低于常规组21.31%（13/61），差异有统计学意义（P<0.05）；试验组的手术相关并发症发生率为9.84%（6/61），略高于常规组8.20%（5/61），差异无统计学意义（P>0.05）。结论　术前无肠道准备能加快胸腔镜肺癌根治术患者术后康复进程，对避免术后胃肠功能紊乱、炎症反应发生并降低胃肠道不良反应发生风险均有积极意义，与传统术前肠道准备措施相比，无肠道准备未明显增加手术相关并发症发生风险，具有较高应用价值。

关键词:

胸腔镜肺癌根治术, 术前肠道准备, 术后恢复, 胃肠功能, 手术风险

Abstract:

Objective　To observe the effect of intestinal preparation-free on recovery and intestinal function in patients after thoracoscopic radical surgery for lung cancer. Methods　This was a randomized controlled trial. A total of 122 patients with lung cancer admitted to the First Affiliated Hospital of Nanyang Medical College from January 2021 to March 2023 were included. The enrolled patients were divided into a conventional group (61 cases) and an experimental group (61 cases) by the random number table method. In the conventional group, there were 40 males and 21 females, aged 48-72 (60.32±5.25) years. In the experimental group, there were 41 males and 20 females, aged 50-70 (61.42±5.31) years. All patients underwent thoracoscopic radical surgery for lung cancer. The conventional group received compound polyethylene glycol electrolyte powder for preoperative intestinal preparation, while the experimental group did not take preoperative intestinal preparation measures. The postoperative recovery, postoperative changes in gastrointestinal function and inflammatory indexes, occurrence of gastrointestinal adverse reactions, and surgical safety were compared between the two groups. χ² test and t test were used. Results　Under different treatment schemes, the operation time of the experimental group was (170.44±20.35) min, which was slightly longer than that of the conventional group [(167.35±20.46) min], with no statistically significant difference (P>0.05); the postoperative exhaust time, defecation time, and hospitalization time of the experimental group were (20.25±5.14) h, (23.36±5.42) h, and (8.76±2.47) d, which were shorter than those of the conventional group [(23.77±5.18) h, (26.62±5.41) h, and (10.36±3.22) d], with statistically significant differences (all P<0.05). Before operation, there were no statistically significant differences in the gastrointestinal function indexes between the two groups (both P>0.05). Under different treatment schemes, the levels of gastrin (GAS) and motilin (MLT) in the experimental groups were (70.22±10.37) ng/L and (78.45±10.27) ng/L, which were lower than those in the conventional group [(75.45±10.26) ng/L and (86.33±10.28) ng/L], with statistically significant differences (both P<0.05). Before treatment, there were no statistically significant differences in the inflammatory indexes between the two groups (both P>0.05). Under different treatment regimens, the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in the experimental group were (15.45±4.49) mg/L and (12.33±3.47) ng/L, which were lower than those in the conventional group [(18.77±4.18) mg/L and (15.66±4.14) ng/L], with statistically significant differences (both P<0.05). Under different treatment schemes, the incidence of gastrointestinal adverse reactions in the experimental group was 8.20% (5/61), which was lower than that in the conventional group [21.31% (13/61)], with a statistically significant difference (P<0.05); the incidence of surgery-related complications in the experimental group was 9.84% (6/61), which was slightly higher than that in the conventional group [8.20% (5/61)], with no statistically significant difference (P>0.05). Conclusions　Preoperative intestinal preparation-free can accelerate the postoperative rehabilitation process in patients undergoing thoracoscopic radical surgery for lung cancer, and has positive significance in avoiding postoperative gastrointestinal dysfunction and inflammatory reactions and reducing the risk of gastrointestinal adverse reactions. Compared with traditional preoperative intestinal preparation measures, intestinal preparation-free does not significantly increase the risk of surgery-related complications, and has high application value.

Key words:

Thoracoscopic radical surgery for lung cancer, Preoperative intestinal preparation, Postoperative recovery, Gastrointestinal function, , Surgical risk

于一鸣李喜龙.

无肠道准备对胸腔镜肺癌根治术后患者康复及肠道功能的影响 [J]. 国际医药卫生导报, 2024, 30(2): 279-283.

Yu Yiming, Li Xilong.

Effect of intestinal preparation-free on recovery and intestinal function in patients after thoracoscopic radical surgery for lung cancer [J]. International Medicine and Health Guidance News, 2024, 30(2): 279-283.

参考文献

[1] 伦文慧,李铁钢,毛纯,等.广州市城区居民肺癌死亡率和发病率趋势分析及预测[J].中国癌症防治杂志,2020,12(1):51-56. DOI:10.3969/j.issn.1674-5671.2020.01.09.
[2] Wu Y, Xu M, Ma Y. Fast-track surgery in single-hole thoracoscopic radical resection of lung cancer[J]. J BUON, 2020, 25(4):1745-1752.
[3] 高晔秋.不同术前肠道准备方法对妇科腹腔镜患者术后康复影响的研究综述[J/CD].实用妇科内分泌电子杂志,2022,9(10):43-45. DOI:10.3969/j.issn.2095-8803.2022.10.013.
[4] 邹雪莲,林晶晶,徐娜,等.复方聚乙二醇电解质散在泌尿外科术前肠道准备中的应用[J].中外医学研究,2022,20(12):149-152. DOI:10.14033/j.cnki.cfmr.2022.12.040.
[5] 康会霞,马俊英,赵彦丽,等.优化术前肠道准备流程对妇科恶性肿瘤择期手术患者的影响[J].河北医药,2022,44(17):2611-2614. DOI:10.3969/j.issn.1002-7386.2022.17.012.
[6] Hartmann L, Arndt M, Hahn EM, et al. Effect of bowel preparation on intestinal permeability and inflammatory response during postoperative ileus in mice[J]. Surgery, 2021, 170(5):1442-1447. DOI: 10.1016/j.surg.2021. 05.014.
[7] Feng SH, Yang ST. The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and limitations with CT image demonstrations[J]. Diagn Interv Radiol, 2019, 25(4):270-279. DOI: 10.5152/dir.2019.18458.
[8] 邢力刚,马晓林.2021版«中华医学会肿瘤学分会肺癌临床诊疗指南»非小细胞肺癌诊疗更新专家解读[J].疑难病杂志,2022,21(6):557-560. DOI:10.3969/j.issn.1671-6450. 2022.06.001.
[9] 杨天宝,王武,谢金标,等.单孔胸腔镜肺癌根治术对肺癌患者免疫功能的影响[J].癌症进展,2023,21(1):30-33. DOI:10.11877/j.issn.1672-1535.2023.21.01.06.
[10] Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention[J]. Clin Chest Med, 2020, 41(1):1-24. DOI: 10.1016/j.ccm.2019.10.001.
[11] 史可峰,钱如林,杨冉,等.胸腔镜下肺癌根治术对非小细胞肺癌患者炎性因子、T淋巴细胞亚群及肿瘤微转移因子水平的影响[J].癌症进展,2022,20(9):931-934. DOI:10.11877/j.issn.1672-1535.2022.20.09.16.
[12] 潘雨婷,周思成,曹少木,等.择期结直肠手术术前机械性肠道准备与抗生素肠道准备的研究进展[J].现代肿瘤医学,2023,31(3):572-575. DOI:10.3969/j.issn.1672-4992. 2023.03.036.
[13] Kim IY. Role of mechanical bowel preparation for elective colorectal surgery[J]. Korean J Gastroenterol, 2020, 75(2):79-85. DOI: 10.4166/kjg.2020.75.2.79.
[14] Krishnamoorthy A, Chandrapalan S, Bosch S, et al. The influence of mechanical bowel preparation on volatile organic compounds for the detection of gastrointestinal disease-a systematic review[J]. Sensors (Basel), 2023, 23(3):1377. DOI: 10.3390/s23031377.
[15] 方庭枫,胡琦玥,朱玉叶,等.评估妇科良性疾病腹腔镜术前机械性肠道准备的必要性[J].中国妇产科临床杂志,2021,22(6):593-596. DOI:10.13390/j.issn.1672-1861.2021. 06.010.
[16] Gray J, Helmer SD, Quinn KR, et al. Is mechanical bowel preparation necessary in bariatric surgery?[J]. Am J Surg, 2022, 224(1 Pt B):449-452. DOI: 10.1016/j.amjsurg.2022. 01.021.
[17] 齐琼,曾立云,潘莺燕.ERAS胃肠道管理方案在腰椎后路融合术患者中的应用[J].实用骨科杂志,2021,27(9):769-773. DOI:10.13795/j.cnki.sgkz.2021.09.001.
[18] 刘春霞,陈曲,贺雨,等.机械性与非机械性肠道准备对后腹腔镜肾/肾上腺手术后康复的影响[J].中国微创外科杂志,2023,29(1):40-44. DOI:10.3969/j.issn.1009-6604.2023. 01.009.
[19] 韩瑞红,徐新朝,崔永红.MBP对胃癌根治术患者的影响[J].菏泽医学专科学校学报,2022,34(1):32-35. DOI:10.3969/j.issn.1008-4118.2022.01.009.
[20] 徐西玲,李姗姗.探讨不同肠道准备对全麻胸腔镜肺癌手术患者胃肠道功能恢复影响[J].中文科技期刊数据库(全文版)医药卫生, 2023(4):131-133.