在结直肠手术中使用腹腔镜和手术机器人操作，围手术期采用加速康复外科（Enhanced recovery after surgery，ERAS）方案处理，观察分析临床短期疗效。方法：选取 2010 年 1 月 ~2018 年 6 月在笔者单位就诊的1139 例结直肠手术患者作为临床研究对象。根据患者病情及肿瘤的位置，选择进行左半结肠、右半结肠、乙状结肠与直肠手术，手术分为开腹、腹腔镜及机器人系统辅助进行。常规开腹手术组 414 例，腹腔镜手术组 260 例，机器人手术组 465 例，围手术期均采用 ERAS 方案，回顾分析各组围手术期肠道通气、住院时间等指标，并观察记 录不良反应及并发症。结果：各组间年龄、BMI、术前 ASA 分级及术后病理分期比较，差异无统计学意义。平均术 后胃肠通气时间（2.86±0.84）d，术后住院天数为（6.98±4.39）d，各组间比较，差异无统计学意义。术后总体并 发症发生率 8.1％（92/1139），各组间术后并发症发生率及严重度比较，差异无统计学意义。结论：ERAS 在结直肠 癌择期手术患者中应用是安全、经济、有效的围手术期处理方案，包括机器人手术在内的微创手术在结直肠手术中 进一步应用，可能带来更有益的短期临床结局。微创手术本身所带来的应激降低作用效果并不明显，ERAS 围手术 期处理措施优化才是降低围手术期应激的主要环节，外科理念比手术技术更重要。

To observe and analyze the short-term clinical effect of laparoscopic operation, Da Vinci robot operation within perioperative accelerated rehabilitation surgery in colorectal surgery. Methods: 1139 patients undergoing colorectal surgery in the author’s medical unit from January 2010 to June 2018 were included in this clinical study. Operations were performed on the left colon, right colon, sigmoid colon and rectum based on the different conditions and locations of tumors. 414 cases in the conventional laparotomy group, 260 cases in the laparoscopic surgery group and 465 cases in the robotassisted surgery group, Enhanced recovery after surgery (ERAS) approach was adopted to all the surgeries. Indicators such as perioperative intestinal ventilation, hospitalization time of each group were retrospectively analyzed, adverse reactions and complications were also observed and recorded. Results: No significant differences in age, BMI, preoperative ASA grading and postoperative pathological staging among three groups were found. No significant differences were found among groups with mean postoperative gastrointestinal ventilation time (2.86±0.84 days) and postoperative hospitalization days (6.98±4.39 days). The overall incidence of postoperative complications 8.1% (92/1139) shows no difference in incidence and severity of postoperative complications among groups. Conclusion: ERAS is a safe, economical and effective way to treat patients with colorectal cancer under selective operation in perioperative management. The further application of minimally invasive surgery, including robotic surgery, on colorectal surgery may lead to better short-term clinical outcomes. No obvious reduction of stress reaction was found in minimally invasive surgery. The optimization of perioperative management in ERAS is the key to reduce stress reaction, and surgical philosophy is more important than surgical technique. 

收稿日期：2020-03-04 录用日期：2020-04-05

Received Date: 2020-03-04 Accepted Date: 2020-04-05

基金项目：国家自然科学基金（81300721）；江苏省社会发展基金（BE2015687）

Foundation Item: National Natural Science Foundation of China (81300721); Social Development Foundation of Jiangsu Province, China (BE2015687)

通讯作者：江志伟，Email: surgery34@163.com 

Corresponding Author: JIANG Zhiwei, Email: surgery34@163.com

引用格式：柳欣欣，刘江，江志伟，等 . 微创及加速康复外科在结直肠手术中的应用 [J]. 机器人外科学杂志，2020, 1 (1):18-25.

Citation: LIU X X，LIU J, JIANG Z W, et al. Application of minimally invasive and ERAS in colorectal surgery[J]. Chinese Journal of Robotic Surgery, 2020, 1 (1):18-25

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