关键词： 直肠癌；机器人手术；加速康复外科；关闭盆底腹膜；短期疗效
段耀星，王赫，王玲，李来元，共东，杨芳花，杨能飞，张维胜，杜斌斌
目的：探讨加速康复外科(Enhanced recovery after surgery，ERAS)联合关闭盆底腹膜在机器人直肠癌手术中的应用和短期临床疗效。方法：回顾性分析 2018 年 10 月 ～2019 年 10 月甘肃省人民医院肛肠科确诊为直肠癌并行机器人全直肠系膜切除术患者的人口学资料和临床资料。根据纳入标准共收集 135 例符合此研究的患者，其中研究组为行ERAS 联合术中关闭盆底腹膜术患者(65 例)，对照组为行常规措施和未关闭盆底腹膜术患者(70 例)， 两组患者均行机器人直肠癌切除术。比较两组患者术前、术中和术后情况。结果：两组患者均顺利完成手术。与 对照组相比，研究组术后首次排气时间、进食流质时间、留置引流管时间、首次下床时间和住院时间均短于对照组(P<0.05)；研究组疼痛程度较轻(P<0.05)；研究组术前血糖维持效果较好(P<0.05)；两组患者术后第 1d和第 3d 炎性指标均较术前水平明显升高，但与研究组相比，术后第 1d 和第 3d 对照组 IL-6 和 PCT、WBC 升高更为明显(P<0.05)。两组患者术后引流噩、并发症发生率和病理学结果比较，差异均尤统计学意义(p>0.05)。结论：ERAS 联合关闭盆底腹膜应用于机器人直肠癌手术可减轻术后疼痛，促进早期胃肠道功能快速恢复，减轻应激反应，安全有效，值得临床推广。
Objective: To investigate the application and short-term clinical effect of enhanced recovery after surgery (ERAS) combined with pelvic peritoneum closure in robot-assisted surgery for rectal cancer. Methods: The demographic and clinical data of patients with rectal cancer underwent robotic total mesorectal excision in the Department of Anorectal of Gansu Provincial People’s Hospital from October 2018 to October 2019 were retrospectively analysed. According to the inclusion criteria, a total of 135 patients were eligible for this study. The study group consisted of 65 patients with pelvic peritoneum closed during ERAS. The control group was given routine care measures and 70 patients with pelvic floor peritoneum closure included. Rectal cancer resection. The conditions of the two groups were compared before, during and after surgery. Results: All the operations were successfully completed. Compared with the control group, the study group had shorter postoperative flatus time, postoperative fluid diet time, drainage time, activity time and hospitalization time than the control group (P<0.05). The pain degree in the study group was less severe and the number of analgesics using was less than that in the control group (P<0.05). The blood glucose maintenance effect of the study group was better before operation (P<0.05). The inflammatory indexes of the two groups on the first and third days after operation were significantly higher than those before operation. Compared with the study group, the levels of IL-6, PCT and WBC in the control group were significantly higher on the first and third days after operation (P<0.05). there="" was="" no="" significant="" difference="" in="" postoperative="" drainage="" complication="" rate="" and="" pathological="" results="" between="" the="" two="" groups="" p="">0.05). Conclusion: The application of ERAS combined pelvic peritoneum closure in robot- assisted rectal cancer surgery can reduce postoperative pain, promote recovery of gastrointestinal function and relieve stress response. It is safe and effective, which is worthy of clinical promotion.