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Early rehabilitation versus conventional care after laparoscopic rectal surgery: A prospective, randomized, controlled trial

机译：腹腔镜直肠手术后的早期康复与常规护理：一项前瞻性，随机对照研究

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Background: Although early rehabilitation programs have been reported to be effective after laparoscopic colectomy, there is no report of the efficacy of rehabilitation programs after rectal cancer surgery. This study was designed to evaluate the efficacy of an early rehabilitation program after laparoscopic low anterior resection for mid or low rectal cancer in a randomized, controlled trial. Methods: Ninety-eight patients who had undergone a laparoscopic low anterior resection with defunctioning ileostomy were randomized on a 1:1 basis to an early rehabilitation program (n = 52) or conventional care (n = 46). The primary endpoint was recovery rate at 4 days postoperatively. The secondary endpoints were recovery time, postoperative hospital stay, complications, readmission rates, pain on a visual analogue scale, and quality of life (QOL) according to Short Form 36. Results: The recovery rates were not different in both groups (rehabilitation, 25 % vs. conventional, 13 %, p = 0.135). Recovery time and postoperative hospital stay was similar between the groups (rehabilitation, 137 h [107-188] vs. conventional, 146.5 h [115-183], p = 0.47; 7.5 days [7-11] vs. 8.0 days [7-10], p = 0.882). The complication rates did not differ between the two groups, but more complications were noted in the rehabilitation program group (42.3 vs. 24.0 %, p = 0.054), which was related to postoperative ileus (28.8 vs. 13.0 %, p = 0.057) and acute voiding difficulty (19.6 vs. 4.7 %, p = 0.032). There was no readmission within 1 month of surgery. Pain and QOL were similar in both groups. Conclusions: This randomized trial did not show that an early rehabilitation program is beneficial after laparoscopic low anterior resection. Our results confirm that postoperative ileus and acute voiding difficulty are major obstacles to fast-track surgery for mid or low rectal cancer. This study was registered (registration number NCT00606944).
机译：背景：尽管有报道说早期的康复计划在腹腔镜结肠切除术后是有效的，但尚无关于直肠癌手术后康复计划功效的报道。本研究旨在通过一项随机对照试验评估腹腔镜低位前切除术后中早期或低位直肠癌的早期康复计划的疗效。方法：将98例行腹腔镜低位前切除术并伴有回肠功能异常的患者按1：1的比例随机分配至早期康复计划（n = 52）或常规护理（n = 46）。主要终点是术后4天的恢复率。次要终点是根据简短表格36得出的恢复时间，术后住院时间，并发症，再入院率，视觉模拟量级疼痛和生活质量（QOL）。结果：两组的恢复率无差异（康复，相对于传统的25％为13％，p = 0.135）。两组之间的恢复时间和术后住院时间相似（康复时间：137小时[107-188]与常规时间; 146.5小时[115-183]，P = 0.47; 7.5天[7-11]与8.0天[7] -10]，p ＝ 0.882）。两组之间的并发症发生率没有差异，但是康复计划组的并发症更多（42.3 vs. 24.0％，p = 0.054），与术后肠梗阻有关（28.8 vs. 13.0％，p = 0.057）。和急性排尿困难（19.6比4.7％，p = 0.032）。手术后1个月内没有再次入院。两组的疼痛和生活质量相似。结论：该随机试验未显示腹腔镜低位前切除术后早期康复计划是有益的。我们的结果证实，术后肠梗阻和急性排尿困难是中低位直肠癌快速手术的主要障碍。该研究已注册（注册号NCT00606944）。

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