腹腔镜胰十二指肠切除术患者ERAS理念指导下的围手术期处理

Perioperative management of patients undergoing laparoscopic pancreaticoduodenectomy under the guidance of ERAS concept

目的探讨应用术后加速康复(ERAS)理念在腹腔镜胰十二指肠切除术(LPD)患者中实施围手术期处理的效果。方法收集西安交通大学医学部附属咸阳市中心医院肝胆外科2016年3月至2020年6月行LPD125例的资料,围手术期管理程序采用随机数字表法,将其分为ERAS组(62例)和传统处理组(63例)。统计两组患者术前一般情况,两组术前术后的胰岛素抵抗指数和C反应蛋白变化、术后应用镇痛药次数、术后首次排气时间、术后腹腔引流管拔除时间、术后住院时间、术后并发症等。结果两组患者均临床治愈出院。两组患者术前一般情况及术后病理学诊断比较(P>0.05)无显著性差异。对其术前至术后7 d的胰岛素抵抗指数与C反应蛋白水平变化趋势比较,差异有统计学意义F=13.28,18.65,P<0.05);手术时间与术中出血量比较(t=0.612,0.352,P>0.05),差异均无统计学意义;术后应用镇痛药次数、术后下床活动时间、术后肛门首次排气时间、术后拔除腹腔引流管时间及术后住院时间比较(t=2.468,-3.26,-6.01,-12.3,-1.926,P<0.05),差异均有统计学意义;两组的术后胰瘘、胆瘘及出血情况比较,差异无统计学意义(χ^(2)=0.361,0.256,0.158,P>0.05);两组的术后胃排空延迟、腹腔感染的发生率差异有统计学意义(χ^(2)=3.592,3.212,P<0.05)。结论实施ERAS的围手术期处理能降低LPD患者的术后应激反应及胃排空延迟的发生率,加速术后康复进程,缩短住院时间,改善临床效果。

Objective To explore the effect of perioperative management of patients undergoing laparoscopic pancreaticoduo⁃denectomy(LPD)with the concept of accelerated rehabilitation after surgery(ERAS).Methods Data of 125 patients who received LPD in the Department of Hepatobiliary Surgery,Xianyang Central Hospital affiliated to Xi'an Jiaotong University Medical Science Cen⁃ter from March 2016 to June 2020 were collected.Perioperative management was conducted by random number table method,and they were divided into ERAS group(62 cases)and traditional treatment group(63 cases).The preoperative general conditions of the two groups,the changes of insulin resistance index c⁃reactive protein before and after surgery,postoperative analgesic application times,postoperative first exhaust time,postoperative abdominal drainage tube removal time,postoperative hospital stay,postoperative compli⁃cations and so on were counted.ResultsBoth groups were cured and discharged.There was no significant difference in preoperative gen⁃eral condition and postoperative pathological diagnosis between 2 groups(P>0.05).Compared with the change trend of insulin resist⁃ance index and C⁃reactive protein level from preoperative to postoperative 7 days,the difference was statistically significant(F=13.28,18.65,P<0.05).There was no significant difference between operation time and blood loss(t=0.612,0.352,P>0.05).Comparison of postoperative analgesic application times,postoperative ambulation time,postoperative anal first exhaust time,postoper⁃ative abdominal drainage tube removal time and postoperative hospital stay(t=2.468,-3.26,-6.01,-12.3,-1.926,P<0.05),the differences were statistically significant.There was no significant difference in postoperative pancreatic fistula,biliary fistula and hemorrhage between the two groups(χ^(2)=0.361,0.256,0.158,P>0.05).The incidence of delayed gastric emptyingand ab⁃dominal infectionbetween the two groups was statistically significant(χ^(2)=3.592,3.212,P<0.05).Conclusions Perioperative management of ERAS can reduce the incidence of postoperative stress response and delayed gastric emptying in LPD patients,acceler⁃ate the postoperative rehabilitation process,shorten the hospital stay and improve the clinical effect.