快速康复外科理念指导下腹腔镜胆道探查术的前瞻性随机对照临床研究

A prospective randomized controlled trial of laparoscopic common bile duct guided by fast-track surgery

目的探讨快速康复外科理念指导下腹腔镜胆道探查术的疗效,并分析其安全性。方法选择2007年8月～2012年2月株洲市一医院肝胆外科择期行腹腔镜胆道探查术的190例患者,按住院号分为快速康复(FTS)组和对照组。快速康复组应用FTS措施进行处理,对照组采取传统的方案治疗,两组行随机对照研究,比较两组术后胰岛素抵抗指数、营养状况、麻醉用药量、术后清醒时间、术后下床活动时间、镇痛效果、住院费用、住院天数、术后并发症发生率以及患者对治疗的满意度。结果实验组与对照组比较,患者术后胰岛素抵抗指数降低,术后体重下降程度缩短,麻醉用药量减少,术后清醒时间及肛门排气时间以及术后住院天数显著缩短,住院费用减少,并发症减少,患者满意度提高。结论快速康复外科理念指导下腹腔镜胆道探查术能明显减少患者痛苦,减少并发症的发生,加速患者术后康复,提高患者满意度,临床应用安全,可行。

【Objective】To analyze the effect of laparoscopic common bile duct guided by fast-track surgery, and analyze its safety. 【Methods】One hundred ninety patients with common bile duct stones from Aug 2007 to Feb 2012 were randomized into FTS group and control group , 103 patients received by fast-track surgery, and 87 patients received by traditional programs. The index of insulin resistance, nutritional status, the dosage of anesthetic, the time of postoperative including wake , the effect of analgesic, the cost of medical, the length of postoperative hospital stay , postoperative complications and satisfaction of patient were analyzed. 【Results】No patient died in the two groups. As compared with those in FTS Group, the index of insulin resistance ,nutritional status, the time of postoperative including wake, the cost of medical care , the length of postoperative hospital stay and postoperative complications, in control group were little shorter, but satisfaction degree of patient increased. 【Conclusions】The application of laparoscopic common bile duct guided by fast-track surgery can decrease the pain ,the complication and fast postoperative recovery, increase satisfaction degree of patient, is a safe, feasible and efficacious procedure.