损伤控制和加速康复外科理念在原发性肝癌手术治疗中的疗效观察

Observation of curative effects of damage control and fast track surgery concept in surgical treatment of primary liver cancer

目的观察损伤控制和加速康复外科理念在原发性肝癌合并肝硬化手术中的临床疗效。方法将2009年2月~2011年4月在萍乡市人民医院肝胆外科住院术治疗的原发性肝癌患者32例作为干预组,实施损伤控制和加速康复外科治疗,对照组15例采用传统围术期治疗方案及常规手术模式,比较两组患者术后下床时间、肛门排气及排便时间、术后并发症、住院时间和术后1周肝脏功能变化。结果与对照组比较,干预组患者的肛门排气排便时间、下床活动时间、住院天数均显著缩短,差异有统计学意义,术后切口感染及胸/腹水发生率明显减少,差异有统计学意义（P〈0.05、0.01）;术后1周干预组患者谷丙转氨酶及血清胆红素明显降低,血清白蛋白及前白蛋白明显升高,差异有统计学意义（P〈0.05、0.01）。结论损伤控制和加速康复外科技术能加快肝肿瘤切除患者的术后恢复,减少术后并发症的发生。

Objective To observe the clinical curative effects of damage control and fast track surgery concept in the surgical treatment of primary liver cancer combined with liver cirrhosis.Methods 32 patients with primary liver cancer receiving surgical treatment in the department of hepatobiliary surgery in Pingxiang hospital from February 2009 to April 2011 were selected as the intervention group.The intervention group received damage control and technical solution of fast tract surgery while the control group received traditional perioperative treatment and routine surgery mode.Then the postoperative ambulation time,anal exsufflation and defecation time,postoperative complications,hospital stay and one-week postoperative liver function changes between the two groups were compared.Results Compared with the control group,the anal exsufflation and defecation time,postoperative ambulation time and hospital stay of the intervention group all remarkably shortened,with statistically significant differences,and the postoperative incision infection and incidence of hydrothorax/ascites significantly reduced,with statistically significant differences（P 〈0.05,0.01）.One week after the surgery,the alanine aminotransferase and serum bilirubin of the patients in the intervention group obviously decreased and the serum albumin and prealbumin obviously increased,with statistically significant differences（P 〈0.05,0.01）.Conclusion Damage control and fast tract surgery techniques can accelerate the postoperative recovery of patients having received liver cancer resection and reduce the incidence of postoperative complications.