快速康复外科在LC联合ERCP治疗胆囊结石合并胆总管结石中的应用

Clinical Application of Fast Track Surgery in Treatment for Cholecystolithiasis Combined with Calculus of Common Bile Duct by Combination of Laparoscope and Duodenoscope

目的探讨快速康复外科(FTS)理念在腹腔镜胆囊切除术(LC)联合经内镜逆行胰胆管造影(ERCP)治疗胆囊结石并胆总管结石中的应用价值。方法选择2010年8月至2011年8月期间在我院择期行LC及ERCP胆管取石患者120例,采用FTS理念指导下的围手术期处理方法(FTS组,n=55)和传统的围手术期处理方法(传统组,n=65),比较2组患者的术后切口疼痛和恶心呕吐情况、输液时间、体质量下降、下床活动时间、进食时间、术后住院时间、住院费用及并发症的差异。结果 FTS组术后输液时间、下床活动时间、进食时间及住院时间均明显短于传统组(P<0.05),其肺部感染率、泌尿系统感染率及胰腺炎、切口疼痛和恶心呕吐发生率均明显低于传统组(P<0.05),住院费用较传统组也明显减少(P<0.05),体质量下降程度也低于传统组(P<0.05),但术后24 h白细胞和血清淀粉酶比较,2组间差异无统计学意义(P>0.05)。结论 FTS理念在LC联合ERCP治疗胆囊结石并胆总管结石中安全、经济、有效。

Objective To evaluate the use of fast track surgery（FTS）in the treatment for cholecystolithiasis combined with calculus of common bile duct（CBD）by combination of laparoscope and duodenoscope.Methods One hundred and twenty patients with cholecystolithiasis combined with calculus of CBD underwent laparoscopic cholecystectomy（LC）and endoscopic retrograde cholangiopancreatography（ERCP）were divided into FTS group（n=55）and conventional group（n=65）,which were accepted the perioperative therapy of FTS or conventional therapy,respectively.After operation,the incision pain,nausea and vomiting,infusion time,loss of body weight,out-of-bed time,dieting time,postoperative hospitalization,hospital costs,and complications were compared in two groups.Results Compared with the conventional group,the postoperative infusion time,dieting time,out-of-bed time,and postoperative hospitalization were shorter,the incidence rates of pulmonary infection,and urinary systems infection,pancreatitis,nausea and vomiting,and incision pain were lower,the loss of body weight was lower in the FTS group（P0.05）,but the differences of WBC and serum amylase at 24 h after operation were not significant between the FTS group and conventional group（P0.05）.Conclusion The FTS is safe,economic,and effective in the treatment for cholecystolithiasis combined with calculus of CBD by combination of laparoscope and duodenoscope.