快速康复理念在肝硬化伴胆道结石患者围手术期应用的前瞻性研究

Application of fast-track surgery concept in perioperative patients with biliary calculi and liver cirrhosis: a prospective study

目的探讨快速康复外科(FTS)理念应用于胆道结石手术伴有肝硬化患者围手术期的优越性和安全性。方法选择2011年1月-2013年9月成都军区总医院收治的52例胆道结石伴肝硬化手术治疗患者,随机分为FTS组30例和对照组22例。FTS组采用FTS理念指导下的围手术期处理措施。对照组采用传统的围手术期处理措施,比较两组患者术中情况,术后肠道恢复通气时间、术后住院日、总住院金额、术后并发症情况。两组间计量资料比较采用t检验,计数资料比较采用χ2检验。结果与对照组比较,FTS组术后肠道通气恢复时间[(22.84±10.78)h vs(27.90±14.22)h](t=2.239,P=0.045)和术后住院日[(10.64±5.23)d vs(11.87±5.08)d](t=4.246,P=0.038)明显缩短,总住院金额[(3.84±2.61)万元vs(3.95±2.63)万元](t=3.045,P=0.033)明显降低,差异均有统计学意义;术后并发症两组比较差异无统计学意义(P>0.05)。结论 FTS理念应用于胆道结石伴肝硬化患者的围手术期是安全有效的,在不增加手术风险前提下,可加速康复进程。

Objective To investigate the advantage and safety of the concept of fast-track surgery （FTS）applied in perioperative patients with biliary calculi and liver cirrhosis.Methods Fifty-two patients undergoing operation for biliary calculi and liver cirrhosis from January 2011 to September 2013 were included in this study.These patients were randomly divided into FTS group （n =30）and control group （n =22）.Patients in the FTS group received perioperative care measures guided by FTS concept,while patients in the control group re-ceived traditional perioperative management measures.The intraoperative situation of patients,time to postoperative recovery of intestinal function,length of postoperative hospital stay,total medical expenses during hospitalization,and postoperative complications were compared between the two groups.Continuous data and categorical data were compared by t-test and χ^2 test,respectively.Results As compared with the control group,the FTS group had significantly time to postoperative recovery of intestinal function （t =2.239,P =0.045）,a significantly shortened length of postoperative stay （t =4.246,P =0.038）,and significantly reduced total medical expenses during hos-pitalization （t =3.045,P =0.033）.No significant difference in postoperative complications was observed between the two groups （P＆gt;0.05）.Conclusion The concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrho-sis,which can accelerate rehabilitation without increasing the risk of surgery.