加速康复外科在胆道外科围手术期应用的临床研究及体会

Perioperative application of enhanced recovery after surgery in biliary tract surgery

目的评价加速康复外科在胆道手术围手术期应用的安全性及临床效果.方法收集2014-10-01/2016-04-30于滨州医学院附属医院肝胆外科行择期胆道手术的616例患者资料,依据是否应用加速康复外科(enhanced recovery after surgery,ERAS)措施分为两组:对照组(n=312)行传统围手术期处理,ERAS组(n=304)实施加速康复外科措施.各组又依据不同术式(腹腔镜胆囊切除术、胆总管切开探查引流术和胆肠吻合术)分成亚组进行比较.分析患者的术前禁饮食时间、胃管和尿管的留置率、胃管和尿管留置时间、腹腔引流管留置时间、T管造影时间、术后持续心电监护时间、术后阿片类药物使用率、术后并发症发生率、术后首次下床活动时间、首次排气时间、住院时间、住院费用、出院30 d再入院率及死亡率的差异.结果总体及各亚组内比较表明,与对照组相比,ERAS组患者术前禁饮食时间缩短,胃肠减压管及导尿管留置率明显降低,胃肠减压管、导尿管及腹腔引流管留置时间缩短,术后T管造影时间提前,术后持续心电监护时间缩短,术后阿片类药物使用率下降,术后下床活动时间提前,术后排气时间提前,术后并发症发生率降低,总住院时间缩短,术后住院时间缩短,各指标差异均有统计学意义(P<0.05),且住院费用有所减少,出院后30 d均无再入院及死亡患者.结论胆道手术围手术期应用加速康复外科理念和措施,减轻了患者术后疼痛、加快了胃肠功能恢复、促进了术后早期下床活动,从而减少了术后并发症发生率、缩短了住院时间,减少了住院费用,促进了患者尽早康复.

AIM To evaluate the safety and clinical effects of enhanced recovery after surgery（ERAS） in the perioperative period of biliary tract surgery.METHODS Clinical data for patients who underwent selective biliary surgery at Department of Hepatobiliary Surgery,Affiliated Hospital of Binzhou Medical University from October 2014 to April 2016 were collected.The patients were divided into either a control group（n- 312） to receive traditional perioperative management or an ERAS group（n- 304） to receive fast-track surgical intervention.Each group was divided into subgroups according to the different operative methods used（laparoscopic cholecystectomy,common bile duct exploration and drainage,and cholangioenterostomy） and compared.The differences in preoperative fasting time,indwelling rate and duration of gastric tube and catheter,indwelling duration of abdominal cavity drainage tube,T tube cholangiography time,continuous postoperative ECG monitoring time,postoperative opioid drug use rate,postoperative complications rate,time to first postoperative ambulation,time to first postoperative exhaust,length of hospital stay,and hospitalization expenses as well as the readmission rate and mortality during 30 d after discharge between groups were compared.RESULTS Compared with the control group,the ERAS group had significantly shortened preoperative fasting time,decreased indwelling rates of gastrointestinal decompression tube and catheter,shortened indwelling durations of gastrointestinal decompression tube,catheter,and peritoneal cavity drainage tube,shortened time for postoperative T tube cholangiography and duration of postoperative continuous ECG monitoring,decreased postoperative opioid drug use rate,shortened time to postoperative ambulation and exhaust,decreased incidence of postoperative complications,shortened total hospital stay and postoperative hospitalization time,and decreased hospitalization expenses（P 0.05）.No readmission or death was found during 30 d after discharge.CONCLUSION The application of ERAS concept and measures in the perioperative period of biliary tract surgery reduces postoperative pain,accelerates the recovery of gastrointestinal function,promotes postoperative early ambulation,reduces the incidence of postoperative complications,shortens hospital stay,decreases the cost of hospitalization,and enhances the early recovery of the patients.