快速康复外科在大范围肝切除术围手术期中的应用

Fast-track surgery in the perioperative management of major hepatectomy

目的探讨快速康复外科(fast-track surgery,FTS)在大范围肝切除术中应用的临床效果。方法行大范围肝切除术患者160例,实施FTS治疗80例为FTS组,传统治疗80例为对照组。比较2组围手术期相关指标及并发症发生情况。结果 FTS组补液量[(1 500±100)mL]较对照组[(2 500±200)mL]减少(P<0.05),麻醉苏醒时间[(11.25±1.62)h]较对照组[(29.68±2.14)h]缩短(P<0.05),术后进食时间[(6.15±1.21)h]、首次排气时间[(46.47±3.58)h]、首次排便时间[(68.12±3.61)h]、下床活动时间[(12.59±1.20)h]较对照组[(90.58±6.47)、(135.56±6.81)、(145.14±8.35)、(93.32±5.86)h]明显提前(P<0.01),术后住院时间[(7.89±1.25)d]较对照组[(11.54±3.62)d]缩短(P<0.01);FTS组术后肺部感染/咽喉炎发生率(1.25%)、尿路感染发生率(2.50%)、腹腔感染发生率(1.25%)、恶心/呕吐发生率(6.25%)均低于对照组(8.75%、11.25%、2.50%、20.00%)(P<0.05)。结论 FTS应用于大范围肝切除患者,可有效减少术后并发症、缩短住院时间。

Objective To investigate the clinical effect of fast-track surgery （FTS） on the perioperative management of major hepatectomy. Methods A total of 160 patients undergoing major hepatectomy were divided into FTS group receiving FTS perioperative management and control group receiving conventional perioperative management, with 80 patients in each group. The perioperative parameters and complications were compared between two groups. Results The transfusion volume during operation （（1 500 ±100） mL） was significantly less, and the recovery time （（11.25 ±1.62） h） was significantly shorter in FTS group than those in control group （（2 500±200） mL, （29. 68±2. 14） h） （P〈0.05）. The feeding time （（6.15±1.21） h）, exhaust time （（46. 47±3.58） h）, defecation time （（68. 12±3.61） h）, off-bed activity time （（12. 59±1. 20） h） and hospitalization stay （（7. 89± 1. 25） d） after operation in FTS group were significantly shorter than those in control group （（90. 58±6.47） h, （1355. 56±6.81） h, （145.14±8.35） h, （93. 32± 5.86） h, （11. 54±3.62） d） （P〈0.01）. The incidences of postoperative pulmonary infection and pharyngitis （1.25%）, urinary tract infection （2.50%）, abdominal infection （1.25%）, and nausea and vomiting （6. 25%） in FTS group were significantly lower than those in control group （8. 75%, 11. 25%, 2. 5%, 20. 00%） （P〈0.05）. Conclusion FTS management could significantly reduce the incidence of complications and shorten the hospitalization stay after major hepatectoruy.