快速康复外科在胆总管结石治疗中的应用

Application of enhanced recovery after surgery in the treatment of common bile duct stones

目的 探讨快速康复外科（ERAS）在胆总管结石治疗中应用的安全性及有效性.方法 将48例胆总管结石接受外科治疗的患者采用随机数字表法分为ERAS组和对照组.对照组采用开腹胆总管探查切开取石术、传统的围手术期处理方法;ERAS组采用腹腔镜胆总管探查切开取石术、快速康复外科的围手术期处理方法.对比分析两组患者术前及术后C反应蛋白（CRP）水平、术后下床活动时间、进食时间、排气时间、住院天数、住院费用及并发症发生情况.结果 与对照组比较,ERAS组患者术后1 d及3 d的CRP明显降低[d1：（102.6±13.5）mg/L比（81.3±17.3）mg/L;d3：（71.8±15.3）mg/L比（41.2±11.2）mg/L,t=2.553、3.287,均P〈0.05]、术后更早下床活动[（3.2±1.8）d比（0.9±0.4）d]、更早进食[（4.3±1.9）d比（1.8±1.2）d、肛门排气时间提前[（2.5±0.7）d比（1.2±0.3）d]、术后住院时间缩短[（7.3±3.2）d比（3.8±1.4）d）、住院花费更少[（7 200±800）元比（5 900±700）元]（t=5.561、4.319、3.765、2.351、1.671,均P〈0.05）、术后并发症发生率明显降低（61.91%比18.52%,x2=25.82,P〈0.05）.结论 在胆总管结石外科治疗中应用ERAS措施是安全、有效的,能够加速患者的康复.

Objective To explore the effect and safety of enhanced recovery after surgery （ERAS） in the surgical treatment of common bile duct stones.Methods According to random number table,48 patients with common bile duct stones were randomly divided into the ERAS group and the control group.The patients of the control group received the traditional perioperative management and laparotomy exploration of common bile duct.The patients of the ERAS group received the ERAS perioperative management and laparoscopic exploration of common bile duct.The preoperative and postoperative level of C reactive protein （CRP）,time to out-of-bed activity,time to food taking,time to anal exsufflation,postoperative hospital stay,hospitalization cost and postoperative complications between the two groups were compared.Results Compared with the control group,the ERAS group had lower levels of CRP on the postoperative 1 day and 3 days[d1：（102.6±13.5） mg/L vs.（81.3±17.3）mg/L;d3：（71.8±15.3）mg/L vs.（41.2±11.2）mg/L,t=2.553,3.287,all P〈0.05],had shorter time to out-of-bed activity[（3.2±1.8）d vs.（0.9±0.4）d],time to food taking[（4.3±1.9）d vs.（1.8±1.2）d] and time to anal exsufflation[（2.5±0.7）d vs.（1.2±0.3）d],and had shorter operative hospital stay[（7.3±3.2）d vs.（3.8±1.4）d]and less hospitalization cost[（7 200±800）RMB vs.（5 900±700）RMB] （t=5.561,4.319,3.765,2.351,1.671,all P〈0.05）.The incidence rate of postoperative complications of the ERAS group decreased markedly （61.91% vs.18.52%,x2=25.82,P〈0.05）.Conclusion ERAS management in the surgical treatment of common bile duct stones is safe and effective,which can enhance the recovery of the patients.