加速康复外科应用于胆囊微创手术的临床观察

Clinical observation of enhanced recovery after surgery in treatment of cholecystolithiasis by laparoscope

目的观察加速康复外科(enhanced recovery after surgery,ERAS)应用于腹腔镜下胆囊切除术或腹腔镜联合胆道镜保胆取石术治疗中的有效性及安全性。方法前瞻性观察2016年4月至2017年6月于贵州医科大学附属医院应用加速康复外科围手术期治疗策略进行腹腔镜胆囊切除术或腹腔镜联合胆道镜保胆取石术的563例病人,观察病人术后不同时间点的疼痛评分[采用疼痛视觉模拟量表(visual analogue scale,VAS)]、术后肠道功能恢复时间及手术后并发症发生的情况。结果本研究中563例病人术后不同时间点VAS评分均未超过3分,最高VAS评分为5分;术后平均肠鸣音恢复时间为5.8 h,术后平均首次排气时间为15.2 h;术后平均住院日为2.85 d,并发症发生率为7.46%,无术后30 d再住院及死亡。结论 ERAS针对腹腔镜胆囊微创手术是安全有效的,病人术后疼痛控制良好,是一种有效的围手术期治疗策略。

Objective To evaluate the efficacy and safety of enhanced recovery after surgery （ERAS） in treating cholecystolithiasis by laparoscopic cholecystectomy or cholecystolithotomy with gallbladder preservation by laparoscope combined with choledochoscope. Methods A prospective observational study was conducted in Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University between April 2016 and June 2017. 563 patients with cholecystolithiasis were subjected to ERAS and laparoscopic surgery. Post-operative pain score, restoration of intestinal sound, first exhaust time and complications were recorded. Results Among 563 patients recruited, the mean pain score was less than 3 points in different evaluation points after surgery, and the highest pain scores were 5 in 3 patients; post-operative restoration time of intestinal sound was 5. 8 h, and the first post-operative exhaust time was 15. 2 h; post-operative hospital stay was 2. 85 days and the complication rate was 7. 46% ; mortality and re-hospitalization rate in 30 days were both 0. Conclusions ERAS is efficacy and safety in cholecystolithiasis laparoscopic surgery.