加速康复外科联合腹腔镜探查治疗老年胆总管结石的疗效

Enhanced recovery after surgery combined laparoscopic common bile duct exploration in elderlypatients of choledocholithiasis

目的探讨加速康复外科在老年腹腔镜胆总管探查围手术期的应用效果。方法前瞻性分析2015年1月至2016年12月80例老年胆总管结石患者临床资料，随机分为对照组（40例，传统围手术期处理）和加速康复组（40例，加速康复外科模式围手术期处理），比较两组围手术期情况。结果两组手术时间、术中出血量比较，差异无统计学意义（t=1．04，0．88，P〉0．05）；与对照组相比，加速康复组术后肛门排气时间、首次下床活动时间、开始进食时间、术后输液时间、手术前后1周体重下降、拔除腹腔引流管时间、术后住院时间、住院总费用明显降低，差异有统计学意义（P〈0．05）；两组术前CRP、PCT、IL-6比较，差异无统计学意义（t=1．18，0．44，1．49，P〉0．05），但术后第1、4、7天，加速康复组CRP、PCT、IL-6水平明显低于对照组，差异有统计学意义（P〈0．05）；加速康复组总并发症发生率低于对照组[3（7．5％）比12（30％）]，差异有统计学意义（r=6．47，P〈0．05）。结论加速康复外科联合腹腔镜胆总管探查治疗老年胆总管结石安全，经济，但远期疗效尚需进一步观察。

Objective To investigate the effects of enhanced recovery after surgery （ERAS） combined with laparoscopic common bile duct exploration （LCBDE） in elderly patients with choledocholithiasis. Methods From Jan 2015 to Dec 2016, in the control group 40 patients received conventional perioperative management and 40 patients in the ERAS group followed the ERAS protocol. The operative details and outcomes were compared in the two groups. Results No perioperative death occurred during the study period. There was no statistically significant difference between the two groups in operative time and intraoperative blood loss （t = 1.04,0. 88 ,P 〉 0. 05 ）. Patients in ERAS group showed significantl shorter time of gastrointestinal tract peristalsis, off-bed, postoperative infusion, food intake, and abdominal drainage tube removal, as well as reduced weight loss, length of hospital stay and total cost than those in the control group （ P 〈 0. 05）. There were no significant difference of preoperative CRP and PCT, IL-6 in the 2 groups （t = 1.18,0. 44,1.49, P 〉 0.05 ）, However, the CRP and PCT, IL-6 levels in ERAS group were significantly lower than those in control group at postoperative days 1, 4, 7 （ P 〈 0. 05 ）. Furthermore, postoperative complications developed in 3 （ 7. 5% ）, and 12 （ 30. 0% ） respectively （X2 = 6.47, P 〈 0. 05）. Conclusions Minimally invasive surgery combined with ERAS is safe and cost-effective approach for elderly patients of choledocholithiasis.