加速康复外科在腹腔镜联合胆道镜治疗胆囊结石合并肝外胆管结石中的应用

ERAS in the treatment of cholecystolithiasis complicating extrahepatic bile duct stones by combination of laparoscopy and choledochoscopy

目的探讨加速康复外科（enhanced recovery after surgery, ERAS）理念在腹腔镜联合胆道镜治疗胆囊结石合并肝外胆管结石患者围手术期的应用。方法将符合条件的患者分为ERAS组和对照组，分别采用加速康复外科理念指导下的围手术期处理方案和传统围手术期处理方案。分析对比两组患者临床指标和相关生化指标。结果ERAS组46例，对照组40例。与对照组比较，ERAS组患者首次排气时间、首次进食时间、首次下床时间、引流管拔除时间、术后住院时间较短（分别t=-3．658，-15．552，-8．864，-6．673，-6．036，均P〈0．05），术后6、1、24、48h疼痛程度较轻（F=8．284，P=0．000），并发症发生率较低（χ^2=4．172，P=0．043），术前和术后1、3、5d的c．反应蛋白（CRP）水平较低（F=6．692，P=0．013），术前与术后1、3、5d的前白蛋白（PA）水平较高（F=21．191，P=0．000），总住院费用较低（t=-0．592，P=0．004）。结论在腹腔镜联合胆道镜治疗胆囊结石合并肝外胆管结石患者围手术期中应用ERAS有助于患者快速康复。

Objective To evaluate enhanced recovery after surgery （ERAS） in the treatment of cholecystolithiasis complicated with extra hepaticbile duct stones by laparoscopy and choledochoscopy. Methods Patients were divided into ERAS an（] control groups according to the inclusion and exclusion criteria. Patients in ERAS group received perioperative management according to enhanced recovery rehabilitation program. Clinical and laboratory results were compared between the two groups. Results 46 patients were enrolled into ERAS group and 40 patients into control group. The ERAS group had shorter time of first postoperative exhaust, first postoperative oral intake, getting out of bed, removal of abdominal drainage tube, postoperative hospital stay （ respectively t = - 3. 658, - 15. 552, - 8. 864, - 6. 673, -6. 036, all P 〈0. 05）, less pain in 6, 12, 24 and 48 hours after operation （F =8. 284, P =0. 000） , and lower complication rate （χ^2 = 4. 172, P = 0. 043 ）, lower C- reactive protein （CRP） level from pre-operation to postoperative day 1, 3 and 5 （ F = 6. 692, P = 0. 013 ） , higher level of prealbumin （PA） from preoperation to postoperative day 1, 3 and 5 （ F = 21. 191, P = 0. 000 ）, lower hospitalization costs （ t = -0. 592, P = 0. 004 ）. Conclusion The application of ERAS in the treatment of eholecystolithiasis complicated with extrahepatic bile duct stones by laparoscopy combined with choledochoseopy is conducive to rapid postoperative recovery of patients.