加速康复外科理念在胰十二指肠切除术围手术期管理中的可行性

Feasibility of Enhanced Recovery after Surgery Program in the Perioperative Management of Pancreaticoduodenectomy

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)模式在胰十二指肠切除术围手术期管理中应用的安全性及有效性。方法 2016年4月至2018年4月在北京协和医院基本外科接受胰十二指肠切除术的患者,其中符合入选和排除标准的63例患者纳入ERAS组,同期行常规胰十二指肠切除术的60例患者设为对照组,观察并比较两组患者术中及术后相关指标、并发症发生情况和临床结局。结果 ERAS组和对照组基线资料均衡可比,无统计学差异。ERAS组以腹腔镜手术为主,而对照组开腹手术居多(P<0. 01); ERAS组的手术时间较对照组延长(P<0. 01),但术中出血量显著降低(P<0. 01),术后胃管拔除时间(P<0. 05)和恢复流食时间(P<0. 05)早于对照组,住院时间明显短于对照组(P=0. 024),住院费用亦低于对照组(P<0. 05)。ERAS组的胃排空障碍发生率明显少于对照组(3. 2%比13. 3%,P<0. 05),总并发症发生率、胰瘘、胆瘘、术后出血、感染、二次入院、二次手术发生率及死亡率等指标两组间差异无统计学意义。ERAS组中腹腔镜手术组的术中出血量(P<0. 01)、术后住院天数(P<0. 05)、住院费用(P<0. 05)显著低于开腹手术组。结论 ERAS理念下行胰十二指肠切除术安全有效,可加速患者康复,且不增加并发症的发生风险。

Objective The aim of this study was to explore the satety and effectiveness of enhanced recovery after surgery （ERAS） in perioperative management of pancreaticoduodenectomy. Methods Among the patients undergoing pancreaticoduodenectomy from April 2016 to April 2018 in the Department of General Surgery of Peking Union Medical College Hospital, 63 patients who met the inclusion and exclusion criteria were enrolled in ERAS group and the other 60 patients in the control group. The perioperative parameters, postoperative complications, and clinical outcomes were compared between the two groups. Results There was no difference between the ERAS group and the control group in baseline data. The operative approach of the ERAS group was mainly laparoscopic surgery and that of the control group was mainly open surgery （P〈0.01）. The operation time in ERAS group was longer than that in control group （P〈0.01） while the intraoperative blood loss was significantly reduced （P〈 0.01 ）. Compared with the control group, the ERAS group had the shorter time of gastric tube removal, earlier postoperative fluid intake, shorter postoperative hospital stay, and significantly less hospitalization expenses （all P〈0.05）. The incidence of delayed gastric emptying of the ERAS group was significantly lower than that of the control group （3.2% vs. 13. 3%, P〈0. 05）. There was no significant ditterence in the incidence of total complications, pancreatic fistula, biliary fistula, postoperative hemorrhage, secondary hospital admission, secondary surgery, and death between the two groups. In the ERAS group, the intraoperative blood loss （P〈0. 01）, postoperative hospital stays （P〈 0. 05）, and the hospitalization expenses （P〈0. 05） of the laparoscopic subgroup were significantly lower than those of the open subgroup. Conclusion ERAS is sate and effective tor the perioperative management d pancreaticoduodenectomy, which can significantly accelerate the recovery of patients without increasing the risk of complications.