加速康复外科理念联合精准肝切除治疗肝细胞癌的有效性及安全性分析

Efficacy and safety of enhanced recovery after surgery concept combined with precise hepatectomy for the treatment of hepatocellular carcinoma

目的探讨加速康复外科理念联合精准肝切除治疗肝细胞癌的有效性及安全性。方法回顾性分析393例肝细胞癌行手术治疗患者的临床资料。按其围手术期处理方法不同分为加速康复外科联合精准肝切除组（EP组，n=73）、精准肝切除联合传统围手术期处理组（P组，n=55）、传统肝切除联合加速康复外科组（ERAS组，n=118）和传统肝切除联合传统围手术期处理组（C组，n=147）。比较4组患者的术后住院时间（1engthofstay，LOS）、住院费用、并发症发生率、术后24、48h疼痛数字等级评定量表（numericalratingscale，NRS）评分、术后下床活动时间和肠道通气时间。结果与P组相比，EP组患者术后LOS更少（F=5．573，P〈0．05），住院费用更低（F=3．090，P〈0．05）。EP组术后24、48hNRS评分低于P组（F=5．235．7．456，P〈0．05），下床活动时间早于P组（x2=41．387，P〈0．05），肠道通气时间早于P组（F=0．387，P〈0．05）。与ERAS组相比，EP组患者术后一般并发症发生率低（X2=2，967，P〈0．05）。结论加速康复外科理念与精准肝切除联合使用可优化肝细胞癌患者外科治疗全过程。

Objective To investigate the safety and efficiency of enhanced recovery after surgery （ERAS） concept combined with precise hepateetomy （EP） in the treatment of hepatocellular carcinoma （HCC）. Methods 393 HCC patients admitted to the Affiliated Provincia Hospital of Anhui Medical University were divided into group EP （ n = 73 ）, precise hepatectomy group P （ n = 55 ）, group ERAS （ n = 118） and conventional hepatectomy group C （n = 147 ）. Outcome measures were postoperative length of stay （ LOS）, hospital charges, postoperative complication, numerical rating scale （NRS） on postoperative 24 h, 48 h, time to ambulation and first passage of flatus, readmission rate, mortality. Results Compared to group P, patients in group EP had significantly shorter postoperative LOS （ F = 4. 573, P 〈 0. 05 ）, less hospital charges（ F = 3. 090, P 〈 0. 05）, lower NRS on postoperative 24 h, 48 h （ F = 5. 235,7. 456, P 〈 0. 05）, shorter time to ambulation （X2 = 41. 387, P 〈 0. 05 ） and first passage of flatus （ F = 0. 387, P 〈 0.05 ）. Compared with the group ERAS, the group EP had significantly lower general postoperative complications （X2 =2. 967, P 〈 0. 05 ）. Conclusion ERAS concept combined with precise hepatectomy could optimize surgical treatment of patients with hepatocellular carcinoma.