快速康复外科在腹腔镜下胰十二指肠切除术中的应用

Clinically applying the program of enhanced recovery after surgery to patients following laparoscopic pancreaticoduodenectomy

目的:探讨快速康复外科(ERAS)在腹腔镜胰十二指肠切除术(LPD)围术期管理中的应用价值。方法:回顾性分析2014年1月～2017年12月我院肝胆外科94例行腹腔镜下胰十二指肠切除患者的围术期临床资料,实施常规护理模式管理的51例患者作为对照组,按照ERAS理念管理的43例患者作为ERAS组,比较两组患者术后下床时间、肛门排气时间、进食时间,拔除胃管时间、导尿管拔除时间,腹腔引流管拔除时间、术后住院时间及胰瘘、出血、胆瘘、腹腔感染、术后死亡等并发症。结果:ERAS组患者术后下床时间、进食时间、拔除胃管时间、尿管拔除时间、腹腔引流管拔除时间及术后住院时间减少,两组间比较差异有统计学意义(P<0.05);②ERAS组术后并发症的发生率为32.6%,对照组为37.3%,差异无统计学意义(χ~2=0.226,P=0.635)。结论:ERAS理念能够有效促进腹腔镜下胰十二指肠切除患者术后恢复,缩短住院时间,提高患者生活质量和满意度,值得推广和应用。

Objective:To assess the clinical value of enhanced recovery after surgery(ERAS)in perioperative management of patients following laparoscopic pancreaticoduodenectomy.Methods:The clinical data were retrospectively analyzed in 94 cases undergone laparoscopic pancreaticoduodenectomy in our department between January 2014 and December 2017.All cases were divided into ERAS group(n=43)and control group(n=51)by perioperative management modality,and compared concerning the time of out-of-bed activity,the first anal exhaust time,the time of first food-intake,removal of gastric tube,urinary catheter and abdominal drainage-tube as well as length of hospital stay,complications including pancreatic fistula,bleeding,biliary fistula,intra-abdominal infection,mortality after surgery.Results:Patients in ERAS group had earlier out-of-bed activity,food intake,removal of gastric tube,urinary catheter and abdominal drainage-tube as well as shortened duration of hospital stay than those in the control group(P<0.05);Postoperative complications were not significant between ERAS group(32.6%,14/43)and control group(37.3%,19/51)(χ2=0.226,P=0.635).Conclusion:The ERAS program can significantly lead to early recovery and shortened postoperative hospital stay in patients following laparoscopic pancreaticoduodenectomy.This nursing program can also better improve the quality of life and satisfaction in such patients,and is therefore worthy of wider clinical recommendation.