加速康复外科理念在腹腔镜胰体尾切除术围手术期的应用体会

The perioperative application of enhanced recovery after surgery in laparoscopic distal pancreatectomy

目的:评估腹腔镜胰体尾切除术中实施加速康复外科(ERAS)相关管理措施的可行性与安全性。方法:收集2018年5月至2018年10月行腹腔镜胰体尾切除术61例患者的临床资料,根据是否实施ERAS相关管理措施分为ERAS组(n=31)与对照组(n=30)。对照组接受常规围手术期治疗与护理方案,ERAS组施行ERAS相关管理措施,包括多模式镇痛,术后早期下床活动,早期拔除胃管、尿管及腹腔引流管,早期进食等。对比分析两组术后临床数据、并发症发生率等情况。结果:ERAS组术后首次饮水时间、首次排气时间、首次下床活动时间、术后疼痛评分、胃肠道功能恢复时间、术后首次进食时间、胃管拔除时间、尿管拔除时间、腹腔引流管拔除时间、术后住院时间等均优于对照组(P<0.05)。结论:在腹腔镜胰体尾切除术中实施ERAS相关管理措施安全、有效,可加速患者术后胃肠道功能的恢复,早日下床活动,缩短住院时间,值得临床推广。

Objective:To evaluate the feasibility and safety of enhanced recovery after surgery(ERAS)in laparoscopic distal pancreatectomy(LDP).Methods:The clinical data of 61 patients who underwent LDP at Fudan University Shanghai Cancer Center(FUSCC)from May 2018 to Oct.2018 were reviewed.31 patients who received ERAS management were allocated into the ERAS group and 30 patients who received traditional perioperative management were allocated into the control group.ERAS group received a series of enhanced recovery procedure,including multi-model analgesia,early ambulation,early removal of gastric tube,urinary catheter and abdominal drainage tube,early oral food/water-taking,etc.The postoperative clinical data and postoperative complications were compared.Results:Time for initial water intake,initial exhaust and initial ambulation,postoperative pain score,time of gastrointestinal function recovery,time of first oral feeding,time of gastric tube removal,urinary catheter removal and abdominal drainage tube removal,hospital stay in the ERAS group were all significantly reduced when compared to the control group(P<0.05).Conclusions:The perioperative ERAS program in the LDP is safe and effective.It can accelerate the recovery of gastrointestinal functions and achieve the early ambulation,so as to shrink the hospital stay.It should be popularized in the clinical application.