加速康复外科在门静脉高压症治疗中的效果评价

Evaluation of the Effect of Enhanced Recovery after Surgery in the Treatment of Portal Hypertension

目的:探讨加速康复外科(ERAS)在腹腔镜脾切除联合选择性贲门周围血管离断术(LSPD)治疗门静脉高压症(PHT)的效果。方法:回顾性分析96例成功实施LSPD手术患者的临床资料,根据围手术期处理方法不同将患者分为ERAS组(43例,围手术期采用ERAS策略)和传统组(53例,围手术期采用传统策略),比较2组患者术中与术后相关指标并对患者进行短期随访。结果:与传统组比较,ERAS组术后下床活动时间[(1.96±0.85) d vs (3.31±1.73) d]、排气时间[(2.25±0.97) d vs (2.81±1.44) d]、首次排便时间[(3.47±1.78) d vs (4.75±2.16) d]、拔管时间[(3.92±1.27) d vs (5.23±1.44) d]、术后补液时间[(5.44±1.87) d vs (7.25±2.81) d]和住院时间[(6.31±2.38) d vs (7.53±3.26) d]明显缩短(P<0.05),2组手术时间、术中出血量、住院费用及术后并发症发生率差异无统计学意义(P>0.05)。结论:ERAS策略应用于LSPD手术安全可行,明显缩短患者住院时间,不增加术后并发症发生率,可促进患者术后快速康复,短期随访疗效满意。

Objective:To investigate the clinical value of combining enhanced recovery after surgery (ERAS) protocols with laparoscopic splenectomy combined with selective pericardial devascularization(LSPD) to treat Portal hypertension. Methods: The clinical data of 96 patients, who underwent LSPD in our hospital, were analyzed retrospectively. The patients were divided into ERAS (43 cases were treated with ERAS protocols) and conventional groups (53 cases were treated with conventional programs) according to different treatments. The intraoperative and postoperative data were compared and the short follow-up was observed. Results: Compared with conventional group, the days of postoperative activity time [(1.96±0.85) d vs (3.31±1.73) d], exhausting time [(2.25±0.97) d vs (2.81±1.44) d], first defecation time [(3.47±1.78) d vs (4.75±2.16) d], extubation time [(3.92±1.27) d vs (5.23±1.44) d], the days of postoperative fluid transfusion [(5.44±1.87) d vs (7.25±2.81) d] and the length of hospital stay [(6.31±2.38) d vs (7.53±3.26) d] of ERAS groups were shorter (P<0.05). There was no significant difference in operation time, operative blood loss, hospitalization expenses and the rates of overall complication between the two groups (P>0.05). Conclusion: The ERAS pathway is feasible and safe for LSPD. It not only can obviously shorten hospitalization time, promote the patients' recovery, but also not increase the rate of postoperative complications with a satisfactory short-term outcome.