加速康复外科在3D腹腔镜辅助下治疗儿童胆总管囊肿的临床应用

Application of enhanced recovery after surgery for three-dimensional laparoscopic excision for choledochal cyst in children

目的探讨加速康复外科(ERAS)措施在治疗儿童胆总管囊肿中的应用价值。方法回顾性分析在广州妇女儿童医疗中心诊断为胆总管囊肿并行3D腹腔镜胆总管囊肿切除+肝总管空肠Roux-en-Y吻合术治疗的33例患儿临床资料。将2017年4~10月围手术期采用传统治疗方案的18例患儿设为对照组。将2017年11月至2018年5月围手术期采用ERAS方案的15例患儿设为ERAS组。手术均由同一手术团队完成,比较这两组患儿在术中出血量、手术时间、中转开腹率、术后首次饮水时间、达全量肠内营养时间、术后住院时间、住院费用、术后并发症、30 d内再入院率等指标上的差异。结果ERAS组与对照组在术中出血量(6.80±6.45) ml比(8.50±10.76) ml、手术时间(3.56±0.88) h比(3.82±1.24) h、术中中转开腹率(0比0)等指标上差异无统计学意义(P>0.05),ERAS组在术后首次饮水时间、达全量肠内营养时间、术后住院时间、住院费用等方面分别为(21.5±2.1)h、(4.3±0.5)d、(5.3±0.6)d、(35945.49±6071.46)元。对照组上述指标分别为(44.1±3.5)h、(7.7±2)d、(9.1±2.5)d、(45609.08±11439.80)元。两组比较差异有统计学意义(P<0.05),ERAS组显著较对照组少。两组术后并发症相比差异无统计学意义,两组30d内再入院率均为0。结论采用加速康复外科措施可以加快患儿术后康复时间,减少患儿围手术期的不适感,减少住院费用,在儿童胆总管囊肿的治疗上有重要意义。

Objective To explore the clinical value of enhanced recovery after surgery (ERAS) for resecting laparoscopic choledochal cyst (CDC) in children.Methods Retrospective review was performed for the clinical data of 33 hospitalized children with a definite diagnosis of CDC.From April 2017 to October 2018,control group (n=18) received traditional treatment for CDC.From November 2017 to May 2018,another 15 patients were enrolled in ERAS group.All patients underwent three-dimensional laparoscopic choledochal cyst excision and Roux-en-Y hepatojejunostomy by the same pediatric surgeon group.Intraoperative blood loss,operative duration,rate of conversion into laparotomy,time for initial water intake,postoperative time to total enteral nutrition,postoperative hospital stay,total hospital expense,postoperative complications and readmission rate within 30 days were reviewed.Results Intraoperative blood loss,operative duration and rate of conversion into laparotomy showed no significant inter-group differences (P>0.05).Time to postoperative initial water intake,postoperative time to total enteral nutrition,postoperative hospital stay and total expense were (21.5±2.1) hours,(4.3±0.5) days,(5.3±0.6) days,(35945.49±6071.46) yuan in ERAS group versus (44.1±3.5) hours,(7.7±2) days,(9.1±2.5) days,(45609.08±11439.80) yuan in control group respectively.ERAS group was significantly less than control group (P<0.05).No significant inter-group differences existed in postoperative complications.Readmission within 30 days occurred in neither groups.Conclusions Perioperative ERAS scheme is effective for treating CDC.It can shorten postoperative hospital stay,relieve perioperative discomforts and relieve financial burden.