加速康复外科在肝癌肝切除术围手术期的应用与效果评价

Application of enhanced recovery after surgery in perioperative period of hepatectomy for liver cancer and effect evaluation

目的探讨加速康复外科(ERAS)在原发性肝癌(肝癌)肝切除术围手术期应用的安全性及效果。方法回顾性分析2017年10月至2018年12月在中山大学附属第三医院行肝切除术的201例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据是否采用ERAS措施将患者分为ERAS组和对照组。其中ERAS组104例,男75例,女29例;平均年龄(53±13)岁;实施ERAS措施。对照组97例,男72例,女25例;年龄(55±11)岁;采用传统围手术期措施。两组术后肛门排气时间、术后首次下床活动时间等比较采用t检验,率的比较采用χ^2检验。结果ERAS组患者术后肛门排气时间、术后首次下床活动时间、术后留置尿管时间、术后住院时间分别为(38±13)h、(44±13)h、(44±13)h、(10±6)d,明显短于对照组的(43±16)h、(60±23)h、(60±23)h、(14±4)d(t=-2.439,-6.123,-6.123,-5.808;P<0.05)。ERAS组术后中重度疼痛患者18例,对照组29例,差异有统计学意义(χ^2=4.440,P<0.05)。ERAS组术后发生并发症1例,对照组4例,差异无统计学意义(χ^2=2.690,P>0.05)。结论ERAS应用于肝癌肝切除术患者围手术期可促进胃肠功能恢复、缩短术后住院时间,能安全、有效地加速患者术后康复。

Objective To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS)in the perioperative period of hepatectomy for primary liver cancer(PLC).Methods Clinical data of 201 patients with PLC who underwent hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from October 2017 to December 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the ERAS group(n=104)and control group(n=79)according to whether ERAS was adopted or not.In the ERAS group,75 cases were male and 29 female,aged(53±13)years on average,where ERAS measures were delivered.In the control group,72 cases were male and 25 female,aged(55±11)years on average,where traditional perioperative treatments were performed.The anal exhaust time,the first ambulation time after operation between two groups were compared by t test.The rate comparison was performed by Chi-square test.Results In the ERAS group,the postoperative anal exhaust time,first ambulation time,postoperative urinary catheter indwelling time and postoperative length of hospital stay were(38±13)h,(44±13)h,(44±13)h and(10±6)d,respectively,significantly shorter than(43±16)h,(60±23)h,(60±23)h and(14±4)d in the control group(t=-2.439,-6.123,-6.123,-5.808;P<0.05).18 cases in the ERAS group suffered from moderate or severe pain after surgery and 29 in the control group with significant difference was observed between two groups(χ^2=4.440,P<0.05).Postoperative complication was observed in 1 case in the ERAS group,and 4 cases in the control group without significant difference was observed(χ^2=2.690,P>0.05).Conclusions ERAS can be used in the perioperative period of hepatectomy to promote the recovery of gastrointestinal function,shorten the postoperative length of hospital stay and accelerate the postoperative recovery for PLC patients.