加速康复外科在肝门部胆管癌围手术期中的疗效分析

Clinical observation of the application of enhanced recovery after surgery in treating hilarcholangiocarcinoma

目的探讨加速康复外科理念(ERAS)在肝门部胆管癌(HCCA)围手术期中的可行性与安全性。方法回顾性分析2015年1月至2018年1月48例HCCA患者,其中25例患者围手术期行加速康复外科处理(ERAS组),23例患者围手术期进行传统处理(传统组),采用SPSS 19.0软件进行统计分析。术中术后各项指标、术后疼痛评分、患者满意度采用(x±s)表示,独立t检验;术后并发症等使用χ2检验,P<0.05为差异有统计学意义。结果两组术前生化指标TBiL、ALT、AST、ALB无差异,术后第7天ERAS组TBiL、ALT、AST显著低于传统组,而ALB显著高于传统组(P<0.05);ERAS组术后首次排气时间、术后平均住院时间、医疗费用均显著减少(P<0.05)。ERAS组术后并发症2例(8%)低于传统组9例(39.1%),差异有统计学意义(P<0.05)。结论在HCCA围手术期中实施ERAS模式是可行的、安全有效的,有助于加快患者术后康复、有利于改善患者预后。

Objective To investigate the feasibility and safety of the application of Enhanced Recovery After Surgery(ERAS)in the perioperative treatment of hilar cholangiocarcinoma(HCCA).Methods A retrospective study was conducted in 48 patients with HCCA and underwent surgical treatment from January 2015 to January 2018.Among them,there were 25 cases underwent ERAS perioperative management(ERAS group),while 23 cases underwent traditionally perioperative management(traditional group).Statistical analysis were performed by using spss 19.0 software.Measurement data,such as intraoperative and postoperative indicators,postoperative pain scores and patient satisfaction were expressed as(x±s),and were examined by using independent t test.Count data such as complication rates were examined by chi square test.A P value<0.05 was considered as statistically significant difference.Results There was no significant difference in terms of TBIL,ALT,AST and ALB between two groups before operation.However on the 7th day after operation,the TBIL,ALT,AST were significantly lower and ALB was significantly higher in ERAS group than those in traditional group respectively(P<0.05).The first anal exsufflation time,postoperative hospital stay,and medical costs were significantly lower in ERAS group than those in traditional group respectively(P<0.05).There were 2 cases(8%)of postoperative complications occurred in ERAS group,which were significantly lower than 9 cases(39.1%)in traditional group.Conclusions It is feasible,safe and effective that perioperative ERAS management in treating HCCA,which is helpful to accelerate the postoperative recovery and could improve the prognosis of patients.