加速康复外科模式在肝门部胆管癌围手术期中的应用

Application of enhanced recovery after surgery in perioperative period for patients with hilar cholangiocarcinoma

目的探讨加速康复外科(ERAS)模式在肝门部胆管癌根治术围手术期的临床应用价值。方法本前瞻性研究对象为2016年8月至2019年8月南京医科大学附属淮安第一医院行肝门部胆管癌切除术的35例患者。患者均签署知情同意书,符合医学伦理学规定。其中男22例,女13例;年龄49~74岁,中位年龄62岁。按围手术期的处理方法不同分为ERAS组和对照组。观察两组术后恢复情况及并发症。两组术后住院时间、术后恢复质量量表(QoR-15)评分等比较采用t检验,并发症比较采用Fisher确切概率法。结果ERAS组术后肛门恢复排气时间、术后住院时间、住院总费用分别为(32±9)h、(13.9±2.8)d、(5.7±0.6)万元,明显低于对照组的(43±14)h、(15.6±4.2)d、(6.7±0.7)万元(t=-2.762,-1.389,-3.157;P<0.05)。ERAS组术后3、5 d的QoR-15评分分别为(75±16)、(128±8)分,明显高于对照组的(63±11)、(112±16)分(t=2.772,3.912;P<0.05)。ERAS组术后发生胸腔积液及下肢深静脉血栓形成分别为3、0例,对照组相应为9、4例,差异有统计学差异(P=0.044,0.039)。结论肝门部胆管癌围手术期应用ERAS模式能有效缩短住院时间,降低住院费用及减少术后并发症,促进患者快速康复。

Objective To evaluate the clinical value of enhanced recovery after surgery(ERAS)in the perioperative period for patients undergoing radical resection of hilar cholangiocarcinoma.Methods In this prospective study,35 patients undergoing radical resection of hilar cholangiocarcinoma in the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from August 2016 to August 2019 were recruited.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,22 cases were male and 13 female,aged 49-74 years with a median age of 62 years.The patients were divided into the ERAS group and control group according to different interventions during perioperative period.Postoperative recovery and complications were observed between two groups.The length of hospital stay and the 15-item Quality of Recovery questionnaire(QoR-15)score were statistically compared between two groups by t test.The incidence of postoperative complications was analyzed by Fisher's exact probability test.Results In the ERAS group,postoperative anal exhaust time,the length of postoperative hospital stay and total hospitalization expense were(32±9)h,(13.9±2.8)d,(5.7±0.6)×10^4 yuan,significantly less than(43±14)h,(15.6±4.2)d and(6.7±0.7)×10^4 yuan in the control group(t=-2.762,-1.389,-3.157;P<0.05).In the ERAS group,the QoR-15 scores at postoperative 3 and 5 d were 75±16 and 128±8,significantly higher than 63±11 and 112±16 in the control group(t=2.772,3.912;P<0.05).3 cases of pleural effusion and 4 of lower limb deep vein thrombosis were observed in ERAS group,and accordingly 9,4 cases in control group(P=0.044,0.039).Conclusions ERAS measures in the perioperative period can effectively shorten the length of hospital stay,reduce hospitalization expense,lower the risk of postoperative complications and accelerate rapid recovery of patients with hilar cholangiocarcinoma.