加速康复外科理念在腹腔镜巨脾切除联合贲门周围血管离断术围手术期的应用

Application of enhanced recovery after surgery in laparoscopic huge splenectomy combined with pericardial devascularization

目的探讨加速康复外科理念(enhanced recovery after surgery,ERAS)在肝硬化门静脉高压症患者行腹腔镜巨脾切除联合贲门周围血管离断术围手术期应用的效果和意义。方法回顾性分析2016年1月至2019年1月南京医科大学附属淮安第一医院收治的肝硬化门静脉高压症行腹腔镜巨脾切除联合贲门周围血管离断术患者共60例的临床资料。病例分为两组:ERAS组(n=32),采用加速康复外科理念进行围手术期相关处理;对照组(n=28),采用传统围手术期处理办法。比较两组患者术中情况、术后并发症发生率及住院时间、住院费用等指标。结果与对照组相比,ERAS组在术中出血、手术时间、中转开腹比例、住院费用以及术后并发症发生率上差异无统计学意义(P>0.05),但是ERAS组患者术后疼痛评分更低、术后住院时间更短(P<0.001)。结论腹腔镜巨脾切除联合贲门周围血管离断术的围手术期采用加速康复理念安全有效,能够提高患者舒适性,缩短住院时间,降低住院费用,值得应用推广。

Objective To investigate the effect and significance of perioperative enhanced recovery after surgery(ERAS) in patients with liver cirrhosis and portal hypertension undergoing laparoscopic huge splenectomy combined with pericardial devascularization. Methods Clinical data of 60 patients with liver cirrhosis and portal hypertension who underwent laparoscopic huge splenectomy combined with pericardial devascularization from Jan. 2016 to Jan. 2019 were retrospectively analyzed. Patients were divided into two groups: ERAS group(n=32), patients recieved perioperative ERAS, control group(n=28), patients received traditional periopereative treatment. The intraoperative condition, complication incidence rate after surgery, hospitalization time and cost between the two groups were compared. Results Compared with the control group, ERAS group had no statistically significant difference in blood loss, operative time, proportion of conversion to laparotomy, hospienlization cost and incidence of postoperative complications(P>0.05). But the ERAS group had a lower pain score, and shorter hospitalization time than those in the control group(P<0.001). Conclusion ERAS is safe and effective for patients who receive laparoscopic huge splenectomy combined with pericardial devascularization, which can improve patients’ comfort, shorten hospitalization time and reduce the hospitalization cost.