加速康复外科对胰头癌行胰十二指肠切除术患者术后恢复及营养状况的影响

Effects of enhanced recovery after surgery on postoperative recovery and nutritional status in patients undergoing pancreatoduodenectomy for pancreatic head cancer

背景与目的:胰头癌是胰腺癌中最常见的一种类型,胰十二指肠切除术(PD)是治疗胰头癌的主要术式,但其并发症多、患者恢复情况较差仍是普通外科领域中的难题。加速康复外科(ERAS)是近年来发展起来的外科围手术期处理创新理念,可降低术后并发症,促进术后恢复,但ERAS在PD术中仍未广泛的应用,因此,本研究探讨ERAS理念的应用对胰头癌行PD术患者术后恢复及营养状况的影响,评价其应用价值。方法:选择2015年5月—2019年5月期间行PD术的胰头癌患者62例,采用随机数字表法随机分为ERAS组与对照组,每组31例。ERAS组患者围手术期采用ERAS指导的干预措施,对照组患者采用常规围手术期管理方案。比较两组患者术中指标、术后恢复指标、术后并发症发生率及营养状况指标变化。结果:两组患者术前一般资料及营养状况指标转铁蛋白(TRE)、前清蛋白(PAB)和白蛋白(ALB)等均无统计学差异(均P>0.05)。两组患者术中失血量、术中输液量和手术时间差异均无统计学意义(均P>0.05)。ERAS组首次肛门排气时间、首次肛门排便时间和下床活动时间均明显早于对照组(均P<0.05)。两组胰瘘、感染、吻合口瘘、胃排空延迟的发生率未见无统计学差异(均P>0.05),但ERAS组术后总并发症发生率明显低于对照组(6.45% vs.32.26%,P<0.05)。两组术后3 d血清TRE、PAB和ALB水平均较术前明显降低,ERAS组的降低程度明显小于对照组(均P<0.05)。结论:对胰头癌行PD术患者采用ERAS策略效果良好,可加快术后恢复,改善患者营养状况,减少术后并发症,推荐临床开展应用。

Background and Aims:Pancreatic head cancer is the most common type of pancreatic cancer,and pancreaticoduodenectomy (PD) is the main surgical procedure for the treatment of pancreatic head cancer.However,the high incidence of complications and poor postoperative recovery are still the difficult problems in the field of general surgery.Enhanced recovery after surgery (ERAS) is an innovative concept in perioperative management of surgery developed in recent years,it has been proven to reduce postoperative complications and speed up postoperative recovery.However,the ERAS concept has not been widely implemented in PD.Thus,this study was designated to investigate the effects of using ERAS protocol on postoperative recovery and nutritional status in patients undergoing PD for pancreatic head cancer,and evaluate its application value.Methods:A total of 62 patients with pancreatic head cancer scheduled to undergo PD from May 2015 to May 2019 were enrolled.Using a random number table,the patients were randomly divided into ERAS group and control group,with 31 cases in each group.Patients in ERAS group received intervention measures guided by ERAS concept during perioperative period,while those in control group were treated with conventional perioperative management.The intraoperative variables,postoperative recovery parameters,incidence rates of postoperative complications,and changes in nutritional status indexes were compared between the two groups of patients.Results:There were no significant differences in preoperative general data and nutritional status indexes that included transferrin (TRE),prealbumin (PAB) and albumin (ALB) between the two groups of patients (all P>0.05).There were no significant differences in intraoperative blood loss,amount of the intraoperative infusion and operative time between the two groups of patients (all P>0.05).The time to first postoperative passage of flatus,first defecation and time to ambulation in ERAS group were significantly earlier than those in control group (all P<0.05).No significant differences were noted in the incidence rates of pancreatic fistula,infection,anastomotic fistula and delayed gastric emptying (all P>0.05),but the overall incidence of postoperative complications in EARS group was significantly lower than that in control group (6.45% vs.32.26%,P<0.05).The serum levels of TRE,PAB and ALB were significantly decreased on the postoperative day 3 in both groups,but the decreasing amplitudes of them in ERAS group were significantly lower than those in control group (all P<0.05).Conclusion:ERAS strategy offers a good effect in patients with undergoing PD for pancreatic head cancer.It can accelerate postoperative recovery,improve the nutritional status of patients and reduce postoperative complications.So,it is recommended to be widely used in clinical practice.