FTS在腹腔镜胆总管探查一期缝合围术期应用的效果评价

Application effect evaluation of fast track surgery in perioperative period of laparoscopic common bile duct exploration primary suture

目的探讨快速康复外科(FTS)应用于腹腔镜胆总管探查一期缝合术(LBEPS)围术期的安全性及效果。方法选择2017年11月至2019年8月该院肝胆外科行LBEPS的患者80例,根据不同治疗方案将其分为两组,其中围术期予以FTS治疗方案的患者40例为FTS组,予以常规方案治疗的患者40例为对照组。分析比较两组间患者围术期并发症发生及术后下床时间、肛门排气时间、排便时间、进食时间、住院时间、住院费用、镇痛效果,以及血清前清蛋白、术后5 d体重下降情况等营养指标,以评估FTS在行LBEPS患者的疗效及安全性。结果两组患者术后均康复出院。与对照组比较,FTS组患者术后下床时间、肛门排气时间、排便时间、进食时间提前,住院时间缩短,住院费用降低,营养状况良好,镇痛效果好,上述指标明显优于对照组(P<0.05);FTS组术后并发症总发生率明显低于对照组(20.00%vs.52.50%,P<0.05),其中肺部感染、尿路感染的发生率明显低于对照组(5.00%vs.20.00%、2.50 vs.15.00%,P<0.05),但两组患者胆漏、切口感染、腹腔感染、心脑血管并发症发生率比较差异无统计学意义(P>0.05)。结论FTS在LBEPS围术期应用安全、有效,可进一步加速患者的康复。

Objective To investigate the safety and efficacy of fast track surgery(FTS)in the perioperative period of laparoscopic common bile duct exploration primary suture(LBEPS).Methods Eighty patients with LBEPS in this hospital from November 2017 to August 2019 were selected and divided into the two groups according to different treatment methods.Among them,40 cases of FTS during the perioperative period served as the FTS group,and other 40 cases were given the routine treatment scheme as the control group.The complications occurrence,time of getting out of bed,anal exhaust time,defecation time,eating time,hospitalization duration,hospitalization costs,analgesic effect,nutritional indicators such as serum albumin and body weight decrease on postoperastive 5 d were analyzed and compared between the two groups for evaluating the efficacy and safety of FTS in the patients with LBEPS.Results The patients in the two groups got recovery and discharge from hospital.The time of getting out of bed,anal exhaust time,defecation time and eating time in the FTS group were in advance,the hospitalization duration was shortened,the hospitalization costs were decreased,the nutritional status was good,the analgesic effect was good,and the above indicators in the FTS group were significantly better than those in control group(P<0.05).The total occurrence rate of postoperative complications in the FTS group was significantly lower than that in the control group(20.00%vs.52.50%,P<0.05),in which,the occurrence rates of pulmonary infection and urinary tract infection were significantly lower than those in the control group(5.00%vs.20.00%,P<0.05).But there was no statistically significant difference in the occurrence rates of bile leakage,incision infection,abdominal infection and cardiocerebrovascular complications between the two groups(P>0.05).Conclusion The FTS application in LBEPS is safe and effective,and can further accelerate the recovery of the patients.