加速康复外科对老年胆总管结石LCTD手术患者预后的影响

Effect of enhanced recovery after surgery on prognosis of elderly patients with choledocholithiasis undergoing LCTD surgery

目的研究加速康复外科(ERAS)对老年胆总管结石LCTD手术患者预后的影响。方法选择2018年1月—2019年12月在本院经腹腔镜手术取石后均行LCTD术治疗的老年胆总管结石(CBDS)患者96例作为研究对象,根据康复方法不同分为观察组(50例,ERAS处理)和对照组(46例,传统康复处理)两组。收集两组患者基础资料,对其术后恢复情况、并发症、肝功能、免疫蛋白及炎症因子水平进行比较。结果观察组CBDS患者术后首次下床活动、进食时间、肛门排气时间、输液时长及拔引流管时间均较对照组患者提前,体重减轻较少、住院所需的时间和费用均较对照组少(P<0.05),且观察组具有更少的并发症(P<0.05)。肝功能情况:术后第1天和第4天相比,除对照组TBIL无显著差异(P>0.05)外,两组患者术后第4天ALT、TBIL及DBIL水平均显著高于术后第1天(P<0.05);两组患者相比,术后第1天观察组AST显著低于对照组(P<0.05),ALT、TBIL及DBIL均无显著差异(P>0.05),术后第4天,除DBIL外,观察组其他参数均较对照组低(P<0.05)。免疫功能情况:术后第1天,两组患者的IgA、IgG及IgM水平显著低于术前(P<0.05),术后第4天基本恢复到术前水平,差异较小(P>0.05);与对照组相比,术后第1天观察组的IgA、IgG及IgM水平明显更高(P<0.05),术后第4天,两组患者免疫蛋白水平差异均未达到统计标准(P>0.05)。炎症因子水平比较:术后第1天和第4天,两组患者的IL-1、IL-6及CRP水平均显著低于术前,且术后第4天降低更加显著(P<0.05);术后第1天,两组患者的IL-1、IL-6及CRP水平未出现明显差异(P>0.05),但观察组于术后第4天,表现出明显更低的炎症因子水平(P<0.05)。结论老年胆总管结石LCTD手术患者应用ERAS改善预后安全有效,值得临床推广应用。

Objective To study the effect of enhanced recovery after surgery(ERAS)on the prognosis of elderly patients with choledocholithiasis undergoing LCTD surgery.Methods From January 2018 to December 2019,a total of 96 cases of elderly patients with common bile duct stones(CBDS)those underwent LCTD surgery after laparoscopic lithotomy were enrolled in the study.According to the rehabilitation approach they were divided into observation group(n=50,ERAS treatment)and control group(n=46,traditional rehabilitation treatment).The basic data of the two groups were collected,and the postoperative recovery,complications,liver function,immune protein and inflammatory factors were compared.Results The first ambulation time,eating time,anal exhaust time,infusion time and drainage tube pulling time of the observation group were earlier than those of the control group,the weight loss was less,the hospitalization time and cost were less than those in the control group(P<0.05),and the observation group had fewer complications,and the incidence of complications in the control group was significantly higher than that in the observation group(P<0.05).Liver function: the levels of ALT,TBIL and DBIL on the 4 th day after operation in both groups were significantly higher than those on the 1 st day after operation(P<0.05).On the first day after operation,concentration of AST in observation group was significantly lower than the control group,and there were no significant differences in ALT,TBIL and DBIL between the two groups(P<0.05).On the fourth day after the operation,except for the DBIL,the other indicators of the observation group were significantly lower than the control group(P<0.05).Immune function: the levels of IgA,IgG and IgM in the two groups were significantly decreased on the first day after operation(P<0.05),and basically recovered to the preoperative level on the fourth day after operation(P>0.05).Compared with the control group,the levels of IgA,IgG and IgM in the observation group on the first day after operation were significantly higher(P<0.05),and the differences of immune protein levels between the two groups were not statistically significant on the fourth day after operation(P>0.05).Comparison of inflammatory factor levels: the levels of IL-1,IL-6 and CRP in the two groups were significantly decreased on the first and fourth day after operation,and the decrease was more significant on the fourth day after operation(P<0.05).On the first day after operation,the levels of IL-1,IL-6 and CRP in the two groups were not significantly different(P>0.05),but the observation group showed significantly lower levels of inflammatory factors on the 4 th day after operation(P<0.05).Conclusions ERAS is safe and effective in improving the prognosis of elderly patients with choledocholithiasis undergoing LCTD surgery,which is worthy of clinical application.