快速康复外科理念在机器人辅助肝切除中的应用

The application of enhanced recovery after surgery (ERAS) in robotic-assisted liver resection

目的探究快速康复外科(ERAS)在机器人辅助肝切除手术中的实施效果和安全性。方法根据纳入排除标准,选取2019年4月~2020年7月在南京鼓楼医院肝胆中心行机器人辅助肝切除治疗的患者共165例,随机分为实验组(81例)和对照组(84例),比较两组患者在机器人辅助手术术后恢复情况(肝功能恢复情况、排气排便情况)、术后并发症的情况。结果实施快速康复方案后,患者术后一般情况恢复更快。两组患者在术前术中的差异无统计学意义(P值均>0.05)。对比对照组,实验组术后肝功能AST、AST恢复水平的差异无统计学意义(P值均>0.05),两组患者术后并发症的发生率和严重程度的差异无统计学意义(P值均>0.05)。但实验组在疼痛、活动评分方面均好于对照组,差异有统计学意义(P值均<0.05),且排气排便的时间和术后平均住院时间均短于对照组,差异有统计学意义(P值均<0.05)。结论ERAS在机器人辅助肝切除围手术期应用可减轻手术应激,促进患者术后迅速康复。

Objective To investigate the application of enhanced recovery after surgery(ERAS)in robotic-assisted liver resection.Methods A total of 165 patients who underwent robot-assisted hepatectomy in Department of Hepatobiliary Surgery,Affiliated Drum Tower Hospital of Nanjing University Medical School,from April 2019 to July 2020 were enrolled and randomly divided into ERAS group with 81 patients and control group with 84 patients(conventional perioperative treatment).The two groups were compared in terms of recovery of liver function after surgery,incidence of postoperative complications,postoperative recovery,postoperative physical recovery score,and quality of life.Results The speed of postoperative recovery was accelerated after the implementation of enhanced recovery after surgery.There were no significant differences in related indices before and during surgery between the two groups(all P>0.05).Compared with the control group.There were no significant differences in the overall incidence of complications,incidence rates of surgical site complications,and the Clavien-Dindo classification of complications between the two groups(all P>0.05).As for postoperative recovery scores,the ERAS group had significantly better comprehensive score,pain score,and activity score than the control group(all P<0.05).Compared with the control group,the ERAS group had significantly shorter time to first flatus,time to first defecation,and length of postoperative hospital stay(all P<0.05).Conclusion Enhanced recovery after surgery can promote rapid recovery of robotic-assisted hepatectomy patients without increasing postoperative complications.