加速康复外科理念在腹腔镜胆囊切除术中的运用及手术并发症影响因素探讨

Application of enhanced surgical recovery treatment in laparoscopic cholecystectomy and exploration of related influential factors of complications after surgery

目的探讨腹腔镜胆囊切除术加速康复外科理念运用及手术并发症机制。方法收集并分析2012年1月至2016年12月在东至县人民医院接受腹腔镜胆囊切除治疗的336例患者的临床资料。所有患者根据是否接受加速康复外科措施分为2组,A组接受加速康复外科措施168例,B组未接受加速康复外科措施168例。通过评估患者的手术相关指标如出血量、下床活动时间、肠道排气时间、术后住院时间等来分析康复的疗效,并同时分析胆管损伤、并发症发病率、死亡率和术中转开腹手术的患者数量来确定腹腔镜胆囊切除术的效果。结果所有患者中,并发症共有22例(6.5%),其中重度并发症有2例,轻度并发症20例。所有重度并发症均发生在20~30岁年龄组,轻度并发症主要发生在年龄>41岁的患者中,A组与B组患者的出血量等相关手术指标和住院花费等比较,差异具有统计学意义(P<0.05)。结论本研究分析了336例患者腹腔镜胆囊切除术后出现不同并发症的情况及原因,有助于帮助外科医生总结经验和预防不良结果的发生。通过引入加速康复外科的理念并实施,明显有助于患者快速恢复和提高患者生活质量。

Objective To investigate the application of enhanced surgical recovery treatment in laparoscopic cholecystectomy and possible mechanism of related influential factors of complications after surgery.Methods Medical files of 336 patients who underwent laparoscopic cholecystectomy from January,2012 to December,2016 in the Dongzhi County People′s Hospital were collected and analyzed.The patients were equally divided into group A and group B,by depending upon whether or not they received enhanced surgical recovery treatment.The patients of group A(n=168)received enhanced surgical recovery treatment,while the patients of group B(n=168)were without enhanced surgical recovery treatment.Such related indicators as blood loss,ambulation time,intestinal exhaust time,first anal exhaust,duration of stay in hospital after surgery were used to analyze treatment efficacy.At the same time,the effects of laparoscopic cholecystectomy were evaluated by analyzing bile duct injury,complication rate,mortality and numbers of patients who transferred to abdominal surgery.Results In all the patients,there were 22 patients(6.5%)who developed complications,of whom 2 had serious complications and 20 had minor complications.The patients who had serious complications were within the age range of 20 to 30 years,while those with minor complications were within the age range of over 41 years.There was statistical significance in such clinical data as blood loss and hospitalization cost,when comparisons were made between group A and group B(P<0.05).Conclusion The study helps surgeons to summarize experience and prevent occurrence of adverse reactions.In addition,the introduction and implementation of enhanced surgical recovery theory will enable patients to hasten recovery and improve their life quality.