快速康复外科理念联合术前3DVT对肝胆管结石病手术效果及康复进程的影响

Effect of the concept of enhanced recovery after surgery combined with preoperative 3DVT on the surgical outcome and rehabilitation process of hepatolithiasis

目的观察快速康复外科(ERAS)理念联合术前三维可视化技术(3DVT)对肝胆管结石病手术效果及康复进程的影响。方法选取2018年8月至2021年8月江苏省淮安市第二人民医院收治的160例肝胆管结石病患者,根据随机数字表法将其分为对照组(80例)和观察组(80例)。对照组给予3DVT术前评估联合传统围手术期处理,观察组给予3DVT术前评估联合ERAS理念围手术期处理。记录两组术前CT检查、3DVT评估情况和手术方案、围手术期情况。比较两组术前及术后7 d血生化指标白蛋白(ALB)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血红蛋白(Hb)和术后并发症总发生率。结果两组术前CT检查与术中所见一致率、3DVT术前评估与术中所见一致率、手术类型比较,差异无统计学意义(P>0.05)。观察组术中出血量低于对照组,术后住院时间短于对照组(P<0.05)。术后7 d,两组ALB、Hb低于术前,且观察组高于对照组;ALT、AST高于术前,且观察组低于对照组(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。结论3DVT术前评估联合ERAS理念围手术期处理能有效减少肝胆管结石病患者术中出血量,缩短住院时间,促进肝功能恢复。

Objective To observe the effect of the concept of enhanced recovery after surgery(ERAS)combined with preoperative three-dimensional visualization technology(3DVT)on the surgical outcome and rehabilitation process of hepatolithiasis.Methods A total of 160 patients with hepatolithiasis admitted to Huaian Second People’s Hospital from August 2018 to August 2021 were selected as the subjects,and they were divided into control group(80 cases)and observation group(80 cases)by random number table method.The control group was given 3DVT preoperative evaluation combined with traditional perioperative treatment,and the observation group was given 3DVT preoperative evaluation combined with ERAS perioperative treatment.Preoperative CT examination,3DVT evaluation,operation plan and perioperative situation of the two groups were recorded.Serum biochemical indexes including albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),hemoglobin(Hb),and the total incidence of postoperative complications were compared between the two groups before and seven days after operation.Results Comparison of preoperative CT examination and intraoperative consistency rate,3DVT preoperative evaluation,and intraoperative consistency rate and operation type between the two groups(P>0.05).The amount of intraoperative blood loss in the observation group was lower than that in the control group,and the postoperative hospital stay was shorter than that in the control group(P<0.05).On seven days after operation,ALB and Hb in both groups were lower than those before operation and higher in observation group than those in control group,while ALT and AST were higher than those before operation and lower in observation group than in those control group(P<0.05).The total incidence of complications in observation group was lower than that in control group(P<0.05).Conclusion 3DVT preoperative evaluation combined with ERAS perioperative management can effectively reduce intraoperative blood loss in patients with hepatolithiasis,shorten hospital stay,and promote liver function recovery.