快速康复外科在肝癌伴门静脉高压症患者开腹射频消融联合切脾断流术中的应用

Application of enhanced recovery after surgery in open radiofrequency ablation combined with splenectomy and devascularization for liver cancer patients with portal hypertension

目的 探讨快速康复外科(ERAS)在肝癌伴门静脉高压症患者行开腹射频消融联合切脾断流术治疗中的应用效果。方法 将我院103例肝癌伴门静脉高压症行开腹射频消融联合切脾断流术的患者随机分为观察组(n=51)和对照组(n=52)。对照组患者予以常规干预,观察组患者予以ERAS管理。比较2组患者术后住院时间、首次排气时间、首次下床时间、生活质量、术后并发症发生率、术后总生存率及术后1年上消化道出血复发率。结果 观察组术后住院时间、生活质量、首次排气时间、首次下床时间、术后并发症发生率及术后1年上消化道出血复发率均明显优于对照组(P <0.05),而2组患者术后总生存率比较,差异无统计学意义(P> 0.05),但是观察组患者中位生存时间明显长于对照组(P <0.05)。结论 ERAS能提高肝癌伴门静脉高压症患者行开腹射频消融联合切脾断流术后的临床疗效,缩短住院时间,改善生活质量,降低术后并发症发生率及术后上消化道出血复发率。

Objective To investigate the effect of enhanced recovery after surgery in the treatment of liver cancer patients with portal hypertension undergoing open radiofrequency ablation combined with splenectomy and devascularization. Methods A total of 103 liver cancer patients with portal hypertension who underwent open radiofrequency ablation combined with splenectomy and devascularization in our hospital were randomly divided into the observation group (n=51) and the control group (n=52).The patients in the control group were given routine intervention,and the patients in the observation group were given ERAS management.The postoperative hospital stay,first exhaust time,first time out of bed,quality of life,incidence of postoperative complications,postoperative overall survival rate and recurrence rate of upper gastrointestinal bleeding 1 year after operation of the two groups were compared.Results The postoperative hospital stay,quality of life,first exhaust time,first time out of bed,incidence of postoperative complications and recurrence rate of upper gastrointestinal bleeding1 year after operation in the observation group were significantly better than those in the control group (P<0.05).While there was no statistically significant difference in the postoperative overall survival rate between the two groups (P>0.05).However,the median survival time of patients in the observation group was significantly longer than that in the control group (P<0.05).Conclusion ERAS can improve the clinical efficacy of open radiofrequency ablation combined with splenectomy and devascularization for liver cancer patients with portal hypertension,shorten the hospital stay,improve the quality of life,reduce the incidence of postoperative complications and the postoperative recurrence rate of upper gastrointestinal bleeding.