加速康复外科在腹腔镜胰十二指肠切除术中的应用

Application of enhanced recovery after surgery program in perioperative management of laparoscopic pancreaticoduodenectomy

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在腹腔镜胰十二指肠切除术(laparoscopic pancreaticoduodenectomy,LPD)围手术期中的临床价值及方法。方法回顾性分析2017年1月至2021年6月期间,河北医科大学第二医院肝胆外科收治的行LPD患者的临床资料,其中常规理念组(对照组)255例、以ERAS理念为指导的试验组(ERAS组)276例。观察比较两组的术后恢复情况。结果ERAS组与对照组一般资料比较,差异无统计学意义(P>0.05),具有可比性。全部病例均顺利完成手术,手术时间[(354.89±93.02)min比(362.90±95.62)min]及术中出血量[300 ml(100,500)ml比300 ml(200,500)ml]比较,差异无统计学意义(P>0.05)。相较于对照组,ERAS组术后首次肛门排气时间[(2.61±0.62)d比(2.76±0.72)d,P<0.05]、胃管拔除时间[(3.07±0.82)d比(3.52±0.66)d,P<0.001]、腹腔引流管拔除时间[(2.77±1.08)d比(5.58±2.14)d,P<0.001]更早;术后疼痛视觉模拟评分[(3.31±1.07)分比(4.90±2.00)分,P<0.001]更低;胃排空障碍[4.3%(12/276)比8.6%(22/255),P<0.05]、术后腹腔感染[1.4%(4/276)比4.3%(11/255),P<0.05]、术后肺部感染[0.7%(2/276)比3.9%(10/255),P<0.05]发生率更低;术后住院时间[(15.36±3.26)d比(17.90±5.66)d,P<0.001]更短;住院费用[124153.00元(112437.75,136604.50)元比133604.00元(115086.00,150758.00)元,P<0.05]更少。两组其他观察指标比较,差异无统计学意义(P>0.05)。结论在熟练掌握LPD的基础上,围手术期实施ERAS安全、有效,能够有效促进LPD患者术后康复,缩短住院时间,减少住院费用。

Objective To explore the clinical value of the enhanced recovery after surgery(ERAS)in laparoscopic pancreaticoduodenectomy(LPD)perioperation.Methods The clinical data of patients undergoing LPD in the Department of Hepatobiliary and Pancreatic Surgery,the Second Hospital of Hebei Medical University from Jan.2017 to Jun.2021 were retrospectively analyzed.The patients were divided into two groups,with 255 patients in the control group according to the type of perioperative concept guidance and 276 patients in the enhanced recovery after surgery(ERAS)group,and the postoperative recovery between the two groups was compared.Results There was no significant difference between the control group and ERAS group(P>0.05).All cases completed the operation successfully.There was no significant difference between the two groups in operation time[(354.89±93.02)min vs(362.90±95.62)min]and intraoperative bleeding[300(100,500)ml vs 300(200,500)ml](P>0.05).Compared with the control group,in ERAS group,time of first anal exhaust[(2.61±0.62)d vs(2.76±0.72)d,P<0.05]and the removal time of gastric tube[(3.07±0.82)d vs(3.52±0.66)d,P<0.001]and removal of drainage tube after operation time[(2.77±1.08)d vs(5.58±2.14)d,P<0.001]is earlier,the postoperative pain score of the ERAS group was lower[(3.31±1.07)vs(4.90±2.00),P<0.001],the incidence of gastric emptying disorder[4.3%(12/276)vs 8.6%(22/255),P<0.05]and the incidence of abdominal infection[1.4%(4/276)vs 4.3%(11/255),P<0.05]and the incidence of pulmonary infection[0.7%(2/276)vs 3.9%(10/255),P<0.05]is lower,shorter hospital stay[(15.36±3.26)d vs(17.90±5.66)d,P<0.001],lower hospitalization cost[124153.00 CNY(112437.75,136604.50)CNY vs 133604.00 CNY(115086.00,150758.00)CNY,P<0.05].There was no significant difference in other observed indicator between the two groups(P>0.05).Conclusions On the basis of skillfully mastering LPD,perioperative implementation of ERAS is safe and effective,which can effectively promote postoperative recovery of LPD patients,shorten hospitalization time and reduce hospitalization costs.