精准肝脏外科联合ERAS理念在复杂肝囊型包虫病手术中的应用

Application of precise liver surgery combined with ERAS concept in complex hepatic cystic echinococcosis

目的探讨精准肝脏外科联合加速康复外科(ERAS)理念在复杂肝囊型包虫病患者手术中的应用价值。方法回顾性分析2012年1月至2021年1月在新疆维吾尔自治区人民医院行手术治疗的42例复杂肝囊型包虫病患者临床资料。其中男23例,女19例;年龄23~61岁,中位年龄39岁。患者均签署知情同意书,符合医学伦理学规定。根据围手术期管理模式的不同将患者分为传统外科治疗组(传统组,23例)和精准外科联合ERAS组(联合组,19例)。比较两组患者围手术期情况、术后并发症发生情况及疗效。两组手术时间、术中出血量等数据比较采用t检验或秩和检验,并发症发生率比较采用χ2检验。结果患者均无围手术期死亡。联合组术前均采用三维重建精准评估,手术方式与评估相吻合。联合组术中出血量、术后肝功能恢复时间中位数分别为200(900)ml、3(4)d,明显少于传统组的400(850)ml、4(10)d(Z=-2.74,-2.25;P<0.05)。联合组平均手术时间、术后肛门排气时间、术后进食时间、腹腔引流管留置时间、术后住院时间分别为(182±25)min、(17.2±3.0)h、(18.6±3.8)h、(3.0±1.0)d、(6.0±2.0)d,亦明显少于传统组的(204±31)min、(20.4±2.4)h、(22.7±3.2)h、(5.0±1.0)d、(8.0±1.0)d(t=-2.51,-3.88,-3.78,-4.14,-2.55;P<0.05)。联合组术后并发症发生率为26%(5/19),明显低于传统组的57%(13/23)(χ2=3.88,P<0.05)。结论精准肝脏外科联合ERAS理念可减少术中出血,降低术后并发症发生率,并有助于患者术后恢复,能有效提高复杂肝囊型包虫病手术疗效。

Objective To evaluate the application value of precise liver surgery combined with enhanced recovery after surgery(ERAS)concept in surgical treatment of complex hepatic cystic echinococcosis.Methods Clinical data of 42 patients with complex hepatic cystic echinococcosis who underwent surgery in People's Hospital of Xinjiang Uygur Autonomous Region from January 2012 to January 2021 were retrospectively studied.Among them,23 patients were male and 19 female,aged from 23 to 61 years,witha median age of 39 years.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the traditional surgery group(traditional group,n=23)and precise surgery combined with ERAS group(combination group,n=19)according to different perioperative management patterns.Perioperative conditions,postoperative complications and clinical efficacy were compared between two groups.The operation time,intraoperative blood loss and other data were statistically compared with t test or rank-sum test.The incidence of postoperative complications was assessed by Chi-square test.Results No perioperative death occurred.All patients in the combination group were evaluated by 3D reconstruction before surgery.Surgical approach was consistent with the evaluation results.In the combination group,the median intraoperative blood loss and postoperative liver function recovery time were 200(900)ml and 3(4)d,significantly less than 400(850)ml and 4(10)d in the traditional group(Z=-2.74,-2.25;P<0.05).In the combination group,the average operation time,postoperative anal exhaust time,postoperative feeding time,abdominal drainage catheter indwelling time and length of postoperative hospital stay were(182±25)min,(17.2±3.0)h,(18.6±3.8)h,(3.0±1.0)d and(6.0±2.0)d,significantly less compared with(204±31)min,(20.4±2.4)h,(22.7±3.2)h,(5.0±1.0)d and(8.0±1.0)d in the traditional group(t=-2.51,-3.88,-3.78,-4.14,-2.55;P<0.05).In the combination group,the incidence of postoperative complications was 26%(5/19),significantly lower than 57%(13/23)in the traditional group(χ2=3.88,P<0.05).Conclusions Precise liver surgery combined with ERAS concept can reduce the intraoperative blood loss,lower the incidence of postoperative complications,enhance postoperative recovery and effectively improve surgical efficacy for complex hepatic cystic echinococcosis.