加速康复外科在肝癌肝切除术标准化流程中的应用研究

Application of enhanced recovery after surgery in the standardized procedures of liver resection due to hepatocellular carcinoma

目的探讨加速康复外科(ERAS)在原发性肝癌肝切除术围手术期的应用,形成适合原发性肝癌肝切除术实际需要的标准化流程。方法选取海军军医大学第三附属医院特需诊疗科2020年1月1日至12月31日182例肝癌肝切除患者作为研究对象,采用数字表法随机将其分为2组,分别为加速康复治疗组和传统治疗组,每组各91例,但实施过程中传统治疗组有3例患者因病情变化提前出院中途退出研究。比较2组患者围手术期处理手段及结果。结果共纳入182例患者,其中男性144例,女性38例,平均年龄(54.68±11.40)岁。平均住院时间(16.47±3.64)d,平均住院费用(57173.11±5578.15)元。2组患者性别、年龄、术前静脉血栓栓塞症(venous thrombo embolism,VTE)评分、术前营养评分比较,差异无统计学意义(P>0.05)。加速康复治疗组患者术中出血量、肝门阻断时间、拔除胃管时间、下床活动时间、肛门排气时间、进食时间、拔除腹腔引流管时间、出院时间、总住院时间、住院费用等明显少于传统治疗组,差异有统计学意义(P<0.05);加速康复治疗组患者术后发热、腹胀、胆漏等并发症明显少于传统治疗组,差异有统计学意义(P<0.05);加速康复治疗组患者满意度高于传统治疗组,差异有统计学意义(P<0.05)。结论应强化加速康复外科在肝切除术围手术期医护之间的密切配合,建立手术护理行为规范标准,形成标准化流程。肝癌肝切除术围手术期应用ERAS理念,其初步尝试是可行的,可以提高患者舒适度,缩短住院时间,降低医疗费用,节省医疗资源。

Objective To investigate the application of enhanced recovery after surgery(ERAS)in the perioperative period of primary liver cancer hepatectomy,and to form standardized procedures suitable for actual needs of primary liver cancer hepatectomy.Methods 182 cases of liver cancer hepatectomy treated in the Department of Special Diagnosis and Treatment of Third Affiliated Hospital of Naval Medical University from January 1,2020 to December 31,2020 were selected as study subjects,and were randomly divided into the enhanced recovery treatment group and the traditional treatment group,each consisting of 91 cases.During the process,3 patients withdrew from the study due to changes of illness.The perioperative treatment methods and results were compared between the patients of the two groups.Results Included in the study were 182 patients,of whom 144 were male and 38 were female,with an average age of(54.68±11.40)years.The average length of hospitalization was(16.47±3.64)days,and the average hospitalization cost was(57173.11±5578.15)yuan.There were no significant differences in gender,age,preoperative VTE scores,and preoperative nutritional scores,when comparisons were made,without statistical significance(P>0.05).The amount of intraoperative blood loss,hepatic portal block time,time to remove gastric tube,off⁃bed activity time,anal exhaust time,eating time,time to remove abdominal drainage tube,hospital discharge time,total length of hospital stay and hospitalization cost of the former were significantly less or shorter than those of the traditional treatment group,with statistical significance(P<0.05).The postoperative fever,abdominal distension,and bile leakage were significantly less than those the latter,also with statistical significance(P<0.05).The satisfaction rate of the former was higher than that of the latter,also with statistical significance(P<0.05).Conclusion Efforts should be made to intensify close cooperation between doctors and nurses during perioperative period of hepatectomy,and to establish the standardized regulations of nursing care and standardized produres.The initial attempt of ERAS in liver resection of HCC is feasible.It could improve patient comfort,shorten hospital stay,reduce medical expenses and save medical resources.