加速康复外科在老年患者腹腔镜胆总管结石再手术一期缝合中的应用

he clinical value of enhanced recovery after surgery(ERAS)in the primary suture of laparoscopic common bile

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在老年患者胆总管结石再手术一期缝合中的临床价值。方法回顾性分析了47例老年患者行腹腔镜胆总管结石再手术一期缝合的临床资料,随机分为加速康复外科策略组(ERAS组,n=24)和对照组(n=23)。比较两组患者术中情况、术后指标和并发症发生情况。结果ERAS组与对照组比较,手术时间、术中出血量比较差异无统计学意义(t=1.55,0.82,P>0.05);与对照组相比,加速康复外科组术后首次肛门排气时间、首次下床活动时间、首次进食时间、引流管拔出时间、术后住院时间、总住院费用明显降低,差异有统计学意义(P<0.05);两组术前CRP、IL-6比较差异无统计学意义(t=0.252,6.718,P>0.05),术后第1、4天CRP、IL-6比较差异有统计学意义(t=16.542,56.535;t=7.890,8.868,P<0.05);术后第24、48小时疼痛评分比较差异有统计学意义(t=256.704,71.437,P<0.05);总并发症发生率比较差异有统计学意义(χ^(2)=0.036,P<0.05)。结论加速康复外科在老年患者腹腔镜胆总管结石再手术一期缝合中是安全、可行的。

Objective To explore the clinical value of enhanced recovery after surgery(ERAS)in the primary suture of lapa-roscopic common bile duct stones reoperation in elderly patients.Methods The clinical data of 47 elderly patients undergoing laparo-scopic common bile duct stones reoperation with primary suture were analyzed retrospectively.They were randomly divided into acceler-ated rehabilitation surgery group(ERAS group,n=24)and control group(n=23).The intraoperative conditions,postoperative indi-cators and complications of the two groups were compared.Results There was no significant difference between ERAS group and con-trol group in operation time and intraoperative blood loss(t=1.55,0.82,P>0.05);Compared with the control group,the time of the first anal exhaust,the time of the first activity out of bed,the time of the first eating,the time of the drainage tube being pulled out,the time of hospitalization after the operation,and the total hospitalization cost in the accelerated rehabilitation surgery group decreased significantly(P<0.05);There was no significant difference in CRP and IL-6 between the two groups before operation(t=0.252,6.718,P>0.05),but there was significant difference in CRP and IL-6 between the two groups on the first and fourth day after opera-tion(t=16.542,56.535;t=7.890,8.868,P<0.05);There was a statistically significant difference in pain scores at 24 and 48 hours after operation(t=256.704,71.437,P<0.05);There was a statistically significant difference in the incidence of total compli-cations(χ^(2)=0.036,P<0.05).Conclusion Enhanced recovery after surgery is safe and feasible in the primary suture of laparoscop-ic common bile duct stones reoperation in elderly patients.