腹腔镜胃袖状切除术围术期加速康复干预措施的研究

Study of perioperative enhanced recovery interventions of laparoscopic sleeve gastrectomy

目的 探讨腹腔镜胃袖状切除术围术期便捷可行的加速康复干预措施。方法 回顾性分析2019年1月~2022年6月新疆维吾尔自治区第三人民医院64例行腹腔镜胃袖状切除术病人的临床资料,男性11例,女性53例,年龄范围24~51岁。分为两组:对照组31例,围术期接受常规加速康复减重外科干预措施;观察组33例,围术期接受改良的加速康复减重外科干预措施。对比分析两组手术相关指标、术后48小时实验室指标和手术并发症(Ⅰ~Ⅱ级:发热、切口感染、术后恶心呕吐、上腹疼痛、肺部感染;Ⅲ~Ⅳ级:胸腔积液、消化道漏、腹腔出血、深静脉血栓;Ⅴ级:死亡)发生情况。结果 两组病人手术时间、手术出血、钉仓使用数量、非计划增加Trocar孔例数、首次肛门排气时间、进食时间、住院时间、术后住院时间比较,以及术后48小时白细胞计数、降钙素原、乳酸、血氧饱和度、血清钠、血清钾、白蛋白、甘油三酯和尿素水平比较,差异均无统计学意义(P>0.05);对照组住院费用、术后恶心呕吐发生率、手术并发症总发生率高于观察组,差异有统计学意义(P<0.05)。结论 腹腔镜胃袖状切除术围术期加速康复干预措施中,不常规放置腹腔引流管和中心静脉导管,对无贫血、凝血功能障碍或未正在进行抗凝治疗的病人,在早期下床活动(术后2~4小时)和进食水(术后24~48小时)基础上,不常规介入静脉栓塞症管理,可能是安全可行的;术后留置胃管12~24小时可降低术后恶心呕吐、上腹疼痛的发生。

Objective To explore a convenient and feasible perioperative enhanced recovery interventions of laparoscopic sleeve gastrectomy(LSG).Methods Retrospective study was performed on the clinical data of 64 patients undergoing LSG in the Third People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to June 2022,including 11 males and 53 females.Age ranged from 24 to 51 years,They were divided into 2 groups:the control group(n=31) received routine perioperative enhanced recovery and weight loss surgical interventions and the experimental group(n=33) received the adjusted perioperative enhanced recovery and weight loss surgical interventions.The operation-related indexes,laboratory indexes at 48 hours after operation and the occurrence of surgical complications(Grade Ⅰ-Ⅱ:fever,incisional infection,postoperative nausea and vomiting,epigastric pain,pulmonary infection.Grade Ⅲ-Ⅳ:pleural effusion,gastrointestinal leakage,abdominal bleeding,deep vein thrombosis.Grade V:death) were compared and analyzed between the two groups.Result There were no statistically significant differences between the 2 groups in terms of operative time,operative bleeding,number of nail bins used,unplanned increase in the number of trocar holes,time to first anal discharge,time to feed,length of hospital stay,postoperative hospital stay,and 48h postoperative white blood cell count,calcitoninogen,lactate,oxygen saturation,serum sodium,serum potassium,albumin,triglyceride and urea levels(P>0.05).The hospitalization cost,incidence of postoperative nausea and vomiting and total incidence of surgical complications were higher in the control group than in the experimental group,and the differences were statistically significant(P<0.05).Conclusion In the perioperative enhanced recovery interventions of LSG,It is maybe safe and feasible that abdominal drainage tube and central venous catheter were not routinely placed in normal patients,and management of venous embolism were not routinely placed on the basis of early ambulation(2-4 h after surgery) and water and food intake(24-48 h after surgery) in patients without anemia,coagulopathy or not undergoing anticoagulant therapy.Gastric tube indwelling for 12-24 hours can reduce the occurrence of postoperative nausea and vomiting and upper abdominal pain.