经脐单孔免气腹腹腔镜肝切除围手术期的加速康复护理1例

Nursing care based on enhanced recovery after surgery for single-incision laparoscopic hepatectomy without pneumoperitoneum

经脐单孔腹腔镜肝切除术(single-incision laparoscopic hepatectomy,SILH)在临床上已成熟应用多年,术后患者恢复快,且生存率与传统腹腔镜手术差异无统计学意义。免气腹的经脐单孔腹腔镜手术可以为心肺功能欠佳患者提供更多手术机会,既往已成功应用于妇科手术及普外科的阑尾、胆囊及脾切除等手术,但应用于肝切除术尚未见报道。加速康复外科(enhanced recovery after surgery,ERAS)理念是基于循证医学证据,采用多模式优化围手术期处理措施的策略,减轻患者围手术期的生理及心理创伤应激,从而减少术后并发症,促进患者康复。海军军医大学第三附属医院肝外三科在积累了一定量SILH的经验上,完成国内首例经脐单孔免气腹腹腔镜肝切除术,同时将ERAS理念应用于围手术期管理中。

Single-incision laparoscopic hepatectomy(SILH)has been widely used in clinical practice for many years.It offers fast postoperative recovery and demonstrates comparable survival rates to traditional laparoscopic surgery.While SILH without pneumoperitoneum provides a new operation opportunity for patients who have poor cardiopulmonary function and has been successfully applied in gynecology and general surgery for procedures such as appendectomy,cholecystectomy and splenectomy,its application in hepatectomy has not been reported.Enhanced recovery after surgery(ERAS)is based on evidence-based medicine,utilizing various strategies to optimize perioperative management and minimize physiological and psychological trauma for surgical patients,thereby reducing postoperative complications and promoting patients'recovery.We completed the first case of SILH without pneumoperitoneum in China and simultaneously applied the ERAS concept to perioperative management.