术后早期活动对伴门静脉高压肝癌切除术患者康复的影响

Effect of early postoperative activity on recovery of hepatocellular carcinoma patients with portal hypertension

目的探讨术后早期活动对伴门静脉高压肝癌切除术患者康复出院的影响。方法回顾性收集2019年6月至2021年6月在海军军医大学第三附属医院接受伴门静脉高压肝癌切除术的423例患者为研究对象,通过回顾性研究筛选348例患者为非早期活动组,75例患者为早期活动组,分析术前因素(年龄、性别、吸烟史等)和术中因素(术中肝门血流阻断、围手术期输血、肿瘤大小)对患者术后康复的影响。为了尽可能地减少选择性偏差,采用倾向性得分匹配方法对348例非早期活动组患者进行倾向性得分匹配,获得75例为非早期活动组,对非早期活动组在倾向性得分匹配前、后与早期活动组在术后早期并发症、胃肠功能恢复(包括术后首次通气时间、术后腹胀、术后腹泻)、术后住院时间、总住院时间方面进行比较。结果倾向性得分匹配前、后的非早期活动组和早期活动组术后严重并发症、术后腹泻、总住院时间比较差异均无统计学意义(P>0.05),术后首次通气时间、术后腹胀、术后住院时间比较差异均有统计学意义(P<0.05)。结论术后早期活动能加快伴门静脉高压肝癌切除术患者胃肠功能恢复,促进营养物质的摄入和吸收,有利于术后肝功能的恢复,缩短患者术后住院时间,促进患者早日康复。

Objective To investigate the effect of early postoperative activities on rehabilitation and discharge in hepatocellular carcinoma patients with portal hypertension.Methods A total of 423 patients who underwent surgical treatment for hepatocellular carcinoma with portal hypertension in The Third Affiliated Hospital of Naval Medical University from June 2019 to June 2021 were collected as research objects.There were 348 patients without early postoperative activity and 75 patients with early postoperative activity.The impacts of preoperative factors(age,gender,smoking history,etc.)and intraoperative factors(intraoperative hepatic portal block,perioperative blood transfusion,and tumor size)on postoperative recovery of patients were analyzed.In order to reduce the selection bias,75 patients were chosen from 348 patients without early postoperative activity by propensity score matching and taken as non⁃early activity group.Early postoperative complications,gastrointestinal function recovery(including first ventilation time,abdominal distension,and diarrhea),postoperative hospital stay,and total hospital stay were compared between non⁃early activity group and early activity group before and after propensity score matching.Results There was no significant difference in the incidences of serious postoperative complications,postoperative diarrhea,or total length of hospital stay between non⁃early activity group and early activity group before and after propensity score matching(P>0.05).But there were significant differences in the incidences of first ventilation time,postoperative abdominal distension,and postoperative hospital stay between the two groups(P<0.05).Conclusion Early postoperative activities can accelerate the recovery of gastrointestinal function in portal hypertension patients undergoing hepatectomy,promote the intake and absorption of nutrients,facilitate the recovery of postoperative liver function,shorten the postoperative hospital stay,and promote the early recovery of patients.