ERAS护理模式在达芬奇机器人辅助解剖性肝切除术中的应用效果

Application effect of ERAS nursing model in Da Vinci robot-assisted anatomical hepatectomy

目的:探讨加速康复外科(ERAS)护理模式在达芬奇机器人辅助解剖性肝切除术中的应用效果。方法:基于回顾性研究,选取2022年1月—2023年12月于本院在ERAS护理模式下行机器人辅助解剖性肝切除术的60例原发性肝癌患者作为研究对象。按照术式不同将其分为机器人手术组(n=30)和腹腔镜手术组(n=30)。机器人手术组采用达芬奇机器人手术系统辅助解剖性肝切除,腹腔镜手术组组采用腹腔镜进行解剖性肝切除。对比分析两组患者围手术期相关数据。结果:机器人手术组与腹腔镜手术组组在在术中出血量、首次排气时间、下床活动时间、住院时间方面比较,差异具有统计学意义(P<0.05);两组患者术后5天ALT、AST、TBIL水平均呈现增长趋势,但机器人手术组ALT、AST、TBIL水平低于腹腔镜手术组,且差异具有统计学意义(P<0.05);机器人手术组总并发症发生率低于腹腔镜手术组,差异无统计学意义(P>0.05);两组患者术后疼痛(NRS)与护理满意度评分差异均无统计学意义(P>0.05)。结论:与腹腔镜手术相比,ERAS护理模式下行达芬奇机器人辅助解剖性肝切除术可减少术中出血、减轻手术创伤,且胃肠功能恢复快,在近期疗效方面具有一定的优势。

Objective:To study the clinical effect of ERAS nursing model in Da Vinci robot-assisted anatomical hepatectomy.Methods:Clinical data of 60 patients with primary liver cancer who underwent robot-assisted anatomic hepatectomy under ERAS nursing model in the First Medical Center of Chinese PLA General Hospital from January 2022 to December 2023 were retrospectively analyzed.They were divided into two groups according to the different surgical methods,with 30 cases in each group.The robotic group received Da Vinci robot-assisted anatomical hepatectomy,and the laparoscopic group received laparoscopic anatomical hepatectomy.Perioperative data of the two groups were compared.Results:The differences between the robotic group and the laparoscopic group in terms of intraoperative bleeding,time to first exhaustion,time to get out of bed,and length of hospital stay were statistically significant(P<0.05).ALT,AST and TBIL levels of patients in the two groups showed an increasing trend 5 days after surgery,but they were lower in the robotic group than those in the laparoscopic group,and the difference was statistically significant(P<0.05).The total incidence rate of complications in the robotic group was lower than that in the laparoscopic group,but the difference was not statistically significant(P>0.05).There was no significant difference in postoperative pain(NRS)and nursing satisfaction scores between the two groups(P>0.05).Conclusion:Compared with laparoscopic surgery,application of ERAS nursing model in Da Vinci robot-assisted anatomical hepatectomy can reduce intraoperative bleeding,recover gastrointestinal function quickly and alleviate surgical trauma,which has certain advantages in the short-term efficacy.