加速康复外科在肝囊型棘球蚴病肝切除术中的应用分析

Application of enhanced recovery after surgery in hepatectomy for hepatic cystic echinococcosis

目的评估加速康复外科(ERAS)理念应用于肝囊型棘球蚴病(HCE)患者肝切除术围手术期管理的安全性与有效性。方法回顾性分析新疆医科大学第一附属医院2014年1月至2023年1月间行肝切除术治疗的140例HCE患者资料。基于ERAS理念在HCE术中成熟推广为时间节点,将患者分为ERAS组(实施ERAS管理,79例)和传统组(实施传统管理,61例),比较分析两组患者一般情况、手术时长、术中出血量、术后相关指标、实验室检查结果、患者满意度、并发症发生率等方面的差异。结果两组患者一般情况、手术时长、术中出血量差异无统计学意义。ERAS组在术后首次肛门排气时间、术后疼痛评分(24、48 h时)、术后住院时间、术后引流管留置时间、住院费用及患者满意度方面均优于传统组(P<0.05)。ERAS组患者术后白细胞、降钙素原水平较传统组更低(P<0.05)。两组无一例复发,并发症总发生率差异无统计学意义。结论ERAS理念应用于HCE肝切除术的围手术期管理中是安全且有效的,其不仅未增加术后并发症的风险,而且能够显著减轻患者的术后疼痛,缩短住院时间,并减少住院费用,从而加速患者的术后恢复,推荐在临床中广泛推广。

Objective To assess the safety and efficacy of applying enhanced recovery after surgery(ERAS)into the perioperative management of patients undergoing hepatectomy for hepatic cystic echinococcosis(HCE).Methods A retrospective analysis of 140 patients treated with hepatectomy for HCE in the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2023 was conducted.Based on the mature promotion of the ERAS concept during HCE surgery as timeline,patients were divided into the ERAS group(79 patients treated with ERAS)and the traditional group(61 patients treated traditionally).A comparative analysis was made of both groups’general conditions,operation time,intraoperative blood loss,postoperative indicators,pre-and postoperative laboratory examination results,and complication rates.Results There were no statistically significant differences in the general conditions of the two groups.The ERAS group showed no significant difference compared to the traditional group in terms of operation time and intraoperative blood loss.However,the ERAS group performed better in terms of first postoperative flatus time,postoperative pain scores(at 24 h and 48 h),postoperative hospital stay,drainage tube indwelling time,hospitalization costs,and patient satisfaction(all P<0.05).In terms of laboratory results,postoperative white blood cells and procalcitonin levels were lower in the ERAS group(P<0.05).The overall complication rate in the two groups showed no significant difference.Conclusions Application of the ERAS concept in perioperative management of HCE hepatectomy is safe and effective,which not only does not increase the risk of postoperative complications,but also significantly alleviates postoperative pains,shortens hospital stay,and reduces hospitalization costs,thereby accelerating postoperative recovery.The widespread promotion of the ERAS concept in clinical practice is recommended.