Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed...Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.展开更多
Objective:The enhanced recovery after surgery(ERAS)program is less implemented in gastric cancer patients.The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastr...Objective:The enhanced recovery after surgery(ERAS)program is less implemented in gastric cancer patients.The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastric cancer.Methods:This clinical observational study enrolled 329 patients between January 2020 and August 2020 in a single gastric cancer center.The questionnaire consisted of 4 par ts:basic information,preoperative status,intraoperative status,and postoperative status of ERAS implementation in gastric cancer surgery.Results:In the preoperative period,patients'education and counseling(100%)were well adopted.Smoking cessation(34.6%),drinking cessation(36.9%),avoidance of preoperative mechanical bowel preparation(24.3%),respiratory function training(11.2%),and administration of carbohydrate-rich drink before surgery(0.6%)were relatively not well adopted.During the operation,maintenance of intraoperative normothermia and fluid management(100%),as well as epidural analgesia(81.5%),were well adopted.Thromboprophylaxis was performed in 133(40.4%)patients.In the postoperative period,early active mobilization was implemented about 9.5 h,and early ambulation was implemented about 39.5 h,after surgery.A total of 140(42.5%)patients received prolonged prophylactic antibiotics;268(81.5%)patients were provided diet upon gas passage;and 320(97.3%)patients received intravenous fluid administration more than 5 d after surgery.The practice rate of early removal of urinary catheter(0%)and nasogastric tube(15.5%)was relatively low.A total of 11(3.3%)patients experienced postoperative complication,and 1(0.3%)patient received unplanned reoperation.The average costs were￥59,500,and the average hospital stay was 12(5,36)d.Conclusions:Standard perioperative management of ERAS program in gastric cancer surgery in China still requires improvement.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)program has been proved to improve postoperative outcome for many surgical procedures,including liver resection.There was limited evidence regarding the feasibility and ...BACKGROUND Enhanced recovery after surgery(ERAS)program has been proved to improve postoperative outcome for many surgical procedures,including liver resection.There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma.AIM To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient outcomes.METHODS We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital,Khon Kaen University between January 2015 and December 2016.The primary outcome was the compliance with ERAS.To determine the association between ERAS compliance and patient outcomes.the patients were categorized into those adhering more than and equal to 50%(ERAS≥50),and below 50%(ERAS<50)of all components.Details on type of surgical procedure,preoperative and postoperative care,tumor location,postoperative laboratory results,and survival time were evaluated.The compliance with ERAS was measured by the percentage of ERAS items achieved.The Kaplan-Meier curve was used for survival analysis.RESULTS The median percentage of ERAS goals achieved was 40%(±12%).Fourteen patients(12.1%)were categorized into the ERAS≥50 group,and 102 patients were in the ERAS<50 group.Postoperative hospital stay was significantly shorter in the ERAS≥50 group[8.9 d,95%confidence interval(CI):7.3-10.4 d]than in the ERAS<50 group(13.7 d,95%CI:12.2-15.2 d)(P=0.0217).No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS≥50 group.Overall survival was significantly higher in the ERAS≥50 group.The median survival of the patients in the ERAS<50 group was 1257 d(95%CI:853.2-1660.8 d),whereas that of the patients in the ERAS≥50 group was not reached.CONCLUSION Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is poor.Greater ERAS compliance could predict in-hospital,short-term,and long-term outcomes of the patients.展开更多
目的:探讨基于加速康复外科(enhanced recovery after surgery,ERAS)理念的主动训练方案对腹腔镜肝癌切除术后患者胃肠道功能的影响。方法:选取2020年8月至2023年3月广州医科大学附属第二医院收治的44例行腹腔镜肝癌切除术患者,按照随...目的:探讨基于加速康复外科(enhanced recovery after surgery,ERAS)理念的主动训练方案对腹腔镜肝癌切除术后患者胃肠道功能的影响。方法:选取2020年8月至2023年3月广州医科大学附属第二医院收治的44例行腹腔镜肝癌切除术患者,按照随机数字表法分为对照组和试验组,各22例。对照组采用常规护理,试验组在常规护理的基础上应用基于ERAS理念的主动训练方案,对比两组患者术后胃肠道功能恢复的相关指标、疼痛评分及术后并发症发生情况。结果:两组患者性别及年龄等一般资料比较差异均无统计学意义(均P>0.05)。试验组患者术后肠蠕动恢复时间、首次排气时间、首次排便时间、首次进食时间及住院时间均短于对照组,术后疼痛程度低于对照组,腹胀发生率低于对照组,以上差异均具有统计学意义(均P<0.05);两组患者出血及胆漏的发生率比较差异均无统计学意义(均P>0.05)。结论:应用基于ERAS理念的主动训练方案,可以加快腹腔镜肝癌切除术后患者胃肠道功能的恢复,促进患者术后康复。展开更多
目的探究加速康复外科(ERAS)理念护理在老年患者胆道术后谵妄及认知功能障碍中的应用效果。方法纳入2022年7月至12月浙江省温州市中心医院肝胆外科收治的胆道手术的患者60例,采用随机数字表法将其分为对照组和ERAS组,各30例。对照组接...目的探究加速康复外科(ERAS)理念护理在老年患者胆道术后谵妄及认知功能障碍中的应用效果。方法纳入2022年7月至12月浙江省温州市中心医院肝胆外科收治的胆道手术的患者60例,采用随机数字表法将其分为对照组和ERAS组,各30例。对照组接受普外科基础护理,ERAS组在对照组的基础上实施EQAS模式护理方案。观察两组术后谵妄发生率、认知功能评分及术后不良反应发生率。结果术后,ERAS组谵妄发生率低于对照组,ERAS组谵妄持续时间短于对照组,差异有统计学意义(P<0.05)。整体分析发现:两组简易智力状态检查量表(MMSE)评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05)。组内比较,两组术后1、3、7 d MMSE评分低于入组时和术后3、7 d,术后1、3个月MMSE评分高于术后1 d,术后1、3个月MMSE评分高于术后3 d,术后1、3个月MMSE评分高于术后7 d,差异有统计学意义(P<0.05);组间比较,ERAS组术后1、3、7 d MMSE评分均高于对照组,差异有统计学意义(P<0.05)。ERAS组恶心/呕吐、尿潴留、睡眠障碍、低血压发生率均低于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05)。结论ERAS理念护理方案相较于常规护理方案可以有效减少老年胆道手术患者术后谵妄的发生,缩短谵妄持续时间,减少术后认知功能障碍,促进认知功能恢复,值得临床推广应用。展开更多
文摘Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.
基金supported by Program of Shanghai Shenkang Hospital Development Center (SHDC22020204)Nursing Science Support Program of Zhongshan Hospital,Fudan University (XK-082-007)Management Fund of Zhongshan Hospital,Fudan University (2022ZSGL01)。
文摘Objective:The enhanced recovery after surgery(ERAS)program is less implemented in gastric cancer patients.The purpose of this survey is to investigate the implementation status of ERAS in perioperative period in gastric cancer.Methods:This clinical observational study enrolled 329 patients between January 2020 and August 2020 in a single gastric cancer center.The questionnaire consisted of 4 par ts:basic information,preoperative status,intraoperative status,and postoperative status of ERAS implementation in gastric cancer surgery.Results:In the preoperative period,patients'education and counseling(100%)were well adopted.Smoking cessation(34.6%),drinking cessation(36.9%),avoidance of preoperative mechanical bowel preparation(24.3%),respiratory function training(11.2%),and administration of carbohydrate-rich drink before surgery(0.6%)were relatively not well adopted.During the operation,maintenance of intraoperative normothermia and fluid management(100%),as well as epidural analgesia(81.5%),were well adopted.Thromboprophylaxis was performed in 133(40.4%)patients.In the postoperative period,early active mobilization was implemented about 9.5 h,and early ambulation was implemented about 39.5 h,after surgery.A total of 140(42.5%)patients received prolonged prophylactic antibiotics;268(81.5%)patients were provided diet upon gas passage;and 320(97.3%)patients received intravenous fluid administration more than 5 d after surgery.The practice rate of early removal of urinary catheter(0%)and nasogastric tube(15.5%)was relatively low.A total of 11(3.3%)patients experienced postoperative complication,and 1(0.3%)patient received unplanned reoperation.The average costs were￥59,500,and the average hospital stay was 12(5,36)d.Conclusions:Standard perioperative management of ERAS program in gastric cancer surgery in China still requires improvement.
基金Supported by the grant of Faculty of Medicine,Khon Kaen University,Thailand,No.IN62330.
文摘BACKGROUND Enhanced recovery after surgery(ERAS)program has been proved to improve postoperative outcome for many surgical procedures,including liver resection.There was limited evidence regarding the feasibility and benefit of ERAS in patients who underwent liver resection for cholangiocarcinoma.AIM To evaluate the feasibility of ERAS in patients who underwent liver resection for cholangiocarcinoma and its association with patient outcomes.METHODS We retrospectively analyzed 116 cholangiocarcinoma patients who underwent hepatectomy at Srinagarind Hospital,Khon Kaen University between January 2015 and December 2016.The primary outcome was the compliance with ERAS.To determine the association between ERAS compliance and patient outcomes.the patients were categorized into those adhering more than and equal to 50%(ERAS≥50),and below 50%(ERAS<50)of all components.Details on type of surgical procedure,preoperative and postoperative care,tumor location,postoperative laboratory results,and survival time were evaluated.The compliance with ERAS was measured by the percentage of ERAS items achieved.The Kaplan-Meier curve was used for survival analysis.RESULTS The median percentage of ERAS goals achieved was 40%(±12%).Fourteen patients(12.1%)were categorized into the ERAS≥50 group,and 102 patients were in the ERAS<50 group.Postoperative hospital stay was significantly shorter in the ERAS≥50 group[8.9 d,95%confidence interval(CI):7.3-10.4 d]than in the ERAS<50 group(13.7 d,95%CI:12.2-15.2 d)(P=0.0217).No hepatobiliary-related complications or in-hospital mortality occurred in the ERAS≥50 group.Overall survival was significantly higher in the ERAS≥50 group.The median survival of the patients in the ERAS<50 group was 1257 d(95%CI:853.2-1660.8 d),whereas that of the patients in the ERAS≥50 group was not reached.CONCLUSION Overall ERAS compliance for patients who underwent liver resection for cholangiocarcinoma is poor.Greater ERAS compliance could predict in-hospital,short-term,and long-term outcomes of the patients.
文摘目的:探讨基于加速康复外科(enhanced recovery after surgery,ERAS)理念的主动训练方案对腹腔镜肝癌切除术后患者胃肠道功能的影响。方法:选取2020年8月至2023年3月广州医科大学附属第二医院收治的44例行腹腔镜肝癌切除术患者,按照随机数字表法分为对照组和试验组,各22例。对照组采用常规护理,试验组在常规护理的基础上应用基于ERAS理念的主动训练方案,对比两组患者术后胃肠道功能恢复的相关指标、疼痛评分及术后并发症发生情况。结果:两组患者性别及年龄等一般资料比较差异均无统计学意义(均P>0.05)。试验组患者术后肠蠕动恢复时间、首次排气时间、首次排便时间、首次进食时间及住院时间均短于对照组,术后疼痛程度低于对照组,腹胀发生率低于对照组,以上差异均具有统计学意义(均P<0.05);两组患者出血及胆漏的发生率比较差异均无统计学意义(均P>0.05)。结论:应用基于ERAS理念的主动训练方案,可以加快腹腔镜肝癌切除术后患者胃肠道功能的恢复,促进患者术后康复。
文摘目的探究加速康复外科(ERAS)理念护理在老年患者胆道术后谵妄及认知功能障碍中的应用效果。方法纳入2022年7月至12月浙江省温州市中心医院肝胆外科收治的胆道手术的患者60例,采用随机数字表法将其分为对照组和ERAS组,各30例。对照组接受普外科基础护理,ERAS组在对照组的基础上实施EQAS模式护理方案。观察两组术后谵妄发生率、认知功能评分及术后不良反应发生率。结果术后,ERAS组谵妄发生率低于对照组,ERAS组谵妄持续时间短于对照组,差异有统计学意义(P<0.05)。整体分析发现:两组简易智力状态检查量表(MMSE)评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05)。组内比较,两组术后1、3、7 d MMSE评分低于入组时和术后3、7 d,术后1、3个月MMSE评分高于术后1 d,术后1、3个月MMSE评分高于术后3 d,术后1、3个月MMSE评分高于术后7 d,差异有统计学意义(P<0.05);组间比较,ERAS组术后1、3、7 d MMSE评分均高于对照组,差异有统计学意义(P<0.05)。ERAS组恶心/呕吐、尿潴留、睡眠障碍、低血压发生率均低于对照组,术后住院时间短于对照组,差异均有统计学意义(P<0.05)。结论ERAS理念护理方案相较于常规护理方案可以有效减少老年胆道手术患者术后谵妄的发生,缩短谵妄持续时间,减少术后认知功能障碍,促进认知功能恢复,值得临床推广应用。
