加速康复外科理念在肝切除术中的应用
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于江涛, Email: renkuiwu@163.com

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Application of concept of enhanced recovery after surgery in hepatectomy
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    摘要:

    目的:探讨加速康复外科(ERAS)理念在肝切除术围手术期中的应用效果。
    方法:选择2014年2月—2018年12月于阜阳市人民医院行肝切除术的97例患者,按随机序贯原则分为ERAS组(49例)和对照组(48例),ERAS组患者采用ERAS理念行围手术期管理,对照组则按照传统方式行围手术期管理。比较两组患者的相关临床指标。
    结果:两组患者的一般资料差异无统计学意义(均P>0.05)。与对照组比较,ERAS组患者手术时间明显延长[(186.18±51.31)min vs.(157.00±66.53)min,P=0.02],但术中出血量与无输血率无统计学差异(均P>0.05);术后拔管时间[(6.04±2.09)d vs.(8.44±2.97)d]、肛门排气时间[(1.96±0.79)d vs.(2.52±1.26)d]及术后住院时间[(8.57±3.21)d vs.(11.54±4.82)d]均明显缩短(均P<0.05);术后并发症发生率明显降低(20.4% vs. 60.4%,P=0.001)。
    结论:ERAS理念在肝切除术治疗肝脏疾病的围术期中应用安全、有效,并可以减少术后并发症的发生,促进患者术后恢复,值得临床应用推广。

    Abstract:

    Objective: To investigate the application efficacy of the concept of enhanced recovery after surgery (ERAS) in perioperative period of hepatectomy. 
    Methods: Ninety-seven patients undergoing liver resection in Fuyang People's Hospital from February 2014 to December 2018 were enrolled, and were randomly allocated to ERAS group (49 cases) and control group (48 cases). Patients in ERAS group received perioperative management directed by ERAS concept, and those in control group underwent perioperative management with a conventional protocol. The main clinical variables were compared between the two groups.
    Results: There were no significant differences in general data between the two groups (all P>0.05). In ERAS group compared with control group, the operative time was significantly prolonged [(186.18±51.31) min vs. (157.00±66.53) min, P=0.02], but the intraoperative blood loss and proportion of blood transfusion showed no significant differences (both P>0.05); the time to postoperative tube removal [(6.04±2.09) d vs. (8.44±2.97)d], time to anal gas passage [(1.96±0.79) d vs. (2.52±1.26) d] and length of postoperative hospital stay [(8.57±3.21) d vs. (11.54±4.82) d] were all significantly reduced (all P<0.05); the incidence of postoperative complications was significantly decreased (20.4% vs. 60.4%, P=0.001). 
    Conclusion: Using ERAS protocol in perioperative management of hepatectomy in the treatment of liver diseases is safe and effective, and it can also reduce the occurrence of postoperative complications and promote the postoperative recovery of patients. It is recommended to be used in clinical practice.

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于江涛, 任魁梧, 吴盼盼, 孙杰, 杨锐, 宋坤.加速康复外科理念在肝切除术中的应用[J].中国普通外科杂志,2019,28(8):989-994.
DOI:10.7659/j. issn.1005-6947.2019.08.012

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  • 收稿日期:2019-01-25
  • 最后修改日期:2019-06-19
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  • 在线发布日期: 2019-08-25