肝内胆管结石围手术期的快速康复治疗  

Fast-track treatment for hepatolithiasis patients during perioperative period

作　　者：刘付宝[1] 毛长坤[1] 张志功[1] 赵义军[1] 赵红川[1] 王国斌[1] 吴鑫尧[1] 耿小平[1] 

机构地区：[1]安徽医科大学第一附属医院肝胆胰外科,安徽合肥230022

出　　处：《中国普通外科杂志》2013年第8期1033-1037,共5页China Journal of General Surgery

基　　金：安徽省科技厅重点科研资助项目(12070403071)

摘　　要：目的:探讨快速康复外科(FTS)在肝内胆管结石患者围手术期的应用效果。方法:分析2005年7月—2012年6月间132例行手术治疗肝内胆管结石患者的临床资料。按照患者围手术期处理方法的不同分为FTS组(56例)和对照组(76例),FTS组采用快速康复的新型围手术期处理方法,而对照组采用传统方法进行围手术期处理。结果:与对照组比较,FTS组患者术后住院天数[(8.8±4.6)d vs.(13.1±6.2)d]、住院费用减少[(3.0±0.6)万元vs.(4.0±0.5)万元],术后总体并发症及切口感染发生率下降[26.8%vs.44.7%,19.7%vs.36.8%],术后拔除腹腔引流管时间及术后首次排气时间提前[(5.4±3.8)d vs.(8.4±4.5)d,(1.9±0.7)d vs.(3.5±0.6)d](均P<0.05),全组患者的Logistic多因素回归分析显示,年龄、既往胆道手术史、术中切口保护措施及术后拔除腹腔引流管时间是术后切口感染发生率的影响因素(均P<0.05)。结论:在肝内胆管结石患者中应用FTS理念是安全有效的,可以降低术后并发症发生率,减少住院费用,缩短住院时间,促进患者康复。Objective：To investigate the efficacy of using fast-track surgery（FTS） in perioperative management of hepatolithiasis patients.Methods：The clinical data of 132 patients with hepatolithiasis undergoing surgical treatment from July 2005 to June 2012 were reviewed.According to the type of perioperative management,patients were divided into FTS group（56 cases） and control group（76 cases）;patients in FTS group received the new perioperative care procedure,namely the fast-track methodology,while those in control group underwent the conventional perioperative treatment.Results：Compared with control group,the length of postoperative hospital stay,medical costs and incidence of postoperative complications and wound infection were reduced,and the times to drainage tube removal and first postoperative passage of flatus were shortened in FTS group（all P＆lt;0.05）.Multivariate Logistic regression analysis for the entire group of patients revealed that age,previous history of biliary surgery,intraoperative wound edge protection and time of drainage tube removal were affecting factors for the incidence of wound infection（all P＆lt;0.05）.Conclusion：The application of FTS in management of hepatolithiasis patients is safe and effective,and can reduce the incidence of postoperative complications and medical costs,as well as shorten the postoperative hospital stay and accelerate recovery of the patients.

关 键 词：胆结石 快速康复外科 围手术期医护 

分 类 号：R657.4[医药卫生—外科学]