快速康复外科理念在开腹胆总管探查术中的应用研究  

Research on the application of enhanced recovery after surgery in exploration of common bile duct stones

作　　者：汪小万 赵中伟[1] 王文卿[1] 孙举来[1] 刘晓红[1] 

机构地区：[1]马鞍山市中心医院普外科,马鞍山243000

出　　处：《肝胆外科杂志》2015年第2期141-144,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨快速康复外科(enhanced recovery after surgery,ERAS)理念在胆道结石患者开腹胆总管探查术中应用的安全性及有效性。方法回顾性分析2009年1月至2014年12月胆总管结石或胆总管合并胆囊结石行开腹胆总管探查手术的113例患者的病例资料,其中快速康复组46例,患者接受的是ERAS理念指导的一系列干预措施;常规处理组67例,患者接受的是传统的围手术期管理办法,比较两组患者的术后恢复情况,从而探讨ERAS理念在胆道结石手术中的应用价值。结果与常规处理组相比,快速康复组患者术后的首次肛门排气时间明显提前[(36.50±5.52)h vs(39.06±5.29)h,P=0.016],手术以及术后的治疗费用显著降低[(12607.98±2414.97)元vs(14207.87±2714.84)元,P=0.002],术后住院天数明显减少[(8.87±2.74)d vs(10.19±2.54)d,P=0.011],患者舒适度以及围手术期的疼痛控制满意率明显提高[34/46(73.9%)vs 36/67(53.7%),P=0.030];而两组的术后并发症的发生率及再入院率无明显差异。结论 ERAS理念在开腹胆总管探查术中的应用是安全有效的,可以减少患者住院治疗费用,缩短术后住院时间,减轻患者疼痛,促进患者早日康复。Objective To observe the safety and clinical efficacy of the application of enhanced recovery after surgery （ERAS） during exploration of common bile duct stones. Methods A total of 113 patients who received common bile duct exploration surgery from Jan 2009 to Dec 2014 enrolled in this study. 46 cases of them in ERAS group received well - organized and consecutive clinical interven- tions guided by ERAS while 67 patients in traditional control group received traditional perioperative management. Observe the recovery of patients in two groups in order to indentify the safety and clinical efficacy of the application of ERAS programs in biliary surgery. Results There was no significant difference on readmission rates and complications between the two groups. But the ERAS group achieved earli- er flatus and defecation [（36.50±5.52） h vs （39.06±5.29） h, P=0.016], a reduction of costs [（12607.98 ±2414.97） RMB vs （ 14207.87±2714. 84） RMB,P =0. 002] and postoperative hospital stay[ （8.87 ±2. 74） d vs （ 10. 19 ±2. 54） d, P =0. 011 ] and an in- crease in pain management and recovery [34/46（73.9% ） vs 36/67 （53.7%）, P =0. 030]. Conclusion The use of ERAS programs after common bile duct exploration surgery were feasible and safe and provided high quality care, a reduction of costs and postoperative hospital stay without an increase in readmission rates and postoperative complications.

关 键 词：快速康复外科 胆道手术 胆总管结石 规范化疼痛管理 

分 类 号：R657.4[医药卫生—外科学]