加速康复外科理念在原发性肝癌患者肝切除围术期中的应用与安全性评价  

Perioperative application and safety of enhanced recovery after surgery in patients undergoing hepatectomy for primary liver cancer

作　　者：邓国荣[1] 陈博艺[1] 张玉胜[1] 钟其焕 王振龙[1] 李康德[1] 

机构地区：[1]广东湛江中心人民医院肝胆外科,广东湛江524037

出　　处：《消化肿瘤杂志（电子版）》2016年第4期243-248,共6页Journal of Digestive Oncology(Electronic Version)

基　　金：湛江市非资助科技攻关计划(编号:2012C3101044)

摘　　要：目的探讨围术期采用加速康复外科(enhanced recovery after surgery,ERAS)理念在原发性肝癌患者行开腹肝切除术中的有效性及安全性。方法回顾性分析2013年5月至2016年5月本中心收治的开腹肝癌切除术的77例患者临床资料,将患者分为2组:传统组45例和ERAS组32例。比较两组患者术前主观感受、术后胃肠功能、术后并发症发生率、术后疼痛和术后总住院时间。结果 ERAS组患者术前口渴、饥饿和焦虑感明显低于传统组(均P<0.05),ERAS组患者对比传统组术后首次肛门排气[(2.5±0.7)天vs.(3.3±0.8)天,t=4.551,P<0.001]和排便时间[(3.1±0.6)天vs.(3.9±0.8)天,t=4.778,P<0.001]明显缩短。ERAS组比传统组患者术后住院时间缩短[(8.6±2.1)天vs.(9.8±2.5)天,P=0.030]。两组患者术后并发症发生率并无差异(22.6%vs.24.4%,P=0.851)。ERAS组患者较传统组患者术后疼痛较轻,术后疼痛消除时间较快(均P<0.05)。结论 ERAS理念应用于肝癌围术期,可以保障围术期安全,并不增加开腹肝切除术的术后并发症发生率,还可改善患者术前主观感受、尽早恢复胃肠功能及减轻疼痛评分。ERAS在开腹肝切除术实施是安全有效的。Objective The aim of this study was to evaluate outcomes and safety after the introduction of the enhanced recovery after surgery （ERAS） program for patients with primary liver cancer undergoing open hepatic resection. Methods A retrospective analysis of patients following open hepatic resection from May 2013 to May 2016 was carried out. The patients were divided into traditional group （n=45） and ERAS group （n=32）. The following parameters were compared between two groups： preoperative subjective sensation, postoperative gastrointestinal function, postoperative complications, postoperative pain and the total postoperative hospital length of stay. Results The cases in the ERAS group had lower rate of thirsty, hunger and thrill before operation than those in the traditional group （all P〈0.05）. Moreover, first flatus [（2.5±0.7）d 仍. （ 3.3±0.8）d, i=4.551, 001] and defecation [（3.1 ±0.6）d 仍. （ 3.9±0.8）d, i=4.778,？ 〈0.001] occurredearlier in ERAS group than traditional group. Total postoperative hospital length of stay was significantly reduced in ERAS group[（8.6±2.l）d （9.8±2.5）d, P=0.030], with no differences in surgical complicationsbetween ERAS group and traditional group （22.6% vs. 24.4%, P= 0.851）. In additional, patients in ERAS group suffered less postoperative pain and recovered faster than those of traditional group （all P〈0.05）. Conclusions Routine use of the ERAS program for patients with primary liver cancer is safe, and not associated with increased postoperative morbidity after open hepatic resection. It not only improve subjective sensation in preoperative but also promote the postoperative recovery of gastrointestinal function and relieve postoperative pain. Hence ERAS was feasible and safe for open hepatectomy.

关 键 词：加速康复外科 肝切除术 有效性 安全性 

分 类 号：R735.7[医药卫生—肿瘤]