腹腔镜胰体尾切除术患者围手术期加速康复管理及效果评估  

Application of enhanced recovery program in laparoscopic distal pancreatectomy

作　　者：丁元[1] 孙忠权 章文燕 章向英[1] 姜源聪 严盛[1] 王伟林[1] DING Yuan, SUN Zhongquan, ZHANG Wenyan, ZHANG Xiangying, JIANG Yuancong, YAN Sheng, WANG Weilin(Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Chin)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,浙江杭州310003

出　　处：《浙江大学学报（医学版）》2017年第6期625-629,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(81372626;81572975);2016年浙江省卫生高层次创新人才培养工程;浙江省重大科技专项重点社会发展项目(2015C03053)

摘　　要：目的:评估在腹腔镜胰体尾切除术中实施加速康复外科(ERAS)相关管理措施的可行性和安全性。方法:收集2016年5月至2017年5月于浙江大学医学院附属第一医院行腹腔镜胰体尾切除术36例患者的资料。所有患者根据是否实施ERAS相关管理措施分为ERAS组(12例)和对照组(24例)。对照组接受常规围手术期治疗和护理方案;ERAS组实施ERAS相关管理措施,包括多模式镇痛、术后早期下床活动和早期进食等。观察两组手术时间、术中出血量、术后排气时间、术后住院时间、术后并发症的发生率和严重程度等。结果:ERAS组手术时间、术中出血量与对照组差异无统计学意义(均P>0.05)。ERAS组患者术后排气时间较对照组提前、术后住院时间缩短(均P<0.05)。ERAS组术后并发症的发生率低于对照组(41.7%与6 6.7%),且严重程度较对照组减轻,但两组间差异无统计学意义(均P>0.05)。结论:在腹腔镜胰体尾切除术患者中实施ERAS相关管理措施能够加速患者术后肠道功能的恢复、缩短术后住院时间,同时可以减少术后并发症的发生,使患者获得更好的围手术期预后。Objective： To evaluate the feasibility and safety of applying enhanced recovery after surgery （ERAS） protocol in patients undergoing laparoscopic distal pancreatectomy. Methods： Data of 36 patients undergoing laparoscopic distal pancreatectomy from May 2016 to May 2017 in the First Affiliated Hospital, Zhejiang University School of Medicine were reviewed. The patients were divided into ERAS group （n = 12） and control group （n = 24）. The patients in ERAS group received a series of enhanced recovery procedures, including multimodal analgesia, early off-bed activity and early oral food-taking, etc. Operation time, intraoperative blood loss, time to first flatus, postoperative complications, and length of postoperative hospital stay were evaluated. Results： There were no statistically significant differences in operation time and intraoperative blood loss between ERAS group and control group （ all P 〉 0.05 ）. The time to first flatus and length of postoperative hospital stay were significantly shortened in ERAS group （ all P 〈 0.05 ）. The ERAS group had lower incidence of postoperative complications （41.7% vs. 66.7% ）, and the complications in ERAS group tended to be milder, but the differences failed to show statistical significance （ all P 〉 0.05 ）. Conclusion： The ERAS protocol for laparoscopic distal pancreatectomy can significantly promote gastrointestinal function recovery and shorten postoperative hospital stay, and may reduce the incidence of postoperative complications.

关 键 词：胰彬外科学 胰腺切除术 腹腔镜检查 康复 围手术期医护 预 后 病例对照研究 随访研究 

分 类 号：R657.5[医药卫生—外科学]