加速康复外科理念用于肝囊型肝包虫病外囊剥离手术治疗的效果观察  

Efficacy observation of enhanced recovery after surgery protocols on the treatment of hepatic cyst-type hepatic echinococcosis by external capsule dissection

作　　者：刘学军[1] 木尼热丁.艾则孜 张新龙[1] 陈智全[1] 买买提江.喀斯木 陈剑[2] LIU Xunjun;Munreding·Aizezi;ZHANG Xinlong(Department of General Surgery, the No.1 People's Hospital of Aksu, Xingjiang 843000, China)

机构地区：[1]新疆阿克苏地区第一人民医院普外科,843000 [2]浙江省立同德医院普外科

出　　处：《浙江医学》2018年第5期475-478,共4页Zhejiang Medical Journal

摘　　要：目的探讨加速康复外科理念用于肝囊型肝包虫病外囊剥离手术治疗的效果。方法选取拟行外囊剥离术治疗的肝囊型肝包虫病患者70例,将患者随机分成加速康复组和传统对照组,各35例。加速康复组患者应用加速康复外科理念治疗。传统对照组患者按照传统围术期治疗方案处理。观察并比较两组患者手术时间、术中出血量、术中与术后输血情况,手术前(术前1d)后(术后1d)血清C反应蛋白(CRP)、TNF-α、降钙素原(PCT)及空腹血糖水平,术后下床活动时间、进食时间、肛门排气时间及住院天数。结果两组患者手术时间、术中出血量、术中与术后输血情况及手术前CRP、TNF-α、PCT、空腹血糖水平比较差异均无统计学意义(均P>0.05);加速康复组患者术后CRP、TNF-α、PCT、空腹血糖水平均低于传统对照组(均P<0.05),术后下床活动时间、进食时间、肛门排气时间均早于传统对照组(均P<0.05),住院天数少于传统对照组(P<0.05)。结论加速康复外科理念应用于肝囊型肝包虫病外囊剥离术治疗中可以有效降低患者围术期应激反应与炎症反应,有助于患者快速康复。Objective To evaluate the application of enhanced recovery after surgery(ERAS)protocol for patients with hepatic cyst-type hepatic echinococcosis treated by external capsule dissection.Methods Seventy patients with hepatic cystic echinococcosis undergoing external capsule dissection were assigned to be managed by ERAS protocol(ERAS group)or conventional protocol(control group),with35patients in each group.The mean operation time,volume of intraoperative blood loss and perioperative blood transfusion were compared between two groups.The serum C-reactive protein(CRP),tumor necrosis-α(TNF-a),procalcitonin(PCT)levels and fasting plasma glucose levels were measured1d before and1d after operation.The times of postoperative ambulation,fasting,anal exhaust and length of postoperative hospital stay were documented and compared.Results There were no significant differences in mean operation time,volume of intraoperative blood loss,intraoperative and postoperative blood transfusion;preoperative serum CRP,TNF-a,PCT and fasting plasma glucose levels between two groups(P>0.05).The postoperative serum CRP,TNF-a,PCT and fasting plasma glucose levels of ERAS group were lower than those of control group(P<0.05).The times of postoperative ambulation,fasting,anal exhaust and the length of postoperative hospital stay of ERAS group were shorter than those of control group(P<0.05).Conclusion ERAS protocols are able to relief perioperative stress and inflammation response,enhance the recovery after surgery for patients with hepatic cyst-type hepatic echinococcosis treated by external capsule dissection.

关 键 词：加速康复外科 肝包虫病 C反应蛋白 肿瘤坏死因子 前降钙素原 

分 类 号：R657.3[医药卫生—外科学]