改良快速康复外科在腹腔镜胆囊切除手术中的实施经验  

Application of improved rapid enhanced recovery after surgery in laparoscopic cholecystectomy

作　　者：邹创欢 周陈杰[2] 袁春辉 陈锦铭 龙定超 ZHOU Chuanghuan;ZHOU Chenjie;YUAN Chunhui;CHEN Jingming;LONG Dingchao

机构地区：[1]广州市番禺区石碁人民医院普通外科,广州511450 [2]南方医科大学珠江医院肝胆外科,广州510282

出　　处：《岭南现代临床外科》2018年第6期668-670,674,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨对传统快速康复外科进行改良的可行性,为腹腔镜胆囊切除手术提供更优化、更完善的临床治疗模式。方法选择2017年2月～2018年6月间需行腹腔镜胆囊切除手术的病人并按入院顺序分成为改良快速康复外科组(改良组)和传统快速康复外科组(传统组),每组各71例,全面对比分析两组在术前紧张度、手术时间、术中出血量、排尿排气时间、自主下床时间、切口疼痛程度、恢复普食时间、住院天数及住院费用的差异。结果与传统组相比,改良组病人术后并发症发生率较传统组低。改良组术后排尿早7.18±1.30 h vs. 6.63±1.62 h,排气早17.48±0.61 vs. 15.45±0.75 h,自主下床早12.75±1.05 vs. 12.27±1.71 h,恢复普食早(30.41±5.84 vs.26.80±4.91)h,费用减低(12794.1±2737.3 vs. 11092.8±2368.9)元,住院时间缩短(7.3±3.2 vs. 5.9±2.5)天,病人的主观感受优于传统组(P<0.001)。结论传统快速康复外科经改良优化后应用腹腔镜胆囊切除手术,缩短住院天数,减少病人围术期痛苦,为快速康复提供了新的方法和思路。Objective To explore the feasibility of the improved on traditional rapid enhanced recovery after surgery(ERAS),for providing more perfect model of clinical treatment in laparoscopic cholecystectomy(LC).Mothed The patients required cholecystectomy from Feb 2017 to jun 2016 were divided into either improved-ERAS group and traditional-ERAS group,with 71 cases in each group.The preoperative tensity,operation time,intraoperative bleeding,micturition and flatus time,time to get out off bed,time to intake general diet,level of incision pain,days of in-hospital,and hospitalization coast were compared.Results Compared with traditional-ERAS group,postoperative complication rate of improved-ERAS group was low.The improved-ERAS group had shorter micturition time(7.18±1.30 vs.6.63±1.62h),shorter flatus time(17.48±0.61 vs.15.45±0.75 h),shorter time to get out off bed(12.75±1.05 vs.12.27±1.71 h),shorter time to general diet(30.41±5.84 vs.26.80±4.91 h),lower coast(12794.1±2737.3 vs 11092.8±2368.9 yuan),shorter days of in-hospital(7.3±3.2 vs.5.9±2.5days),and patients′subjective feeling were superior to traditional-ERAS group(P<0.001).Conclusion Laparoscopic cholecystectomy is applied to traditional ERAS after improvement and optimization could shorten the length of in-hos-pital and reduce the pain of patients during perioperation.It will provide new methods and ideas for ERAS.

关 键 词：改良快速康复外科 腹腔镜 胆囊切除 

分 类 号：R657.4[医药卫生—外科学]