腹腔镜胆囊切除术围手术期中医加速康复外科理念的应用  

Application of Chinese medicine enhanced recovery around surgery in perioperative period of laparoscopic cholecystectomy

作　　者：阎良[1] 黄建平[1] 汤雪峰[1] 沙粒[1] 蒋海锋[1] 孔宪诚[1] 赵聪[1] YAN Liang;HUANG Jian-ping;TANG Xue-feng;SHA Li;JIANG Hai-feng;KONG Xian-cheng;ZHAO Cong(Department of General Surgery, Shuguang Hospital Affiliated to ShanghaiUniversity of Traditional Chinese Medicine, Shanghai 200021, China)

机构地区：[1]上海中医药大学附属曙光医院普外科

出　　处：《肝胆胰外科杂志》2019年第6期352-355,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：2016年度上海中医药大学预算内项目(2016TS08)

摘　　要：目的探讨中医加速康复外科(CMERAS)理念在腹腔镜胆囊切除术(LC)围手术期中的应用。方法本试验系前瞻性研究,为系列CMERAS研究的一部分。收入2017年3月至2018年9月上海中医药大学附属曙光医院收治的胆囊息肉、胆囊结石或慢性胆囊炎患者,均接受LC,随机分为试验组和对照组两组,每组30例。试验组围手术期给予口服中药胃肠汤治疗,且试验组及对照组均按加速康复外科理念进行围手术期准备。观察术后患者胃肠道功能恢复、术后并发症、术后住院时间等情况。结果试验组LC术后排气时间[(12.5±2.2)h vs (16.1±3.4)h]、排便时间[(24.9±4.2)h vs (38.5±8.3)h]、进食时间为[(8.6±1.5)h vs(12.5±1.3)h]均显著短于对照组(P<0.05);试验组LC术后第1天胃泌素水平[(69.56±11.23)μg/mL vs (48.11±6.22)μg/mL]、胃动素水平[(198.27±36.04)μg/mL vs (124.98±20.46)μg/mL]均明显高于对照组(P<0.05);试验组术后首次下床活动时间[(4.1±1.3)h vs (7.9±1.7)h]、术后住院时间[(1.6±1.2)d vs (2.5±1.5)d]均短于对照组(P<0.05)。结论中医加速康复理念应用于LC围手术期,能加快患者胃肠道功能恢复,减少术后并发症的发生,加速患者术后康复。Objective To explore the application of Chinese medicine enhanced recovery around surgery (CMERAS) in perioperative period of laparoscopic cholecystectomy (LC). Methods This prospective study was one part of series of CMERAS experiments. Patients with gallbladder polyps, gallstones or chronic cholecystitis admitted to Shuguang Hospital from Mar. 2017 to Sep. 2018 were randomly divided into experimental group and control group (n=30 each group), all patients underwent lc . Both groups were prepared for perioperative period according to enhanced recovery around surgery theory, while the experimental group was treated with oral Chinese medicine Gastrointestinal Decoction during the perioperative period additionally. The recovery time of gastrointestinal function, complication incidence and hospitalization duration were recorded. Results In the experimental group, exhaust time after operation [(12.5±2.2) h vs (16.1±3.4) h], defecation time [(24.9±4.2) h vs (38.5±8.3) h], and feed time [(8.6±1.5) h vs (12.5±1.35) h] were significantly shorter than those in the control group (P<0.05). On the first day after operation, the gastrin level in the experimental group [(69.56± 11.23)μg/mL vs (48.11±6.22)μg/mL] and the motilin level [(198.27±36.04)μg/mL vs (124.98±20.46)μg/mL] were significantly higher than those in the control group (P<0.05). In the experimental group, the first time out of bed after operation [(4.1±1.3) h vs (7.9±1.7) h] and the hospitalization duration [(1.6±1.2) d vs (2.5±1.5) d] were shorter than those in the control group (P<0.05). Conclusion Application of Chinese medicine enhanced recovery around surgery in perioperative period of laparoscopic cholecystectomy accelerates the recovery of gastrointestinal function, reduces the occurrence of postoperative complications and enhances the postoperative rehabilitation.

关 键 词：中医加速康复 胆囊切除术 腹腔镜 中药胃肠汤 胃肠功能 

分 类 号：R619.9[医药卫生—外科学] R657.4[医药卫生—临床医学]