加速康复外科策略在老年患者行腹腔镜胆总管一期缝合术中的应用  

Application of enhanced recovery after surgery strategy in laparoscopic primary choledochal suture in elderly patients

作　　者：刘进衡 王妍亭[1] 唐世川 肖宏[1] 尹思能[1] Liu Jin-heng;Wang Yan-ting;Tang Shi-chuan;Xiao Hong;Yin Si-neng.(Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Chengdu City, Chengdu 610015,China)

机构地区：[1]成都市第二人民医院肝胆胰外科

出　　处：《肝胆胰外科杂志》2019年第9期526-530,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：四川省卫生计生委2017年科研课题（17PJ119）

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)策略在老年患者行腹腔镜胆总管一期缝合术中的应用效果。方法前瞻性分析62例行腹腔镜胆囊切除术+经胆囊管切开胆道镜取石+一期缝合术的胆总管结石合并胆囊结石的老年患者(年龄>60岁),随机分为加速康复外科策略组(ERAS组,n=31)和传统组(n=31)。比较两组患者术中指标、术后指标和并发症情况。结果 ERAS组与传统组比较,手术时间[(165.52±26.69)min vs (161.45±19.09)min]、术中出血量[20(20,30)mL vs 20(20,30)mL]、术后第1天腹腔引流量[30(15,50)mL vs 30(15,110)mL]、术后胆红素[26.8(17.8,33.3)μmol/L vs 25.3(14.8,57.2)μmol/L]、术后血清淀粉酶[54(35,85)U/L vs 51(32,115)U/L]、术后谷丙转氨酶[101(56,157)U/L vs 110(68,157)U/L]水平差异均无统计学意义(P>0.05)。两组术后住院时间[10(9,11)d vs 13(12,18)d]、患者首次下床活动时间[1(1,1)d vs 2(1,2)d]、肠道功能恢复时间[1(1,1)d vs 1(1,1)d]、引流管拔除时间[4(4,5)d vs 6(5,7)d、P<0.05]、术后输液停止时间[8(7,9)d vs 11(9,16)d]以及术后疼痛[4(12.9%) vs 13(41.9%)]方面,差异有统计学意义(P<0.05)。两组并发症发生情况[1(3.2%) vs4(12.9%)]差异无统计学意义(P>0.05)。结论加速康复外科策略能提高老年患者在腹腔镜胆总管一期缝合术围手术期的恢复,提高术后生活质量。Objective To investigate the effect of enhanced recovery after surgery (ERAS) strategy in elderly patients undergoing laparoscopic primary choledochal suture. Methods Clinical data of 62 elderly patients with choledocholithiasis complicated with cholecystolithiasis who underwent laparoscopic cholecystectomy, cholecystectomy via choledochoscopy and primary choledochal suture were analyzed prospectivly. Patients were randomly divided into the ERAS group (n=31) and the traditional group (n=31). Surgical indicators, postoperative indicators and complications were compared between the two groups. Results Compare the two groups (ERAS group vs traditional group): there were no significant differences on operative time [(165.52±26.69)min vs (161.45±19.09)min], intraoperative bleeding volumn [20(20, 30)mL vs 20(20, 30)mL], intraperitoneal drainage on 1^st day postoperative [30(15, 50)mL vs 30(15, 110)mL], postoperative bilirubin [26.8(17.8, 33.3)mol/L vs 25.3(14.8, 57.2)mol/L], postoperative serum amylase [54(35, 85)U/L vs 51(32, 115)U/L] and postoperative ALT [101(56, 157)U/L vs 110(68, 157)U/L, P>0.05];there were significant differences on postoperative hospitalization time [10(9, 11)d vs 13(12, 18)d, P<0.05], time to get out of bed [1(1, 1)d vs (1, 22)d], recovery time of intestinal function [1(1, 1)d vs 1(1, 1)d], time of drainage tube removal [4(4, 5)d vs 6(5, 7)d], postoperative infusion stop [8(7, 9)d vs 11(9, 16)d, P<0.05], postoperative pain [4(12.9%) vs 13(41.9%), P<0.05]. The difference of postoperative complication incidence between two groups was not significant [1(3.2%) vs 4(12.9%), P>0.05]. Conclusion The strategy of ERAS can improve the perioperative recovery of the elderly patients after primary laparoscopic choledochal suture, which has a positive effect on postoperative quality of life.

关 键 词：加速康复外科策略 腹腔镜胆总管一期缝合术 老年患者 

分 类 号：R657.42[医药卫生—外科学]