加速康复外科在Ⅰ型小儿胆管扩张症围手术期治疗中的应用  

Application of enhanced recovery after surgery in perioperative treatment of typeⅠbiliary dilatation in children

作　　者：张现伟 贾英萍 张飞[1] 朱莹莹[1] 耿荷红 燕林 刘如意 冯欣[1] 侯广军 张万存 Zhang Xianwei;Jia Yingping;Zhang Fei;Zhu Yingying;Geng Hehong;Yan Lin;Liu Ruyi;Feng Xin;Hou Guangjun;Zhang Wancun(The Second Department of General Surgery,Children's Hospital Affiliated of Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China;Anesthesiology Department,Children's Hospital Affiliated of Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院普通外科二病区,郑州450018 [2]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院麻醉科,郑州450018

出　　处：《中华肝胆外科杂志》2019年第8期582-586,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省科技厅科技攻关项目(15210231006);郑州市科学技术局(20150169)

摘　　要：目的研究加速康复外科(ERAS)在Ⅰ型小儿胆管扩张症(BD)围手术期治疗中的临床应用价值。方法回顾性分析2014年6月至2018年5月在郑州儿童医院普通外科接受治疗的Ⅰ型BD患儿资料。采用随机数表法选取ERAS理念治疗和传统方法治疗的患儿资料各20例,分为ERAS组和对照组。比较两组患儿术后观察指标(手术时间、首次排便时间、血及腹腔渗出液淀粉酶变化、住院时间、治疗费用)及术后相关并发症(咽喉疼痛、恶心呕吐、尿道疼痛、上呼吸道感染、切口感染、粘连性肠梗阻、吻合口瘘、胰瘘)的发生情况。结果ERAS组首次排便时间[(1.98±0.25)d比(2.25±0.31)d]、术后住院时间[(6.91±1.25)d比(9.95±1.53)d]、治疗费用[(23.32±2.25)千元比(25.99±3.10)千元]均低于对照组,差异具有统计学意义(均P<0.05)。同时,ERAS组咽喉疼痛(5.0%比45.0%)、恶心呕吐(5.0%比30.0%)、尿道疼痛(5.0%比45.0%)及上呼吸道感染的发生率(5.0%比40.0%)均低于对照组,差异具有统计学意义(均P<0.05)。两组患儿手术时间、血液及腹腔渗出液淀粉酶的变化、切口感染、粘连性肠梗阻、吻合口瘘、胰瘘的发生率比较差异无统计学意义(均P>0.05)。结论ERAS在小儿Ⅰ型BD围手术期应用安全可行,可有效促进术后胃肠道功能的恢复和减少术后相关并发症的发生。Objective To study the clinical value of enhanced recovery after surgery(ERAS)in the perioperative treatment of typeⅠ(Todami,1975)biliary dilatation(BD)of children.Methods To retrospectively analyze the data of children with typeⅠBD who were treated in the General Surgery Department of Zhengzhou Children's Hospital from June 2014 to May 2018.A total of twenty children with typeⅠBD treated with ERAS and 20 children treated with the traditional method in our department were selected in this study using the random number table method.Postoperative indicators(including operation time,first defecation time,changes in amylase in blood and abdominal cavity exudates,length of hospital stay,and hospitalization fee)and relevant postoperative complications(including sore throat,nausea and vomiting,urethral pain,upper respiratory tract infection,incision wound infection,adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula)of the ERAS group and the control group were compared.Results The first defecation time,length of hospital stay and hospitalization fee were significantly lower in the ERAS group than the control group(all P<0.05)[first defecation time(1.98±0.25)d vs.(2.25±0.31)d;length of hospital stay(6.91±1.25)d vs.(9.95±1.53)d;hospitalization fee(23.32±2.25)thousand yuan vs.(25.99±3.10)thousand yuan].Moreover,the incidences of sore throat,nausea and vomiting,urethral pain and upper respiratory tract infection were significantly lower in the ERAS group than the control group(all P<0.05)[the incidences of sore throat(5.0%vs.45.0%);the incidences of sickness and vomiting(5.0%vs.30.0%);the incidences of urethral pain(5.0%vs.45.0%);the incidences of upper respiratory tract infection(5.0%vs.40.0%)].On the other hand,there were no significant differences in the mean operation times,changes in amylase levels in the blood or abdominal cavity exudates,incision wound infection,and incidences of adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula(all P>0.05).Conclusions ERAS

关 键 词：胆总管囊肿 手术后并发症 加速康复外科 小儿 

分 类 号：R65[医药卫生—外科学]