“LEER”模式加速康复外科理念在胰十二指肠切除术中的应用  

Application of“LEER”mode enhanced recovery after surgery in pancreatoduodenectomy

作　　者：雷泽华[1] 谢青云[1] 赵欣 杨洁[1] 鲁恒[2] 高峰畏 龚杰 张艳[3] 余会平[4] 罗忠纯 蒋康怡 刘宇[1] 王清[1] 周泉宇[1] 薜谦 甘元涛 乌建平[1] 付金强[1] 杜波[1] 王志旭[1] 许鹏 LEI Ze-hua;XIE Qing-yun;ZHAO Xin;YANG Jie;LU Heng;GAO Feng-wei;GONG Jie;ZHANG Yan;YU Huiping;LUO Zhong-chun;JIANG Kang-yi;LIU Yu;WANG Qing;ZHOU Quan-yu;XUE Qian;GAN Yuantao;WU Jian-ping;FU Jin-qiang;DU Bo;WANG Zhi-xu;XU Peng(Department of Hepatobiliary and Pancreatic and Splenic Surgery,Leshan People’s Hospital,Sichuan 614000,China;Department of Surgical Anesthesiology,Leshan People’s Hospital,Sichuan 614000,China;Department of Nutrition,Leshan People’s Hospital,Sichuan 614000,China;Department of Psychosomatic Medicine,Leshan People’s Hospital,Sichuan 614000,China;Department of Rehabilitative Medicine,Leshan People’s Hospital,Sichuan 614000,China)

机构地区：[1]乐山市人民医院肝胆胰脾外科,四川乐山614000 [2]乐山市人民医院手术麻醉科,四川乐山614000 [3]乐山市人民医院营养科,四川乐山614000 [4]乐山市人民医院心身医学科,四川乐山614000 [5]乐山市人民医院康复医学科,四川乐山614000

出　　处：《肝胆胰外科杂志》2020年第3期138-142,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨"LEER"模式加速康复外科(ERAS)理念在胰十二指肠切除术中的临床应用价值。方法回顾性分析2017年9月至2019年5月乐山市人民医院收治的62例行胰十二指肠切除术的患者基本临床资料。37例围术期采用传统方案(传统组),25例围术期采用"LEER"模式ERAS方案(ERAS组)。"LEER"模式为:少痛(less pain)、早动(early move)、早食(early eat)、安心(reassuring)。结果 ERAS组相比于传统组,术后疼痛评分更低[(3.12±0.78) vs (4.59±1.01),t=6.459,P<0.05],术后胃肠道功能恢复更快[(3.28±0.46)d vs (3.76±1.01)d,t=2.205,P<0.05],术后下床活动时间[(1.96±0.79)d vs (2.62±0.64)d,t=3.635,P<0.05]及术后拔除引流管时间[(3.28±0.46)d vs (6.05±1.39)d,t=7.056,P<0.05]更早,胰漏发生率更低[20.00%(5/25) vs 51.35%(19/37),χ^2=6.181,P<0.05],住院时间更短[(11.52±1.39)d vs (15.76±2.51)d,t=7.671,P<0.05],住院费用更低[(61 610.92±4 272.13)元 vs (70 167.70±3 736.14)元,t=8.348,P<0.05]。两组手术时间、术中出血量及其他并发症无统计学差异(P>0.05)。结论"LEER"模式加速康复外科理念应用于胰十二指肠切除术安全有效,可加快术后康复,缩短住院时间,减少医疗费用。Objective To explore the clinical value and experience of the“LEER”mode enhanced recovery after surgery(ERAS)in pancreaticoduodenectomy.Methods The clinical data of 62 patients underwent pancreaticoduodenectomy in Leshan People’s Hospital from Sep.2017 to May 2019 were retrospectively analyzed.Thirty-seven cases were treated with traditional scheme during the perioperative period(traditional group),and 25 cases were applied with“LEER”mode ERAS scheme during the perioperative period(ERAS group).“LEER”mode means less pain,early move,early eat,reassuring.Results Compared with the traditional group,the postoperative pain score in the ERAS group was lower[(3.12±0.78)vs(4.59±1.01),t=6.459,P<0.05],the postoperative gastrointestinal function recovered faster[(3.28±0.46)d vs(3.76±1.01)d,t=2.205,P<0.05],time to get out of bed after operation was earlier[(1.96±0.79)d vs(2.62±0.64)d,t=3.635,P<0.05],removal of drainage tube after operation was earlier[(3.28±0.46)d vs(6.05±1.39)d,t=7.056,P<0.05],the incidence of pancreatic leakage was lower[(5/25)vs(19/37),χ^2=6.181,P<0.05],hospitalization time was shorter[(11.52±1.39)d vs(15.76±2.51)d,t=7.671,P<0.05],and hospitalization cost was lower[(61610.92±4272.13)yuan vs(70167.70±3736.14)yuan,t=8.348,P<0.05].There was no significant difference in the operation time,intraoperative blood loss or other complications between the two groups.Conclusion The“LEER”mode ERAS is safe and effective for pancreaticoduodenectomy,which can accelerate postoperative recovery,shorten hospitalization duration,and reduce medical costs.

关 键 词：加速康复外科 胰十二指肠切除术 “LEER”模式 

分 类 号：R657.5[医药卫生—外科学]