ERAS策略在腹腔镜保留脾脏的胰体尾切除术中的应用  

Application of ERAS strategies in laparoscopic spleen-preserving distal pancreatectomy

作　　者：钱建平[1,2] 朱碧娟 张起帆[1] 王恺[1] 孙世波[1] 朱碧丽[2] 李加[2] 付霞[2] 张思云[1] 李欢娱 谭清 周杰[1] QIAN Jian-ping;ZHU Bi-juan;ZHANG Qi-fan;WANG Kai;SUN Shi-bo;ZHU Bi-li;LI Jia;FU Xia;ZHANG Si-yun;LI Huan-yu;TAN Qing;ZHOU Jie(Division of Hepatobiliary and Pancreatic Surgery,Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Huiqiao Medical Center,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普通外科学肝胆胰外科,广东广州510515 [2]南方医科大学南方医院惠侨医疗中心,广东广州510515

出　　处：《肝胆胰外科杂志》2021年第12期711-714,720,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(82070642);广东省自然科学基金面上项目(2020A1515011205)。

摘　　要：目的探讨腹腔镜保留脾脏的胰体尾切除术的安全性以及围术期加速康复外科(enhanced recovery after surgery,ERAS)实施的策略和方法。方法回顾性收集2018年6月至2020年12月收治的38例胰体尾良性病变和低度恶性肿瘤行腹腔镜胰体尾切除术患者的临床资料,其中保脾组23例(实施Kimura法20例,Warshaw法3例),切脾组15例;围术期均实施ERAS措施,并分析患者术前影像学资料、手术时间、失血量、具体术式、ERAS实施方法、术后腹腔引流管拔除时间、术后住院时间、术后并发症和随访资料。结果保脾组和切脾组在肿瘤大小、手术时间、术中失血量、术后腹腔引流管拔除时间、术后住院时间及术后严重并发症方面,差异均无统计学意义(P>0.05)。全组中位引流管拔除时间为6(5~7)d,保脾组为7(4~7)d,切脾组为6(5~7)d;无死亡病例。随访时间3~18个月,无肿瘤复发转移。结论胰体尾良性和低度恶性肿瘤实施腹腔镜保留脾脏的胰体尾切除术安全可行,围术期可按照ERAS策略实施。Objective To investigate the application of ERAS strategies in laparoscopic spleen-preserving distal pancreatectomy.Methods The clinical data of 38 patients with benign and low-grade malignant tumors in body and tail of pancreas who underwent laparoscopic pancreatectomy between Jun.2018 and Dec.2020 were retrospectively analyzed.Among 38 patients,23 cases received spleen-preserving surgery,and 15 cases received splenectomy.ERAS strategies were implemented in perioperative period for all 38 patients.The preoperative imaging data,operation time,blood loss,specific operation approach,ERAS implementation methods,time of postoperative abdominal drainage tube extraction,time of postoperative hospitalization,incidence of postoperative complications and follow-up data were analyzed.Results There were no significant differences in tumor size,operation time,intraoperative blood loss,time of postoperative drainage tube removal,time of postoperative hospitalization and incidence of postoperative complications between the two groups(P>0.05).The mean time of drainage tube removal was 6(5-7)d in the whole group,7(4-7)d in the spleen-preserving group 6(5~7)d in splenctomy group,and no patient died.There was no recurrence or metastasis during the follow-up of 3~18 months.Conclusion Laparoscopic spleen-preserving distal splenectomy for benign and low-grade malignant tumors in the body and tail of pancreas can be carried out according to ERAS strategies in the perioperative period.

关 键 词：保留脾脏的胰体尾切除术 腹腔镜手术 加速康复外科 围术期管理 胰瘘 引流管拔除时间 

分 类 号：R657.5[医药卫生—外科学]