加速康复外科在腹腔镜胰十二指肠切除围手术期的渐进式应用  

Progressive application of enhanced recovery after surgery in perioperative period of laparoscopic pancreaticoduodenectomy

作　　者：张成[1] 安东均 冯金鸽 成鹏 杨林[1] 王金涛[1] 徐垚 ZHANG Cheng;AN Dongjun;FENG Jinge;CHENG Peng;YANG Lin;WANG Jintao;XU Yao(Department of Hepatobiliary Surgery,Xianyang Central Hospital Affiliated to Xi’an Jiaotong University,Shanxi 712000,China;Nursing Department,Xianyang Central Hospital Affiliated to Xi’an Jiaotong University,Shanxi 712000,China;Department of Anesthesiology,Xianyang Central Hospital Affiliated to Xi’an Jiaotong University,Shanxi 712000,China)

机构地区：[1]西安交通大学附属咸阳市中心医院肝胆外科,陕西咸阳712000 [2]西安交通大学附属咸阳市中心医院护理部,陕西咸阳712000 [3]西安交通大学附属咸阳市中心医院麻醉科,陕西咸阳712000

出　　处：《肝胆胰外科杂志》2022年第2期88-92,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨加速康复外科(ERAS)在腹腔镜胰十二指肠切除术(LPD)围手术期渐进式应用的临床效果。方法前瞻性分析西安交通大学附属咸阳市中心医院肝胆外科2018年3月至2021年3月拟行LPD的112例患者临床资料。采用渐进式推行ERAS:所有病例经术前按标准严格排查,术前及术中均采用ERAS所要求的处理措施。手术过程复杂的23例患者术后退出ERAS模式,剩余89例患者随机数字法分为两组:全程ERAS组(45例)和术后常规处理组(44例)。统计两组患者术前一般情况,比较两组LPD术中出血量、手术进行时间、术后应用镇痛药次数、肛门排气时间、拔除腹腔引流管时间、住院时间及手术后并发症等。结果两组均无围手术期死亡。两组术后应用镇痛药次数、下床活动时间、肛门首次排气时间、腹腔引流管拔除时间及住院时间比较(t值分别为3.468、-3.26、-6.01、-12.3、-1.926),两组胃排空障碍、腹腔感染发生率比较(χ;值分别为3.592、3.212),差异有统计学意义(均P<0.05),全程ERAS组优于术后常规处理组;但全程ERAS组术后C级胰瘘、胃肠吻合口瘘、计划外再手术发生率高于术后常规处理组(P<0.05)。两组术后腹腔出血及胆瘘情况比较,差异无统计学意义(P>0.05)。结论 LPD围手术期根据患者的个体化情况,推行渐进式ERAS,以追求康复质量为第一,快速康复为其次,可以降低计划外手术及死亡风险,加速部分患者术后康复进程,缩短平均住院时间。objective To investigate the clinical effects of perioperative application of progressive enhanced recovery after surgery(ERAS) in laparoscopic pancreaticoduodenectomy(LPD). Methods The clinical data of 112 patients who would undergo LPD in Xianyang Central Hospital between Mar. 2018 and Mar. 2021 were prospectively analyzed. Progressive ERAS administration: All cases were strictly investigated preoperatively according to the standard, and the management measures required by ERAS were used preoperatively and intraoperatively. The 23 patients with complicated surgical procedures were discharged from ERAS mode after surgery, and the remaining 89 patients were divided into two groups by random number method: whole-process ERAS group(45 cases) and conventional postoperative treatment group(44 cases). The general preoperative situation of patients in the two groups was analyzed, and the intraoperative blood loss, operation time, postoperative analgesic times, anal exhaust time, abdominal drainage tube removal time, hospitalization time and postoperative complications of LPD between the two groups were compared. Results There was no perioperative death in both groups. Comparison of postoperative analgesic times, ambulation time, first anal exhaust time, abdominal drainage tube removal time and hospitalization time between the two groups(t=3.468,-3.26,-6.01,-12.3,-1.926), the incidences of gastric empting disorders and abdominal infection between the two groups(χ2=3.592, 3.212), were all statistically significant(P<0.05), the whole-process ERAS group was superior to the conventional postoperative treatment group, but the incidences of grade C pancreatic fistula, gastrointestinal anastomotic fistula and unplanned reoperation in whole-process ERAS group were higher than those in conventional postoperative treatment group(P<0.05). There was no significant difference in postoperative abdominal bleeding or biliary fistula between the two groups(P>0.05). Conclusion In the perioperative period of LPD, progressive ERAS is impl

关 键 词：腹腔镜手术 胰十二指肠切除术 加速康复外科 围手术期处理 计划外手术 住院时间 

分 类 号：R657.5[医药卫生—外科学]