基于加速康复外科理念的腹腔镜胰十二指肠切除术腹腔引流管拔管指征的临床价值研究  

A retrospective comparative study on optional timing of removal of abdominal drains after laparoscopic pancreaticoduodenectomy based on the enhanced recovery after surgery concept versus conventional practice

作　　者：张树彬[1] 周新博 冯峰 胡子轩 邢中强 刘建华[1] Zhang Shubin;Zhou Xinbo;Feng Feng;Hu Zixuan;Xing Zhongqiang;Liu Jianhua(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Hepatobiliary Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000 [2]河北医科大学第一医院肝胆外科,石家庄050000

出　　处：《中华肝胆外科杂志》2022年第4期250-253,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：河北省卫生厅课题(20190586)。

摘　　要：目的探讨基于加速康复外科(ERAS)理念的腹腔镜胰十二指肠切除术(LPD)腹腔引流管拔管指征的临床价值。方法回顾性分析2020年1月至2021年6月在河北医科大学第二医院肝胆外科及河北医科大学第一医院肝胆外科行LPD患者的临床资料。共纳入127例患者,其中男性74例,女性53例,年龄(58.68±8.65)岁。依据LPD后腹腔引流管采用的拔管指征分为两组:以ERAS理念为指导的患者作为ERAS组(n=61),以传统拔管指征为指导的患者作为对照组(n=66)。ERAS组同时满足以下两点即可拔管:(1)术后第1天腹腔引流液无胆汁、无胃肠内容物及脓性分泌物渗出,无活动性出血;(2)术后第1天腹腔引流液淀粉酶<5000 U/L。对照组同时满足以下三点可拔管:(1)腹腔引流液无胆汁、无胃肠内容物及脓性分泌物渗出,无活动性出血;(2)自术后第1天始,每间隔1 d测定引流管引流液淀粉酶,连续2次血清淀粉酶浓度<5000 U/L;(3)腹腔引流液量小于100 ml/24 h。观察比较两组患者的术后恢复情况等临床资料。结果两组患者均顺利行LPD,无死亡病例。与对照组相比,ERAS组患者的腹腔引流管拔除时间[1比7(5,9)d]、第一次经肛门排气时间[3(2,4)比3(3,5)d]和术后住院天数[14(10,18)比17(14,22)d]均缩短,住院费用减少[10.33(9.64,11.52)比11.22(10.38,13.58)万元],两组间差异均具有统计学意义(P<0.05)。结论在熟练掌握LPD技术的基础上,应用基于ERAS理念定义的腹腔引流管拔管指征指导LPD术后腹腔引流管的拔管是安全可行的。Objective To study the optional timing of removal of abdominal drains after laparoscopic pancreaticoduodenectomy(LPD)based on the enhanced recovery after surgery(ERAS)concept versus conventional practice.Methods The clinical data of patients who underwent LPD at the Second Hospital of Hebei Medical University and the First Hospital of Hebei Medical University from January 2020 to June 2021 were retrospectively analyzed.Of 127 patients included in this study,there were 74 males and 53 females,with age of(58.68±8.65)years old.Then patients were divided into two groups according to the timing of removal of abdominal drains based on the ERAS concept(the ERAS group,n=61),and conventional clinical practice(the control group,n=66).The abdominal drains in the ERAS group was removed based on 2 criteria:(1)no discharge of bile,gastrointestinal contents,pus,and active bleeding in the abdominal drains on the first day after operation;(2)amylase in abdominal drainage fluid was less than 5000 U/L on the first day after operation.The abdominal drains in the control group was removed after meeting the following criteria:(1)no discharge of bile,gastrointestinal contents,pus,and active bleeding in the abdominal drains;(2)from the first day after operation,amylase levels in the drain fluid was measured once everyday,and the concentrations of the amylase were less than 5000 U/L for 2 consecutive days;(3)the volume of drainage was less than 100 ml/24 h.The postoperative recovery and other clinical data of the two groups were also compared.Results LPD was successfully performed in the 2 groups,and there was no perioperative death.The timing of removal of abdominal drains[1 vs.7(5,9)d],the first passage of flatus[3(2,4)vs.3(3,5)d]and the postoperative hospital stay[14(10,18)vs.17(14,22)d]in the ERAS group were significantly shorter than the control group,and the hospitalization cost was also significantly less[10.33(9.64,11.52)vs.11.22(10.38,13.58)wan yuan](all P<0.05).Conclusion The ERAS concept in guiding the timing of removal of ab

关 键 词：腹腔镜检查 胰十二指肠切除术 康复 

分 类 号：R657.5[医药卫生—外科学]