ERAS理念下腹腔镜精准肝切除在肝血管瘤治疗中的应用  

Application of precise laparoscopic hepatectomy under ERAS concept in treatment of hepatic hemangioma

作　　者：李业荣 王涛[1] 汪新天[1] 陈晨[1] Li Yerong;Wang Tao;Wang Xintian;Chen Chen(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital),Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)肝胆外科,长沙410005

出　　处：《中华肝脏外科手术学电子杂志》2023年第1期44-48,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：湖南省教育厅项目(19C1183);湘卫医政管处便函{2019}118号。

摘　　要：目的探讨加速康复外科(ERAS)理念下腹腔镜精准肝切除在治疗肝血管瘤中的应用价值。方法本研究对象为2018年4月1日至2022年4月1日在湖南省人民医院行腹腔镜精准肝切除的60例肝血管瘤患者。患者均签署知情同意书,符合医学伦理学规定。其中男24例,女26例;年龄33~71岁,中位年龄42岁。2020年以后诊治病例设为ERAS组,2020年之前病例设为对照组,各30例。观察两组围手术期情况。两组术后住院时间等数据比较采用t检验,手术方式等率的比较采用χ^(2)检验。结果两组均手术顺利,无中转开腹。ERAS组左半肝切除2例,右半肝切除9例,肝段切除19例,对照组相应为5、9、16例,两组手术方式比较差异无统计学意义(χ^(2)=1.543,P>0.05)。两组术后均无发生出血、肝衰竭、胆漏等并发症,无围手术期死亡,无术后90 d再入院。ERAS组术后24 h视觉模拟评分、首次肛门排气时间、首次排便时间、引流管留置时间、住院时间、住院费用分别为(3.7±0.6)分、(29±7)h、(43±8)h、(22±5)h、(5.3±1.2)d、(5.4±1.0)万元,明显少于对照组的(4.1±0.7)分、(36±7)h、(53±8)h、(40±7)h、(6.5±1.5)d、(6.1±1.1)万元(t=-2.382,-4.034,-4.823,-11.945,-3.305,-2.362;P<0.05)。结论ERAS理念下腹腔镜精准肝切除治疗肝血管瘤安全、有效,能促进患者快速康复,缩短住院时间,减少住院费用。Objective To evaluate the application value of precise laparoscopic hepatectomy under the concept of enhanced recovery after surgery(ERAS)in the treatment of hepatic hemangioma.Methods 60 patients with hepatic hemangioma who underwent precise laparoscopic hepatectomy in Hunan Provincial People's Hospital from April 1,2018 to April 1,2022 were recruited.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,24 patients were male and 26 female,aged from 33 to 71 years,with a median age of 42 years.30 patients who were diagnosed and treated after 2020 were assigned into the ERAS group,and 30 cases before 2020 were allocated into the control group.Perioperative conditions were observed between two groups.The data,such as length of postoperative hospital stay,were compared between two groups by t test,and the rate comparison,such as surgical method,was performed by Chi-square test.Results Patients in both groups completed the surgery successfully,without conversion to open surgery.In the ERAS group,2 patients underwent left hepatectomy,9 cases of right hepatectomy and 19 cases segmental hepatectomy,and 5,9 and 16 cases in the control group,correspondingly,where no significant difference was observed between two groups(χ^(2)=1.543,P>0.05).No postoperative complications,such as bleeding,liver failure and bile leakage,occurred in two groups.No perioperative death or readmission at postoperative 90 d was reported in two groups.In the ERAS group,the visual analogue scale(VAS)score at postoperative 24 h,time to first flatus and defecation,drainage tube indwelling time,length of hospital stay and hospitalization expense were 3.7±0.6,(29±7)h,(43±8)h,(22±5)h,(5.3±1.2)d and(5.4±1.0)×10^(4) Yuan,significantly less compared with 4.1±0.7,(36±7)h,(53±8)h,(40±7)h,(6.5±1.5)d and(6.1±1.1)×10^(4) Yuan in the control group(t=-2.382,-4.034,-4.823,-11.945,-3.305,-2.362;P<0.05).Conclusions Precise laparoscopic hepatectomy under the ERAS concept is a safe and effec

关 键 词：加速康复外科 肝切除术 血管瘤 肝脏 

分 类 号：R73[医药卫生—肿瘤]