ERAS理念在腹腔镜肝切除术治疗肝内胆管结石中的应用  

Application of enhanced recovery after surgery concept during laparoscopic liver resection for intrahepatic bile duct stones

作　　者：董瑞鹏 沈娜 刘彩云[1] 史光军[1] Dong Ruipeng;Shen Na;Liu Caiyun;Shi Guangjun(Department of Hepatobiliary Surgery,Qingdao Hospital,University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital),Shandong Qingdao 266000,China)

机构地区：[1]康复大学青岛医院(青岛市市立医院)东院肝胆外科,山东青岛266000

出　　处：《腹部外科》2024年第3期185-189,共5页Journal of Abdominal Surgery

基　　金：青岛市卫健委科技计划项目(2020-WJZD008)。

摘　　要：目的探讨加速术后康复(enhanced recovery after surgery,ERAS)理念应用于微创肝切除术治疗肝内胆管结石肝萎缩病人围手术期的临床价值。方法回顾性队列研究分析青岛市市立医院肝胆外科2016年12月至2023年3月通过腹腔镜下肝切除术治疗的63例肝内胆管结石肝萎缩病人的临床资料,根据围手术期处理方法不同将其分为ERAS组(32例)和对照组(常规组,31例)。比较分析ERAS理念对病人术中情况(手术时间及术中出血量)、住院费用、术后肝功能、康复时间及并发症等指标的影响。呈偏态分布的计量资料以M(Q1,Q3)表示,采用秩和检验。结果ERAS组与对照组比较,病人术后康复时间明显缩短[6.0(5.0,7.0)d比8.0(5.0,9.0)d,P<0.01],住院费用更少[46531(38676,51311)元比55553(47638,65529)元,P<0.01],并发症发生率更低[31.3%(10/32)比93.5%(29/31),P<0.01],术后留置T管率更低[28.1%(9/32)比58.1%(18/31),P<0.01];两组病人在手术时间、出血量以及术后1 d、3 d的血谷丙转氨酶、谷草转氨酶、C反应蛋白及预后营养指数方面差异均无统计学意义(均P>0.05)。结论ERAS理念应用于肝切除治疗肝胆管结石肝萎缩的围手术期管理是安全有效的,有助于病人的快速安全康复,值得在肝内胆管结石肝切除术中推广。Objective To explore the application value of enhanced recovery after surgery(ERAS)in patients with intrahepatic biliary stones plus liver atrophy.Methods From December 2016 to March 2023,a retrospective cohort study was conducted.The relevant clinical data were retrospectively reviewed for 63 patients with intrahepatic biliary stones plus liver atrophy undergoing laparoscopic liver resection.They were assigned into two groups of ERAS(n=32)and contro(l n=31).Comparative analysis was performed for examining the effects of ERAS concept on intraoperative status(operative duration&intraoperative blood loss),hospitalization expense,postoperative liver function,rehabilitation time and complications.Results As compared with control group,ERAS patients had significantly shorter postoperative recovery time[6.0(5.0,7.0)vs.8.0(5.0,9.0)day,P<0.01],lower hospitalization expense[46531(38676,51311)vs.55553(47638,65529)yuan,P<0.01],lower incidence of complications[31.3%(10/32)vs.93.5%(29/31),P<0.01]and lower postoperative T-tube retention rate[28.1%(9/32)vs.58.1%(18/31),P<0.01].However,no significant inter-group differences existed in intraoperative duration,volume of blood loss,plasma alamine/aspartate aminotransferase level,C-reactive protein or prognostic nutritional parameters(all P>0.05).Conclusion During perioperative management of liver resection,application of ERAS concept is both safe and effective.With a rapid and safe rehabilitation of patients,it is worth popularizing for liver resection of intrahepatic bile duct stones plus liver atrophy.

关 键 词：加速术后康复 肝内胆管结石 肝切除术 

分 类 号：R675.3[医药卫生—外科学]