加速康复外科在小儿胆总管囊肿围手术期应用的全国多中心前瞻性研究  

A national multi-center prospective study on the perioperative practice of enhanced recovery after surgery for choledochal cysts in children

作　　者：岳铭[1] 冯杰雄[2] 李延安[1] 刘远梅 高志刚[4] 陈琦[5] 席红卫[6] 尹强[7] 赵成基 白玉作[9] 李万富[10] 朱利斌[11] 唐维兵[12] 卞红强[13] 牛会忠[14] 郭志恒 杨合英[1] Yue Ming;Feng Jiexiong;Li Yan'an;Liu Yuanmei;Gao Zhigang;Chen Qi;Xi Hongwei;Yin Qiang;Zhao Chengji;Bai Yuzuo;Li Wanfu;Zhu Libin;Tang Weibing;Bian Hongqiang;Niu Huizhong;Guo Zhiheng;Yang Heying(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China;Department of Pediatric Surgery,Afiliated Hospital of Zunyi Medical University,Zunyi 563099,China;Department of General Surgery,Affiliated Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310005,China;Department of General Pediatric Surgery,Third Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of General Surgery,Children's Hospital of Shanxi Province,Taiyuan 030013,China;Department of General Surgery,Hunan Children's Hospital,Changsha 410007,China;Department of Pediatric Surgery,Second Hospital Affiliated to Lanzhou University,Lanzhou 730030,China;Department of Pediatric Surgery,Afiliated Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of Pediatric General Surgery,Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China;Department of Pediatric Surgery,Second Afiliated Hospital&Yuying Children's Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Neonatal Surgery,Children's Hospital,Nanjing Medical University,Nanjing 210008,China;Department of Pediatric Surgery,Wuhan Children's Hospital,Wuhan 430015,China;Department of General Surgery,Hebei Children's Hospital,Shijiazhuang 050031,China;Department of General Surgery,Huaihe Hospital of Henan University,Kaifeng 475002,China)

机构地区：[1]郑州大学第一附属医院小儿外科,郑州450052 [2]华中科技大学附属同济医院小儿外科,武汉430030 [3]遵义医科大学附属医院小儿外科,遵义563099 [4]浙江大学医学院附属儿童医院普通外科,杭州310005 [5]郑州大学第三附属医院小儿普通外科,郑州450052 [6]山西省儿童医院普通外科,太原030013 [7]湖南省儿童医院普通外科,长沙410007 [8]兰州大学第二医院小儿外科,兰州730030 [9]中国医科大学附属盛京医院小儿外科,沈阳110004 [10]新疆医科大学第一附属医院小儿普通外科,乌鲁木齐830054 [11]温州医科大学附属第二医院小儿外科,温州325027 [12]南京市儿童医院新生儿外科,南京210008 [13]武汉市儿童医院小儿外科,武汉430015 [14]河北省儿童医院普通外科,石家庄050031 [15]河南大学淮河医院普通外科,开封475002

出　　处：《中华普通外科杂志》2024年第11期827-832,共6页Chinese Journal of General Surgery

基　　金：河南省科技厅科技攻关项目(22210230292);河南医学教育研究(WJLX2024070)。

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在小儿胆总管囊肿围手术期应用中的效果和安全性。方法本研究采用多中心前瞻性随机对照方法,共纳入273例患儿,其中ERAS组123例、传统组150例,分别按照ERAS模式和传统模式进行围手术期的管理。比较两组患儿术后首次排气时间、开始进食时间、术后住院时间和总住院时间、并发症发生率和术后30 d再入院率及相关检验指标差异。结果与传统组相比,ERAS组术后肝功能和应激指标恢复快,开始排气的中位时间(2.0 d比3.0 d,P<0.001)、开始进食的中位时间(5.0 d比7.0 d,P<0.001)、术后住院的中位时间(6.0 d比9.0 d,P<0.001)、总住院的中位时间(13.0 d比15.0 d,P<0.001)均较短,中位住院费用低(3.7万比4.3万,P<0.001)。两组术后并发症的发生率和30 d再入院率差异均无统计学意义。结论ERAS在小儿胆总管囊肿围手术期实施安全可行,能够减少围手术期应激反应,达到快速康复和节约医疗费用的效果。ObjectiveTo evaluate the safety and efficacy of enhanced recovery after surgery(ERAS)in the perioperative period of congenital choledochal cysts in children.MethodsThis is a multicenter prospective randomized controlled study.The clinical data of 273 pediatric congenital choledochal cysts(CCC)patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform.Among them,123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode,and 150 cases in conventional group were managed according to traditional mode.The length of hospital stay,time to first farting,time to complete feeding,the incidence of complications,cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.ResultsCompared with the conventional group,median time to start farting(2.0 d vs.3.0 d,P<0.001),median time to complete feeding(5.0 d vs.7.0 d,P<0.001),median postoperative hospitalization time(6.0 d vs.9.0 d,P<0.001),the median total length of stay(13.0 d vs.15.0 d,P<0.001)were shorter,the median hospitalization cost(37,000 yuan vs.43,000 yuan P<0.001)was lower,and stress indexes recovered quickly.The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups.ConclusionIt is safe and feasible to implement ERAS for children with CCC in the perioperative period,which can reduce stress response,speed up recovery,and save medical costs.

关 键 词：康复研究 胆总管囊肿 围手术期 应激反应 

分 类 号：R726.5[医药卫生—儿科]