加速康复外科理念下日间腹腔镜胆囊切除术患者手术当日出院的可行性  

Feasibility of discharge on the day of day-surgery laparoscopic cholecystectomy based on the concept of enhanced recovery after surgery

作　　者：钟熙豪 王月栋 刘海斌[1] 王继生[1] 金洲祥[1] 王兆洪[1] 周斌[1] ZHONG Xihao;WANG Yuedong;LIU Haibin;WANGJisheng;JIN Zhouxiang;WANG Zhaohong;ZHOU Bin(Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital and Yuying Children’s Hospital,Wenzhou Medical University,Wenzhou,Zhejiang 325200,China)

机构地区：[1]温州医科大学附属第二医院/育英儿童医院肝胆胰外科,浙江温州325200

出　　处：《肝胆胰外科杂志》2024年第12期735-739,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨加速康复外科(ERAS)理念下接受日间腹腔镜胆囊切除术(DSLC)的患者手术当日出院的可行性及安全性。方法回顾性分析温州医科大学附属第二医院2023年3月至2024年3月在ERAS指导下行DSLC的142例患者临床资料。根据是否在住院当日完成手术并出院将患者分为手术当日出院组(n=31,住院时间≤12 h)和非手术当日出院组(n=111,住院时间>12 h)。比较两组患者的基线资料、术中情况、术前及术后实验室指标、术后恢复情况。结果两组均成功实施DSLC,均无早期并发症发生,无因手术原因再次入院的病例。手术当日出院组比非手术当日出院组手术时间更短[(34.4±11.0)min vs(41.4±12.5)min,P<0.01],术后C反应蛋白(CRP)[(1.0±0.8)mg/L vs(9.4±12.7)mg/L]、谷丙转氨酶(ALT)[(32.0±11.4)U/L vs(38.9±12.5)U/L]、总胆红素(TBIL)[(12.5±4.8)μmol/L vs(18.0±6.9)μmol/L]水平更低(均P<0.01)。多因素Logistic回归分析显示,术后CRP(OR=7.062,95%CI 3.224-23.068,P<0.01)和TBIL(OR=1.282,95%CI 1.090-1.595,P<0.01)水平是DSLC患者当日出院的独立危险因素。结论在ERAS指导下部分患者DSLC手术后当日出院安全可行。Objective To explore the feasibility and safety of discharge on the day of day-surgery laparoscopic cholecystectomy(DSLC)based on the concept of enhanced recovery after surgery(ERAS).Methods A retrospective analysis was conducted on 142 patients who underwent DSLC at the Second Affiliated Hospital of Wenzhou Medical University from Mar.2023 to Mar.2024.Based on the hospitalization time(≤12 h or>12 h),patients were classified into the discharge on the day of DSLC group(n=31)and the non-discharge on the day of DSLC group(n=111).The baseline characteristics,intraoperative data,preoperative and postoperative laboratory indicators,and recovery outcomes were compared between the two groups.Results DSLC was successfully performed in both groups,with no early complication or no readmission for surgery-related reasons.Compared with the non-discharge on the day of DSLC group,the discharge on the day of DSLC group had a shorter operation time[(34.4±11.0)min vs(41.4±12.5)min,P<0.01],as well as lower postoperative levels of C-reactive protein(CRP)[(1.0±0.8)mg/L vs(9.4±12.7)mg/L],alanine aminotransferase(ALT)[(32.0±11.4)U/L vs(38.9±12.5)U/L],and total bilirubin(TBIL)[(12.5±4.8)μmol/L vs(18.0±6.9)μmol/L].Multivariate Logistic regression analysis identified that postoperative CRP(OR=7.062,95%CI 3.224-23.068,P<0.01)and TBIL(OR=1.282,95%CI 1.090-1.595,P<0.01)were independent risk factors affecting discharge on the day of DSLC.Conclusion Under the concepet of the ERAS,discharge on the day of DSLC is both feasible and safe.

关 键 词：腹腔镜胆囊切除术 日间手术 加速康复外科 手术当日出院 

分 类 号：R657.4[医药卫生—外科学]