加速康复外科对腹腔镜胆总管探查一期缝合病人康复及应激的影响

doi:10.3969/j.issn.1005-6483.2020.07.021

摘要/Abstract

摘要： 目的分析加速康复外科（ERAS）对腹腔镜胆总管探查一期缝合病人康复及应激反应的影响。
方法回顾性分析2016年5月至2019年4月重庆市人民医院肝胆外科行腹腔镜胆总管探查一期缝合术60例病人临床资料。根据康复方式分为ERAS组（30例），对照组（30例），ERAS组采用ERAS理念进行围手术期管理，对照组则按照常规方法管理。对比两组间病人下床时间、肛门排气时间、进食时间、住院时间、住院费用、术后并发症，术前和术后第1、3、5天外周血白细胞介素（IL）-6、C反应蛋白（CRP）及白细胞计数（WBC）等。
结果两组均顺利完成手术。ERAS组术后下床时间、排气时间、进食时间提前，术后住院时间缩短，住院费用显著降低。术后并发症发生率（26.7%比50%）低于对照组，术后镇痛效果优于对照组，差异有统计学意义（P<0.05）。术后第1、3、5天，ERAS组IL-6和CRP低于对照组，分别为（80.05±27.84）μg/L比（191.47±118.26）μg/L、（52.78±33.28）μg/L比（112.98±63.89）μg/L、（18.11±8.20）μg/L比（55.80±38.62）μg/L，以及（30.46±16.37）mg/L比（56.38±38.12）mg/L、（80.05±27.84）mg/L比（113.88±68.44）mg/L、（43.60±22.49）mg/L比（66.59±35.72）mg/L，差异有统计学意义（P＜0.05）。
结论 ERAS理念应用于腹腔镜胆总管探查一期缝合病人，能够减轻术后应激反应，减少术后并发症，加速病人康复。

关键词: 加速康复外科, 腹腔镜手术, 一期缝合, 应激反应

Abstract: Objective To analyze the effect of enhanced recovery after surgery（ERAS）procedures on recovery and stress response in patients undergoing laparoscopic common bile duct exploration and primary suture（LBEPS）.
Methods Retrospective analysis of 60 patients with the LBEPS in Chongqing People’s Hospital from May 2016 to April 2019.According to the rehabilitation method，it was divided into intervention group（n=30）and control group（n=30）.The intervention group adopted the concept of ERAS for perioperative management，and the control group was managed according to the routine method.The time to get out of bed，anal exhaust time，eating time，length of stay，hospital costs，postoperative complications，and interleukin-6（IL-6），C-reactive protein（CRP），and white blood cell count（WBC）on day 1st，3rd，and 5th before and after surgery were compared between the two groups.
Results Both groups completed the operation successfully.There was no significant difference in general data between the two groups（P>0.05）.In the intervention group，the time of getting out of bed，exhaust and eating were earlier，the time of hospitalization was shorter and the cost of hospitalization was lower.The incidence of postoperative complications（26.7% vs.50%）was lower than that of the control group，and the analgesic effect was better，with statistically significant differences（P<0.05）.On the first，third and fifth days after surgery，IL-6 and CRP in the intervention group were lower than those in the control group，respectively（80.05±27.84）μg/L vs.（191.47±118.26）μg/L，（52.78±33.28）μg/L vs.（112.98±63.89）μg/L，（18.11±8.20）μg/L vs.（55.80±38.62）μg/L，（30.46±16.37）mg/L vs.（56.38±38.12）mg/L，（80.05±27.84）mg/L vs.（113.88±68.44）mg/L，（43.60±22.49）mg/L vs.（66.59±〖LM〗35.72）mg/L，the difference were statistically significant（P<0.05）.
Conclusion The concept of the ERAS to patients with the LBEPS can reduce postoperative stress response，reduce postoperative complications，and accelerate rehabilitation of patients.

Key words: fast tract surgery, laparoscopy operation, primary closure, stress reaction

张涛郑明友黄书明陈圣开李剑波商阳阳. 加速康复外科对腹腔镜胆总管探查一期缝合病人康复及应激的影响[J]. 临床外科杂志, 2020, 28(7): 669-672.

ZHANG Tao, ZHENG Mingyou, HUANG Shuming, et al.. The influence of fast tract surgery on postoperative recovery and stress reaction for laparoscopic common bile duct exploration and primary suture[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(7): 669-672.

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