加速康复外科在腹腔镜胰十二指肠切除术中的应用

目的 评估加速康复外科（enhanced recovery after surgery，ERAS）在腹腔镜下胰十二指肠切除术（laparoscopic pancreatoduodenectomy，LPD）围手术期的临床应用价值。方法 回顾性分析2016年1月至2018年1月河南省人民医院收治的79例行LPD的患者临床资料，其中围手术期采用ERAS处理方案的患41例（ERAS组），采用传统处理方案的患者38例（传统组）。比较分析两组患者围手术期相关参数。结果 ERAS组的术后AST（110.38±102.43）U/L]和术后血肌酐（61.20±16.46）μmol/L]均较传统组轻（427.09±1 434.66）U/L，（74.28±49.58）μmol/L，均P＜0.05）；住院时间（17.29±5.44）d]较传统组（24.68±13.28）d]短（P＜0.05）。ERAS组术后总并发症发生率、腹腔出血及肺部感染发生率均明显低于传统组（P＜0.05）。ERAS组绝大部分患者（90.4%）的术后并发症可自愈，而传统组近一半（48.5%）的术后并发症需干预处理（P＜0.05）。结论 LPD围手术期实施ERAS方案能减少患者肝肾功能损害，降低并发症发生率，缩短住院时间，促进患者早日康复。

Clinical application of enhanced recovery after surgery in laparoscopic pancreaticoduodenectomy

Objective To evaluate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic pancreatoduodenectomy (LPD). Methods Clinical data of 79 patients who underwent LPD in Henan Provincial People’s Hospital from Jan. 2016 to Jan. 2018 were retrospectively collected. Among them, 41 patients were managed with ERAS program (ERAS group) and the other 38 patients received conventional program (traditional group). The perioperative conditions of the two groups were compared and analyzed. Results Postoperative serum aspartate amino transferase AST, (110.38±102.43)U/L] and serum creatinine (61.20±16.46)μmol/L] in ERAS group were lower than those in the traditional group (427.09±1434.66)U/L, (61.20±16.46)μmol/L, all P<0.005]. The hospitalization time of ERAS group (17.29±5.44)d] was shorter than that of the traditional group (24.68±13.28)d, P<0.05)]. The total postoperative complications incidence, abdominal hemorrhage and pulmonary infection incidence in ERAS group were significantly lower than those in the traditional group (P<0.05). The vast majority of postoperative complications (90.4%) in ERAS group could be healed by themselves, while nearly half of those (48.5%) in the traditional group needed intervention (P<0.05). Conclusion The implementation of ERAS during the perioperative period of LPD can reduce the incidence of postoperative complications, reduce the impairment of liver and kidney function, promote the early recovery of patients and shorten the hospitalization time.