加速康复外科在儿童肝囊型棘球蚴病围手术期的应用

目的:探讨儿童肝囊型棘球蚴病围手术期采用加速康复外科管理模式的安全性及有效性。方法:本研究为回顾性研究，连续纳入2017年2月至2019年1月期间在新疆医科大学第一附属医院小儿外科收治的肝囊型棘球蚴病患儿44例。根据围手术期是否采用加速康复外科管理模式，将患儿分为ERAS组与对照组。其中，围手术期采用加速康复外科管理模...

Application of enhanced recovery after surgery for perioperative management of hepatic cystic echinococcosis in children

Objective To explore the safety and efficacy of employing the model of enhanced recovery after surgery(ERAS)in perioperative management of hepatic cystic echinococcosis in children.Methods From February 2017 to January 2019,retrospective analyses were performed for 44 hospitalized children with hepatic cystis echinococcosis.They were divided into two groups of ERAS(n=20)and control(n=24)according to whether or not ERAS management model was adopted.Two groups were compared with regards to operation duration,intraoperative volume of blood loss,perioperative volume of blood transfusion,postoperative complications and serum C-reactive protein(CRP),procalcitonin(PCT),interleukon-6(IL-6),fasting plasma glucose(FPG)at Day 1 postoperatively,initial time of postoperative ambulation,fasting time,exhaust time,stay of postoperative hospitalization and hospitalization expenditure.Results The levels of CRP and IL-6 at Day 1 postoperatively were lower in ERAS group than those in control group(5.73 vs.7.57 mg/L,8.17 vs.11.7 pg/ml).However,the difference was not statistically significant(P>0.05).The values of PCT and FPG at Day 1 post-operation were lower in ERAS group than those in control group(0.24±0.28)vs.(0.75±1.16)ng/L,(5.05±0.96)vs.(5.77±0.86)mmol/L]and the difference was statistically significant(P<0.05).No postoperative complication occurred in ERAS group;Four cases(16.7%)in control group,including residual cavity effusion(n=2),infection(n=1)and biliary leakage(n=1).All complications improved after conservative measures.Statistically significant inter-group differences existed in the incidence of postoperative complications(P<0.05).In ERAS group,initial time of postoperative ambulation,fasting time,exhaust time,postoperative hospitalization stay and hospitalization expenditure were(11.1±3.22)h,(17.7±3.61)h,(12.6±6.7)h,(7.75±1.58)d and(14951±3418)yuan.They were less than control group(16.2±5.32)h,(21.5±3.81)h,(24.8±8.2)h,(9.50±2.57)d and(21085±5560)yuan,And the difference was statistically significant(P<0.05).Conclusions ERAS model may lower traumatic stress,promote postoperative recovery and reduce hospitalization expenditure.And it is both safe and effective for perioperative management of children with hepatic cystic echinococcosis.