快速康复外科在腹腔镜肝切除围手术期中的应用

摘 要] 目的 探讨将快速康复外科（enhanced recovery after surgery，ERAS）策略应用于腹腔镜肝切除围手术期的临床效果。方法 采用回顾性队列研究方法，收集金华市中心医院2014年1月至2017年9月实施腹腔镜肝切除手术的190例患者资料，其中围术期采用ERAS处理策略的纳入ERAS组（n=60），围术期采用传统处理策略的纳入对照组（n=130），分析ERAS策略对患者手术时间、术中出血量、引流管留置时间、半流质饮食时间、住院费用等指标的影响。结果 两组在手术时间、术中出血量、术中输血、并发症发生率等方面，差异无统计学意义（P＜0.05）。与对照组比较，ERAS组术后第1、2、3天疼痛评分低（P=0.011、0.009、0.002），留置胃管、尿管、腹腔引流管天数少（P＜0.001），半流质饮食及肠道功能恢复天数早（P＜0.001），术后住院天数及住院费用少（P=0.001、0.014）。结论 将ERAS策略应用于腹腔镜肝切除围手术期安全可行，可以减轻术后疼痛，减少腹腔引流管及术后半流质时间，降低住院费用，值得推广应用。

Application of enhanced recovery after surgery in the perioperative period of laparoscopic hepatectomy

Abstract objective To investigate the clinical effect of enhanced recovery after surgery (ERAS) program in the perioperative period of laparoscopic hepatectomy. Methods From Jan. 2014 to Sep. 2017, 190 patients who underwent laparoscopic hepatectomy in Jinhua Central Hospital were retrospectively reviewed. Patients in the ERAS group (n=60) received ERAS management and the control group (n=130) received conventional management. The operation duration, intraoperative bleeding, drainage tube retention duration, semi-liquid food time and hospitalization cost were compared between the two groups. Results Compared with the control group, ERAS group had lower pain scores on postoperative day 1, 2 and 3 (P=0.011, 0.009, 0.002), shorter time of gastric tube, urinary catheter, abdominal drainage tube, earlier semi-fluid diet and intestinal function recovery (P< 0.001), and shorter hospitalization duration and lower cost (P=0.001, 0.014). Conclusion Guided by ERAS program, laparoscopic hepatectomy is safe and feasible, which can reduce postoperative pain, the duration of drainage tube retention and semi-liquid diet, and hospitalization cost.