加速康复外科在腹腔镜胰十二指肠切除围手术期的渐进式应用

目的 探讨加速康复外科(ERAS)在腹腔镜胰十二指肠切除术(LPD)围手术期渐进式应用的临床效果.方法 前瞻性分析西安交通大学附属咸阳市中心医院肝胆外科2018年3月至2021年3月拟行LPD的112例患者临床资料.采用渐进式推行ERAS:所有病例经术前按标准严格排查,术前及术中均采用ERAS所要求的处理措施.手术过程...

Progressive application of enhanced recovery after surgery in perioperative period of laparoscopic pancreaticoduodenectomy

Objective To investigate the clinical effects of perioperative application of progressive enhanced recovery after surgery (ERAS) in laparoscopic pancreaticoduodenectomy (LPD). Methods The clinical data of 112 patients who would undergo LPD in Xianyang Central Hospital between Mar. 2018 and Mar. 2021 were prospectively analyzed. Progressive ERAS administration: All cases were strictly investigated preoperatively according to the standard, and the management measures required by ERAS were used preoperatively and intraoperatively. The 23 patients with complicated surgical procedures were discharged from ERAS mode after surgery, and the remaining 89 patients were divided into two groups by random number method: whole-process ERAS group (45 cases) and conventional postoperative treatment group (44 cases). The general preoperative situation of patients in the two groups was analyzed, and the intraoperative blood loss, operation time, postoperative analgesic times, anal exhaust time, abdominal drainage tube removal time, hospitalization time and postoperative complications of LPD between the two groups were compared. Results There was no perioperative death in both groups. Comparison of postoperative analgesic times, ambulation time, first anal exhaust time, abdominal drainage tube removal time and hospitalization time between the two groups (t=3.468, -3.26, -6.01, -12.3, -1.926), the incidences of gastric empting disorders and abdominal infection between the two groups (χ²=3.592, 3.212), were all statistically significant (P<; 0.05), the whole-process ERAS group was superior to the conventional postoperative treatment group, but the incidences of grade C pancreatic fistula, gastrointestinal anastomotic fistula and unplanned reoperation in whole-process ERAS group were higher than those in conventional postoperative treatment group (P<; 0.05). There was no significant difference in postoperative abdominal bleeding or biliary fistula between the two groups (P>; 0.05). Conclusion In the perioperative period of LPD, progressive ERAS is implemented according to the individual situation of patients, with safe recovery as the first and rapid recovery as the second, which can reduce the risk of unplanned surgery and death, accelerate the postoperative rehabilitation process, and shorten the average length of hospitalization time.