加速康复外科程序在肝胆管结石肝切除术中的应用

目的:探讨加速康复外科(ERAS)程序在肝胆管结石肝切除术中的应用价值。方法:回顾性分析2013年1月—2016年12月178例采用ERAS处理行肝切除术治疗的肝胆管结石患者(ERAS组)和2009年1月—2012年12月218例按传统方法进行围手术期处理行肝切除术治疗的肝胆管结石患者(常规组)的临床资料。比较两组患者的相关临床指标。结果:与常规组比较,ERAS组术后肝功能指标恢复较好(部分P0.05),术后住院时间明显缩短、首次排气时间明显提前、体质量下降明显减少、治疗总费用明显下降(均P0.05)。两组术后总并发症与各并发症发生率差异均无统计学意义(均P0.05)。两组均无死亡病例。结论:肝胆管结石肝切除术中采用ERAS程序安全、可行,既加速患者术后器官功能的恢复,又可以减少住院时间与治疗费用。

Application of enhanced recovery after surgery protocols in liver resection for hepatolithiasis

Objective: To investigate the value of using enhanced recovery after surgery (ERAS) programs in liver resection for hepatolithiasis. Methods: The clinical data of 178 patients undergoing liver resection for hepatolithiasis with ERAS management (ERAS group) from January 2013 to December 2016 and 218 patients undergoing liver resection for hepatolithiasis with conventional perioperative management (conventional group) from January 2009 to December 2012 were retrospectively analyzed. The main clinical variables between the two groups of patients were compared. Results: In ERAS group compared with conventional group, the recovery of liver function parameters after surgery was faster (partial P<0.05), the length of postoperative hospital stay was significantly shortened, the time to first flatulence was significantly reduced, the postoperative body weight loss was significantly decreased and the total hospitalization cost was significantly reduced (all P<0.05). There were no statistical differences either in incidence of overall postoperative complications or incidence of specific complication between the two group (all P>0.05). No death occurred in either of the groups. Conclusion: Using ERAS protocol in liver resection for hepatolithiasis is safe and feasible. It can effectively promote the postoperative recovery of the patients, and reduce the length of hospital stay and medical cost.