快速康复外科在胆道外科中应用的初探

目的 探讨快速康复外科(FTS)在胆道外科中应用的安全性及有效性.方法 将哈尔滨医科大学第一临床医学院2005年3月至2007年3月收治的234例接受腹腔镜胆囊切除术、小切口胆囊切除术、开腹胆总管探查切开取石术和肝管-空肠Roux-en-Y吻合术的病人随机分为对照组和FTS组.对照组采用传统的围手术期处理方法 ;FTS组采用加速康复的新型围手术期处理方法 ,主要包括术前口服碳水化合物,不留置鼻胃减压管和尿管;术中维持病人体温,控制补液量及不留置腹腔引流管;术后早期下床活动,早期进食和采取有效的镇痛措施等.结果 与传统对照组相比,FTS组病人的术后住院时间和输液时间明显缩短,术中出血量和治疗费用显著减少,术后首次排气、排便时间明显提前(P<0.05);两组手术时间并无显著差异.结论 在胆道外科中应用FTS治疗是安全、有效的,可以减少治疗费用,缩短住院时间,更好地促进病人早日康复.

Application of fast track surgery in biliary tract surgery

Objective To investigate the safety and efficacy of fast track surgery (FTS) in bili-ary tract surgery. Methods A total of 234 patients undergoing laparoscopic cholecystectomy, mini-cholecystectomy, laparo-choledocholithotomy with exploration and Roux-en-Y hepatojejunostomy in our hospital from March 2005 to March 2007 were randomly divided into control group and FTS group. The patients in the control group received conventional perioperative care, while those in the FTS group underwent optimization included preoperative oral carbohydrate without nasogastric decom-presive tube and urinary canal;intraoperative temperature maintenance, transfusion control and disuse of abdominal drainage;early postoperative mobilization, oral feeding and potent analgesia, etc. Results Compared with control group, FTS group was associated with significantly shorter postoperative hos-pital stay and duration of intravenous infusion, less medical cost and intraoperative hemorrhage as well as earlier first postoperative passage of flatus and defecation (P<0. 05). There was no significant difference in operative duration between the two groups. Conclusion The application of FTS in biliary tract surgery is safe and effective, and it can reduce medical cost, shorten postoperative hospital stay and accelerate early recovery of inpatients.