加速康复外科在微创保胆手术中的应用

目的：探讨加速康复外科（FTS）理念在微创保胆手术中的应用价值。 方法：将2010年1月—2013年12月间60例胆囊结石、胆囊息肉样病变患者行微创保胆者随机分为观察组和对照组，每组30例，观察组采用FTS理念围手术期处理方法，而对照组行常规的围手术期处理。比较两组患者术后住院时间、术后输液时间、住院费用、术后C反应蛋白（CRP）水平的变化、术后并发症发生率以及胆囊功能恢复时间、恢复程度。 结果：与对照组比较，观察组术后住院天数、输液时间、住院治疗总费用均有减少；术后CRP升高程度降低及升高的持续时间缩短、胆囊功能恢复时间短、胆囊功能恢复程度增加，差异均有统计学意义（均P<0.05）；两组的术后并发症发生率差异无统计学意义（P>0.05）。 结论：在微创保胆手术治疗过程中，遵循FTS理念，强化围手术期的处理，减少人为操作带来的应激反应，能更好地促进胆囊功能恢复，缩短住院时间，加速病人的康复。

Application of fast-track surgery in minimally invasive gallbladder-preserving operation

Objective: To evaluate the application value of fast-track surgery (FTS) concept in minimally invasive gallbladder-preserving operation. Methods: Sixty patients with gallstone or polypoid lesions of the gallbladder undergoing minimally invasive gallbladder-preserving operation from January 2010 to December 2013 were randomly designated to observational group and control group, with 30 cases in each group. Patients in observational group received FTS perioperative care, while those in control group were given the traditional perioperative management. The length of postoperative hospital stay, duration of postoperative transfusion, hospitalization expenses, alteration in postoperative C-reactive protein (CRP) levels and incidence of postoperative complications as well as the time and degree of gallbladder function improvement were compared between the two groups of patients. Results: In observational group compared with control group, the length of postoperative hospital stay, duration of postoperative intravenous fluid infusion and hospitalization cost were reduced, the increasing degree of postoperative CRP level was lessened with a shortened duration, the time to gallbladder function recovery was decreased and the degree of gallbladder function recovery was increased. All differences had statistical significance (all P<0.05). There was no statistical difference in incidence of postoperative complications between the two groups (P>0.05). Conclusion: In minimally invasive gallbladder-preserving therapy, using FTS conception with enhanced preoperative management and reduced stress responses to medical procedures can help accelerate gallbladder function recovery, shorten the length of hospital stay, and thereby facilitate the recovery of patients.