加速康复外科在开腹大肝癌切除病例中的应用与研究

发布时间：2018-10-21 17:30

【摘要】：目的:本次研究将探讨与评价围手术期拟用ERAS程序在开腹大肝癌切除术病例中是否具有可行性、有效性及安全性。方法:选取西南医科大学附属医院2014年08月01日~2017年04月01日在我院行大肝癌切除术的患者为研究对象,总共101例,男性58例,女性43例,并将患者随机分为ERAS组与传统围手术期管理组,ERAS组围手术期采取加速康复理念指导下的优化处理方案,对照组围手术期采取传统的处理方案,两组患者都以共同的出院标准。就两组患者围手术期应激指标变化情况、达到出院标准的时间、术后患者住院时间、术后患者的疼痛VAS评分、术后患者胃肠道功能恢复情况、术后患者留置鼻胃管时间、术后患者留置腹腔引流管时间、术后相关并发症等做出比较分析。结果:(1)基本资料:两组患者在年龄、性别、体重、身高、BMI、术前血红蛋白、术前ALT、术前AST、术前ASA分级、术前ECOG评分、术前BCLC分级、术前肝功能Child-pugh分级差异无统计学意义(P0.05)。(2)术中肝叶切除术的类型:两组患者术中肝叶切除术的类型差异无统计学意义(P0.05)。(3)术前评估中,ERAS组患者饥饿、口渴感发生率明显低于传统围手术期管理组,(P值0.001);ERAS组患者恐慌、焦虑感发生率低于传统围手术期管理组,具有统计学意义(P值0.05)。(4)两组患者在手术所需时间、术中出血量的多少、术中第一肝门阻断时间、术中有无输血方面差异无统计学意义。(5)术后相关应激指标:ERAS组术后第1、3、5天CRP水平明显低于传统治疗组,两组间差异具有统计学意义(P0.05);两组患者在术后IL-6、白细胞、血糖方面无统汁学差异(P0.05)。(6)术后疼痛感:术前及术后第5天VAS评分两组间差异无统计学意义(P0.05),加速康复组术后当天以及术后第1,3天VAS评分明显低于传统管理组,两组间差异具有统计学意义(P0.05)。(7)术后拔管时间:ERAS组患者术后鼻胃管、导尿管、腹腔引流管拔除时间明显短于传统管理组,两组间差异具有统计学意义(P0.05)。(8)术后康复:ERAS组患者术后开始进食时间、术后下床活动时间、术后肛门排气时间、术后肛门排便时间明显短于传统治疗组,两组间差异具有统计学意义(P0.05)。(9)术后90天内并发症发生率与再入院率:术后相关并发症以Dindo-Clavien分类法进行分级,ERAS组与传统治疗组患者术后90天内并发症发生率及再入院率两组间差异无统计学意义(P0.05)。(10)TRD以及术后住院日,总住院费用:ERAS组患者在TRD、术后住院日明显短于传统治疗组,两组间差异有统计学意义(P0.05),ERAS组总住院费用明显少于传统治疗组,两组间差异具有统计学意义(P0.05)。结论:ERAS理念应用于大肝癌切除术病例中能够加速康复进程,减轻术后应激反应,缩短住院时间,减少住院费用,然而ERAS组与传统管理组在控制术后并发症发生率方面无明显差异;总之,围手术期拟用ERAS程序在大肝癌切除术病例中具有可行性、有效性及安全性。
[Abstract]:Objective: to investigate and evaluate the feasibility, efficacy and safety of perioperative ERAS program in patients with large open liver cancer. Methods: 101 patients (58 males and 43 females) who underwent hepatectomy in our hospital from 01 August 2014 to 01 April 2017 in the affiliated Hospital of Southwest Medical University were selected. The patients were randomly divided into ERAS group and traditional perioperative management group. The ERAS group adopted the optimized treatment plan under the guidance of the idea of accelerated rehabilitation during the perioperative period, and the control group adopted the traditional treatment plan during the perioperative period. The two groups of patients were discharged to the same standard. According to the changes of stress index in perioperative period, the time of discharge, the time of hospitalization, the VAS score of postoperative pain, the recovery of gastrointestinal tract function, the time of keeping nasogastric tube. The time of indwelling celiac drainage tube and postoperative complications were compared and analyzed. Results: (1) basic data: age, sex, weight, height, hemoglobin before BMI, preoperative ASA grade before ALT, ECOG score before operation, BCLC grade before operation in both groups. There was no significant difference in preoperative Child-pugh grade of liver function (P0.05). (2). There was no significant difference in the type of intraoperative hepatectomy between the two groups (P0.05). (3). In the preoperative evaluation, the patients in the ERAS group were hungry. The incidence of thirst was significantly lower than that of the traditional perioperative management group (, (P value 0.001); ERAS), and the incidence of anxiety was lower than that of the traditional perioperative management group (P0. 05). (4). There was no significant difference in the first hepatic portal occlusion time and blood transfusion during the operation. (5) postoperative stress index: the level of CRP in the ERAS group was significantly lower than that in the traditional treatment group on the 1st day, 3th day after operation, and 5 days after operation. The difference between the two groups was statistically significant (P0.05). There was no significant difference in blood glucose between the two groups (P0.05). (6): there was no significant difference in VAS score between the two groups before and after 5 days (P0.05). The VAS score in the accelerated rehabilitation group was significantly lower than that in the traditional management group on the postoperative day and the 1st day after the operation (P0.05). There was significant difference between the two groups (P0.05). (7) postoperative extubation time: ERAS group patients after nasal and gastric tube, catheter, abdominal drainage tube extraction time was significantly shorter than the traditional management group. The difference between the two groups was statistically significant (P0.05). (8) postoperative rehabilitation: the ERAS group patients began to eat time after surgery, the time to get out of bed, postoperative anal exhaust time, postoperative anal defecation time was significantly shorter than the traditional treatment group. The difference between the two groups was statistically significant (P0.05). (9) the incidence of complications within 90 days after operation and readmission rate: the postoperative complications were classified by Dindo-Clavien classification, and the incidence of complications and re-entry in the ERAS group and the traditional treatment group within 90 days after operation. There was no significant difference in hospital rate between the two groups (P0.05). (10) TRD and postoperative hospitalization days. Total hospitalization cost: the hospitalization days of ERAS group were significantly shorter than that of the traditional treatment group after TRD, and the difference between the two groups was statistically significant (P0.05). The total hospitalization cost of the), ERAS group was significantly lower than that of the traditional treatment group (P0.05). Conclusion: the idea of ERAS can accelerate the rehabilitation process, reduce the stress response, shorten the hospitalization time and reduce the hospitalization cost in patients with large liver cancer. However, there was no significant difference in the incidence of postoperative complications between the ERAS group and the traditional management group. In short, the perioperative ERAS procedure was feasible, effective and safe in patients with large liver cancer.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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