ERAS在小儿先天性胆总管囊肿腹腔镜手术治疗中的应用

目的观察加速康复外科(ERAS)在小儿先天性胆总管囊肿腹腔镜手术围术期应用的临床效果。方法回顾性分析2013年7月~2019年9月行腹腔镜手术治疗的42例先天性胆总管囊肿患儿的临床资料,按围手术期处理方法的不同分为两组,各21例:对照组术后采用传统围手术期处理措施,ERAS组则在传统围手术期处理的基础上采取ERAS策略干预。比较两组患儿围术期指标及恢复情况。结果与对照组比较,ERAS组术后首次排气及拔除腹腔引流管时间早,输液总量少,术后住院时间短,差异均有统计学意义(P<0.05)。在术后炎症反应的监测中,术后1 d两组WBC及CRP均升高,第3 d、第5 d均下降,但两组仅第3 d WBC和第5 d CRP水平比较有统计学差异,ERAS组均低于对照组(P<0.05)。术后ERAS组发生胰漏、右上腹脓肿1例,经穿刺引流后治愈,肺部感染1例,对症治疗后治愈;对照组术后胆汁漏1例,保持引流通畅,术后第8 d自愈。两组术后并发症率及住院费用比较,差异均无统计学意义(P>0.05)。两组均顺利恢复出院,30 d内无再入院者。结论小儿先天性胆总管囊肿腹腔镜围术期应用ERAS策略是安全有效的,可以缩短住院时间,加速患儿康复。

Clinical Application of ERAS in the Laparoscopy for Congenital Choledochus Cyst in Children

Objective To explore the clinical effect of enhanced recovery after surgery(ERAS)in peri-operative treatment of congenital choledochus cyst in children.Methods The clinical data of 42 children with congenital choledochal cyst who underwent laparoscopic surgery from July 2013 to September 2019 were analyzed retrospectively.According to the different peri-operative treatment methods,all the children were divided into two groups,with 21 cases for each:The control group was carried out the traditional peri-operative treatment,while ERAS group plus ERAS intervention.The time of gastrointestinal recovery,time of free-abdominal drainage tube,total amount of infusion,1-,3-,5 d of WBC and CRP,incidence of complications,hospital stays and the cost of hospitalization after the surgery and the rate of readmission within 30 days after discharge were compared between the two groups.Results Compared to the control group,the time of gastrointestinal recovery and free-abdominal drainage was earlier,the total amount of infusion was less and the post-operative hospital stays was shorter in the ERAS group,and all the differences were significantly(P<0.05).In the monitoring of postoperative inflammatory reaction,both WBC and CRP increased on the 1st day and decreased on 3rd and 5th day after the operation in both groups,but there was statistical difference in WBC on 3rd and CRP on 5th day between the two group,and both index were lower in the ERAS group than those in the control group(P<0.05).In the ERAS group,pancreatic leakage and right upper abdominal abscess was found in one case and cured by drainage,pulmonary infection in one case and cured by symptomatic treatment.Bile leakage occurred in one case of the control group,and achieved self-healing on the 8th day after operation by adequate drainage.There was no statistical difference in the incidence of post-operative complication and hospital cost between the two groups(P>0.05).All cases were discharge from the hospital successfully without readmission during 30 days.Conclusion It is safe and effective to apply ERAS in the peri-operative period,which can shorten the hospitalization time,and accelerate the recovery for the children performed laparoscopic surgery of congenital choledochus cyst.