加速康复外科对肝门部胆管癌根治术的应用效果及并发症影响

目的探讨加速康复外科(ERAS)对腹腔镜肝门部胆管癌根治术的应用效果及并发症的影响。方法回顾性分析2017年3月2019年3月于我院肝胆外科行肝门部胆管癌根治术患者45例资料,将其分为围术期加速康复外科组及传统组,前者设为EARS组21例,后者设为常规组24例。采用统计软件SPSS24.0进行数据分析处理,围术期指标、VAS疼痛评分、应激反应指标等计量资料采用(±s)表示,行独立t检验;术后并发症采用χ^2检验,P<0.05为检验标准。结果EARS组术中出血量、术后恢复指标优于常规组,手术时间长于常规组(P<0.05)。术中淋巴结清扫、术后并发症总发生率两组差异无统计学意义(P>0.05)。术后6 h、12 h、24 h两组疼痛程度随时间均明显增加,48 h时两组疼痛程度逐渐减低,EARS组疼痛度始终小于常规组(P<0.05)。术后1 d两组应激指标皮质醇(Cor)、去甲肾上腺素(NE)及白介素-6(IL-6)水平较术前明显升高,但第3天逐渐下降,EARS组始终明显低于常规组(P<0.05)。结论加速康复外科应用于肝门部胆管癌根治术中可有效促进患者术后快速康复,降低术后并发症的发生,临床应用效果较好。

Clinical outcome and complications of radical resection of hilar cholangiocarcinoma based on enhanced recovery after surgery principles

ObjectiveTo investigate the clinical outcome and complications of radical resection of hilar cholangiocarcinoma based on enhanced recovery after surgery principles. MethodsFrom March 2017 to March 2019, clinical data of 45 patients underwent radical resection of portal cholangiocarcinoma were analyzed retrospectively. 21 patients were divided into the enhanced recovery after surgery group (EARS group) and 24 patients were divided into the conventional group. Statistical analysis were performed by using SPSS24.0 software. Measurement data such as perioperative indicators, VAS pain scores, stress response indicators were represented as ( ±s) and were examined by using independent t test. Postoperative complications were analyzed by using χ² test. A P value of <0.05 was considered as statistical significant difference. ResultsThe intraoperative blood loss and postoperative recovery indicators in the EARS group were better than those in the conventional group, and the operation time was much longer than that in the conventional group (P<0.05). There was no significant difference, in terms of intraoperative lymph node dissection time and total incidence of postoperative complications, between two groups (P>0.05). In both two groups, pain scores increased significantly at 6h, 12h and 24 h after surgery and gradually decreased at 48 h after surgery Pain scores in the EARS group were always lower than those in the conventional group at each time point respectively (P<0.05). The levels of Cor, NE and IL-6 were significantly increased in both two groups on day 1 after surgery, then gradually were decreased on day 3, and with lower levels in the EARS group at each time point respectively, compared with the conventional group (P<0.05). ConclusionBased on enhanced recovery after surgery principles, radical resection of hepatic hilar cholangiocarcinoma could effectively promote the rapid postoperative recovery of patients, and could reduce the incidence of postoperative complications, with better clinical outcome.