摘要 背景与目的:近年来,快速康复外科(ERAS)理念已在许多外科领域推广应用,并取得了显著成效。然而ERAS在胰十二指肠切除术(PD)围术期的应用仍然有限。本研究通过前瞻性临床分析,探讨ERAS在PD围术期管理中的应用价值。方法:前瞻性连续收集2017年12月—2019年9月间中南大学湘雅医院胰腺外科收治的101例行PD患者的临床资料,其中32例采用ERAS临床路径进行围术期管理(ERAS组),69例采用传统方法进行围术期管理(传统组)。比较两组患者的临床结局。结果:与传统组比较,ERAS组的术中失血量明显较低(P<0.05)。此外,ERAS组术后血清白蛋白水平明显高于传统组,术后肛门排气时间、下床活动时间和术后住院时间明显短于传统组,住院费用明显低于传统组(均P<0.05)。在术后并发症方面,ERAS组的总体并发症的发生率、术后胰瘘、肺部并发症发生率以及严重并发症比例均明显低于传统组(均P<0.05)。结论:将ERAS理念应用于PD围术期管理是安全、有效的,能明显降低术后并发症发生率,促进患者的快速康复。 Background and Aims:Over the past years,the concept of enhanced recovery after surgery(ERAS)has applied in a variety of surgical fields,and achieved remarkable results.However,the application of ERAS in the perioperative period of pancreaticoduodenectomy(PD)is still limited.Therefore,this study was conducted to explore the application value of ERAS in perioperative management of PD through a prospective clinical analysis.Methods:A prospective series of 101 consecutive patients undergoing PD in the Department of Pancreatic Surgery,Xiangya Hospital,Central South University from December 2017 to September 2019 were enrolled.Of these patients,32 cases adopted ERAS clinical pathway for perioperative management(ERAS group)and 69 cases received conventional protocols for perioperative management(conventional group).The clinical results were compared between the two groups of patients.Results:Compared to conventional group,the intraoperative blood loss of patients in ERAS group was significantly reduced(P<0.05).Moreover,the postoperative albumin level in ERAS group was significantly higher than that in conventional group,the time to the first postoperative anal gas passage and ambulation as well as the length of postoperative hospital stay were significantly shorter in ERAS group than those in conventional group,and the hospitalization cost in ERAS group was significantly lower in ERAS group than that in conventional group(all P<0.05).In terms of postoperative complications,the overall incidence of postoperative complication,the incidence rates of postoperative pancreatic fistula and pulmonary complications as well as proportion of cases with severe complications were significantly decreased in ERAS group compared with conventional group(all P<0.05).Conclusion:The clinical application of ERAS protocols for perioperative management of PD is safe and feasible,which can effectively reduce the incidence of postoperative complications and accelerate the recovery of patients.
机构地区 中南大学湘雅医院普通外科/胰腺外科
出处 《中国普通外科杂志》 CAS CSCD 北大核心 2021年第3期305-312,共8页 Chinese Journal of General Surgery
基金 国家自然科学基金资助项目(81802450) 湖南省技术创新引导计划临床医疗技术创新基金资助项目(2017SK50101) 湖南省卫生健康委科研计划课题资助项目(B2019190)。
关键词 胰十二指肠切除术 快速康复外科 围手术期 术后并发症 Pancreaticoduodenectomy Enhanced Recovery After Surgery Perioperative Period Postoperative Complications
