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您现在的位置:首页 => 在线期刊 => 2016年 11期 乙型肝炎抗病毒治疗 => 胆道疾病 =>加速康复外科策略在腹..
加速康复外科策略在腹腔镜联合胆道镜行胆总管切开取石Ⅰ期缝合术围手术期的临床应用
Application of fast track surgery strategy in perioperative period of primary suture of laparoscopic choledocholithotomy
文章发布日期:2016年09月28日  来源:  作者:刘进衡,王妍亭,易斌,等  点击次数:1317次  下载次数:321次

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【摘要】:目的探讨加速康复外科策略(EARS)在腹腔镜治疗胆总管结石行Ⅰ期缝合术围手术期的临床应用价值。方法选取2015年10月-2016年2月于成都市第二人民医院肝胆外科住院的胆囊结石合并胆总管结石患者64例,按其围手术期处理方式不同分为EARS组(n=32例)和对照组(n=32例),比较两组患者临床观察项目及并发症发生情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果ERAS组患者较对照组引流管拔除时间、住院时间、术后停止输液的时间明显缩短[(1.6±0.9)d vs (2.7±1.0)d, (5.1±1.0)d vs (6.8±1.1)d,(3.8±1.0)d vs (4.9±1.2)d,t值分别为-5.675、-5.910、-3.923,P值均<001],术后首次下床活动时间及肠道功能恢复时间提前[(1.0±03)d vs (1.6±0.7)d, (1.1±0.4)d vs (1.8±0.6)d,t值分别为-4.313、-4.842,P值均<0.01],住院总费用降低[(17 433.5±1411.3)万元 vs (26 651.6±2945.8)万元,t=-15.942,P<0001],且术后疼痛例数少于对照组[4(12.5%) vs 13(40.6%),χ2=6.490,P=0.011],术后ERAS组患者ALT和TBil明显低于对照组[(105.25±35.34)U/L vs (179.00±48.64)U/L,(50.78±12.60)μmol/L vs (79.70±18.56)μmol/L,t值分别为-5.973、-7.090,P值均<0.05]。结论EARS在腹腔镜手术中的围手术期治疗实用性高,能够促进患者快速康复,在肝胆胰外科的应用前景十分广阔。
【Abstract】:ObjectiveTo investigate the clinical application value of fast track surgery strategy (EARS) in the perioperative period of primary suture of laparoscopy in the treatment of common bile duct stones. MethodsA total of 64 patients with gallstones complicated by common bile duct stones who were hospitalized in Department of Hepatobiliary Surgery in The Second People′s Hospital of Chengdu from October 2015 to February 2016 were enrolled, and according to the treatment in the perioperative period, the patients were divided into EARS group (32 patients) and control group (32 patients). Clinical indices and complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the control group, the ERAS group had significantly shortened time of extraction of drainage tube (1.6±0.9 d vs 2.7±1.0 d, t=-5.675, P<0.01) and length of hospital stay (5.1±1.0 d vs 6.8±1.1 d, t=-5.910, P<0.01), significantly shorter time to first ambulation (1.0±0.3 d vs 1.6±0.7 d, t=-4.313, P<0.01) and time to intestinal functional recovery (1.1±0.4 d vs 1.8±0.6 d, t=-4.842, P<0.01), a significantly shortened time to stopping infusion after surgery (3.8±1.0 d vs 4.9±1.2 d, t=-3.923, P<0.01), significantly reduced total hospital costs (17 433.5±1411.3 ten thousand yuan vs 26 651.6±2945.8 ten thousand yuan, t=-15.942, P<0.001), a significantly lower proportion of patients who experienced pain after surgery [4 (12.5%) vs 13 (406%), χ2=6.490, P=0.011], and significantly lower levels of alanine aminotransferase (105.25±35.34 U/L vs 179.00±48.64 U/L, t=-5.973, P<0.05) and total bilirubin (50.78±12.60 μmol/L vs 79.70±18.56 μmol/L, t=-7.090, P<0.05) after surgery. ConclusionEARS is highly practical in the perioperative period of laparoscopic surgery and can promote patients′ rapid recovery. Therefore, it holds promise for clinical application.
【关键字】:胆囊结石病; 胆总管结石; 胆囊切除术, 腹腔镜; 康复
【Key words】:cholecystolithiasis; choledocholithiasis; cholecystectomy, laparoscopic; rehabilitation
【引证本文】:刘进衡, 王妍亭, 易斌, 等. 加速康复外科策略在腹腔镜联合胆道镜行胆总管切开取石Ⅰ期缝合术围手术期的临床应用[J]. 临床肝胆病杂志, 2016, 32(11): 2141-2145.

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