加速康复外科理念在老年患者行腹腔镜胆道探查术中的应用

Application of enhanced recovery after surgery in the elderly patients undergoing laparoscopic common bile duct exploration

摘要:

目的 探讨加速康复外科(ERAS)理念下行腹腔镜胆道探查术(LCBDE)对老年胆总管结石患者的效果。方法 入选2014年2月至2018年3月内蒙古医科大学第三附属医院普外科收治的老年胆总管结石患者120例,随机数字表法分为ERAS组及对照组,每组60例。ERAS组给予加速康复方案治疗,对照组给予常规治疗,比较2组患者的术后疗效、术后并发症及术后镇痛效果。采用SPSS 18.0统计软件对数据进行处理。组间比较采用t检验、χ²检验或秩和检验。结果 ERAS组患者相比对照组患者术后下床时间[(9.62±2.35) vs(22.51±3.32)h]、排气时间[(22.13±5.12) vs(37.51±6.43)h]、进食时间[(18.75±3.28) vs(34.69±4.47)h]、住院天数[(9.73±1.48) vs(14.73±2.92)d]明显提前,住院费用降低[(1.68±0.23)×10⁴ vs(2.47±0.32)×10⁴ RMB￥],肺部感染[5.00%(3/60) vs 13.33%(8/60)]、尿路感染[3.33%(2/60) vs 11.67%(7/60)]、腹胀发生率[8.33%(5/60) vs 20.00%(12/60)]均降低,差异均具有统计学意义(P＜0.05)。ERAS组患者术后镇痛达到优者占81.67%(49/60),明显高于对照组的48.33%(29/60),差异有统计学意义(P＜0.05)。结论 老年患者在ERAS原则下行LCBDE安全、有效,值得推广。

Abstract:

Objective To investigate the effect of laparoscopic common bile duct exploration(LCBDE) in the elderly patients with choledocholithiasis using the concept of enhanced recovery after surgery (ERAS). Methods A total of 120 elderly patients were included in the study, who were treated for choledocholithiasis in the Department of General Surgery of the Third Affiliated Hospital of Inner Mongolia Medical University from February 2014 to March 2018. They were randomly divided into ERAS group and control group with 60 in each, with the former being treated with ERAS regimen and the latter with routine procedure. The two groups were compared in the postoperative efficacy, complications and analgesia. SPSS statistics 18.0 was used to process the data. Student′s t test, Chi-square test or rank sum test was performed. Results Compared with the control group, the patients in the ERAS group got out of bed earlier [(9.62±2.35) vs (22.51±3.32) h], passed gas earlier [(22.13±5.12) vs (37.51±6.43) h], started eating earlier [(18.75±3.28) vs (34.69±4.47) h], had shorter hospital stay [(9.73±1.48) vs (14.73±2.92) d] and less hospitalization cost [(1.68±0.23)×10⁴ vs (2.47±0.32)×10⁴ RMB￥], and had lower rates of pulmonary infection [5.00%(3/60) vs 13.33%(8/60)], of urinary tract infection [3.33%(2/60) vs 11.67%(7/60)] and of abdominal distention [8.33%(5/60) vs 20.00%(12/60)]. The differences were all statistically significant (P<0.05). The proportion of the patients with satisfactory postoperative analgesia in the ERAS group was 81.67%(49/60), which was significantly higher than that in the control group [48.33%(29/60), P<0.05]. Conclusion LCBDE in elderly patients with ERAS is safe and effective, and is worth popularizing.