腹腔镜胆总管探查术患者围手术期的快速康复外科处理
郑晓燕 安琳 冯金鸽 安东均 周党军
摘 要
目的：探讨腹腔镜胆总管探查术（LCBDE）患者应用快速康复外科（FTS）理念实施围手术期处理的效果。
方法：回顾性分析咸阳市中心医院肝胆外科2014年3月～2015年5月行LCBDE患者76例的资料，随机分为FTS组（39例）和传统处理组（37例）。计算2组术前术后的胰岛素抵抗指数、C反应蛋白变化、术后应用镇痛药次数、术后首次排气时间、术后腹腔引流管拔除时间、术后住院时间、术后住院总费用、术后并发症和患者满意度调查等。
结果：2组患者均临床治愈出院。对其术前至术后7d的胰岛素抵抗指数与C反应蛋白水平变化趋势比较，差异有统计学意义（F=12.93，17.74，P＜0.05）；术后应用镇痛药次数、术后首次排气时间、术后拔除腹腔引流管时间、术后时间、术后住院总费用比较，差异均有统计学意义（t=2.488，2.165，14.996，2.188，2.183，P＜0.05）；术后并发症发生率分别为15.4%（6/39）和32.4%（12/37），差异有统计学意义（x2=5.361，P＜0.05）；患者满意度调查比较，差异有统计学意义（x2=6.829，P＜0.01）。
结论：FTS能降低LCBDE患者的术后应激反应及并发症的发生率，加快其康复进程，缩短住院时间，改善临床效果。
关键词
腹腔镜外科；胆石症，胆总管；快速康复外科；胆总管探查术；围手术期处理
Management of fast tract surgery in perioperative period of patients received laparoscopic common bile duct exploration
ZHENG Xiaoyan，AN Lin ，FENG Jinge，et al.1 Department of Hepatobiliary Surgery，the Center Hospital of Xianyang City，Xianyang 71200，China；2 School of Statistics，Xi'an University of Finance and Economics，Xi'an 710100，China
ABSTRACT
Objective:To investigate the effect of management by fast tract surgery（FTS）in perioperative period of laparoscopic common bile duct exploration（LCBDE）.
Methods:The perioperative management data of 76 patients who were hospitalized from Mar 2014 to May 2015 in department of hepatobiliary surgery，the center hospital of Xianyang City and received LCBDE were retrospectively analyzed.All the patients were randomly divided into the FTS group（39 patients）and the routine nursing group（37 patients）.Before and after surgery the insulin resistance（IR）index and level of serum C-reactive protein（CRP）were calculated.The indexex such as postoperative times of analgesic medication，first time to anal exsufflation，time for removal of abdominal cavity drainage tube，hospitalization time and total cost，postoperative complications and satisfaction of patients by the third party survey were compared.
Results:All patients were cured.Their IR and CRP level change trend have been compared from preoperative day to postoperative 7 days，differences were statistically sig-nificant（F=12.9393，17.，P＜0.05）；Comparison of two groups of patients after surgery:times of analgesic medication，first time to anal exsufflation，time for removal of abdominal cavity drainage tube，hospitalization time，total cost，with statistically significant differences（t=2.488，2.165，14.996，2.188，2.183，P＜0.05）；incidence of postoperative complications were 15.4%（6/39）and 32.4%（12/37），respectively，showing statistically significant differences（x2=5.361，P＜0.05）.Two groups of patients satisfaction survey，respectively，showing statistically significant differences（x2=6.829，P＜0.01）.
Conclusion:The perioperative management by FTS in patients who received LCBDE could alleviate the postoperative stress reaction，reduce the incidence of postoperative complications，accelerate the recovery process，reduce the duration of hospital stay，improve clinical results.
KEY WORDS
Laparoscopic surgery；Cholelithiasis，common bile duct；Fast tract surgery；Common bile duct exploration；Perioperative management
快速康复外科（fast tract surgery，FTS）是在围手术期采用系列有循证医学证据的处理优化措施，以减轻患者的身心应激，促使患者快速康复，缩短患者的住院时间。自Kehlet和Wilmore［1］首次提出FTS概念以来，FTS已成功应用于胃肠外科、肝胆外科等多个外科领域［2］。但是FTS在腹腔镜胆总管探查术（laparoscopic common bile duct exploration，LCBDE）的围手术期应用尚少［3］。咸阳市中心医院肝胆外科2014年3月～2015年5月共有LCBDE患者76例，现将采用FTS的围手术期处理报道如下。