加速康复外科在肝门部胆管癌手术患者中的应用
冯金鸽 郑晓燕 安琳 张成 安东均
摘 要
目的：探讨应用加速康复外科（ERAS）理念实施肝门部胆管癌手术的围手术期处理效果。
方法：回顾性分析我科2011年3月～2014年5月收治的36例行肝门部胆管癌手术患者的围手术期处理资料，术前采用随机数字表法将其分为ERAS组（A组）和传统管理组（B组），各18例。A组按ERAS的理念行围手术期管理，B组按传统常规措施行围手术期管理。比较两组患者术后排气时间、腹腔引流管拔除时间、术后应用镇痛药的次数、术后住院时间、住院总费用、术后并发症发生情况和出院时患者满意度等情况。计量资料的比较采用t检验，计数资料的比较采用x2x检验。
结果：2组患者均临床治愈出院，无围手术期死亡。A组在术后排气时间、术后拔除腹腔引流管时间、术后应用镇痛药的次数、术后住院时间、术后并发症情况、住院总费用及患者满意度调查等方面均优于B组，差异有统计学意义（P＜0.05）。
结论：肝门部胆管癌手术患者应用ERAS理念进行围手术期管理安全有效，能降低患者术后应激反应和并发症，加速其康复进程，促使医患关系的进一步和谐。
关键词
肝门部胆管癌；围手术期；加速康复外科
Implementation of enhanced recovery after surgery in patients undergoing surgery for hilar cholangiocarcinoma
FENG Jinge，ZHENG Xiaoyan，AN Lin，ZHANG Cheng，AN Dongjun
（1.Department of hepatobiliary surgery，Xianyang Center Hospital，Xianyang 712000；2.School of Statistics，Xi'an University of Finance and Economics，Xi'an 710100，China）
ABSTRACT
Objective:To investigate the effect of ERAS on patients in perioperative period of hilar cholangiocarcinoma surgery.
Methods:The Perioperative management data of 36 patients with hilar cholangiocarcinoma who were hospitalized from March 2011 to May 2015 in our hospital were retrospectively analyzed.All the patients were randomly divided into ERAS group（A group）and the routine managements group（B group），18 patients in each group.The indexes such as postoperative evacuation time，time for removal of abdominal cavity drainage tube，time of analgesic medication，postoperative hospitalization time，total hospitalization cost，postoperative complications and satisfaction of patients were compared between the two groups.All data were analyzed using the t test or chi-square test.
Results:All patients were cured with no perioperative death.The postoperative evacuation time，time for removal of abdominal cavity drainage tube，times of analgesic medication，postoperative hospitalization time，postoperative complications，satisfaction of patients and total hospitalization cost in group A were better than that in group B（P＜0.05）.
Conclusion:The perioperative managements by ERAS in patients with hilar cholangiocarcinoma surgery is safe and effective，it could alleviate the postoperative stress reaction and reduce the occurrence rate of complications，accelerate the recovery progression of patients and improve physician patient relationship.
KEY WORDS
cholangiocarcinoma；hilar；perioperative managements；enhanced recovery after surgery
加速康复外科（enhanced recovery after surgery，ERAS）是在围术期采用有循证医学证据的系列处理优化措施，以减轻或降低患者的身心应急，使患者快速康复。肝门部胆管癌外科手术是近年来临床常采用的治疗方法，但其术后恢复慢、并发症多、死亡率高。加强围手术期管理，减轻患者的围手术期应激反应，降低术后并发症是肝门部胆管癌术后快速康复的重点。我科2011年3月～2014年5月共行肝门部胆管癌外科手术36例，现将其围手术期处理报道如下。