摘要
目的探讨加速康复外科(ERAS)在日间病房内镜逆行胰胆管造影(ERCP)治疗胆总管结石(CBDS)中的安全性、有效性。方法回顾性分析2015年4月至2018年4月新疆医科大学第一附属医院肝胆包虫科接受ERCP术治疗的CBDS患者211例。其中在2015年4月至2016年3月间接受传统治疗的患者85例,设为传统治疗组;2016年4月至2018年4月间接受ERAS日间治疗的126例,设为ERAS日间组。分析比较两组患者围手术期及随访情况。结果ERAS日间组患者的首次进食时间、下床活动时间显著早于传统治疗组(P<0.05),平均术后住院时间、医疗费用、口渴/饥饿感、术后恶心呕吐(PONV)发生率、腹胀腹痛发生率及术后3、12h血清淀粉酶水平明显低于传统治疗组(P<0.05);ERAS日间组患者满意度评分为(96.66±3.39)分,显著高于传统治疗组的(90.25±4.87)分(t=10.54,P<0.05),术后疼痛评分显著低于传统治疗组(z=-5.12,P<0.05)。两组患者无一例30d内再入院,术后并发症发生率、白细胞计数比较,差异无统计学意义。结论在ERAS模式下行日间ERCP治疗CBDS是安全可行的,可加快患者康复,减轻术后疼痛,提高患者满意度。
Objective To explore the safety and efficacy of enhanced recovery after surgery (ERAS) performed in ambulatory surgery ward for treatment of common bile duct stones (CBDS) using endoscopic retrograde cholangiopancreatography (ERCP).Methods A retrospective analysis was performed concerning two hundred and eleven patients who underwent ERCP surgery for CBDS in the First Affiliated Hospital of Xinjiang Medical University from April 2015 to April 2018.Eighty-five patients who were treated from April 2015 to March 2016 were divided into traditional treatment group (Group T),and 126 patients who were treated from April 2016 to April 2018 were divided into ERAS day care group (Group E). Perioperative period and follow-up status of patients between the two groups were compared and analyzed. Results The first feeding time and the time of getting out of bed in Group E were significantly earlier than that in Group T (P<0.05).The average postoperative hospital stay,medical expenses,thirst/hunger, the incidence of postoperative nausea and vomiting (PONV),the occurrence of abdominal distension and abdominal pain,and the serum amylase level at 3 and 12 h after surgery in Group E were significantly lower than those of Group T (all P<0.05).The satisfaction degree of patients in Group E was (96.66±3.39),which was higher than Group T of (90.25±4.87),with significant difference (t=10.54,P<0.05).The pain scores in Group E were significantly lower (z=-5.12,P<0.05).None of the patients in the two groups were re-admitted within 30 days.There was no significant difference in the incidence of complications and white blood cell count after operation between the two groups.Conclusion It is safe and feasible to treat CBDS with ERCP under ERAS mode in ambulatory surgery ward,which can accelerate the recovery of patients,alleviate postoperative pain and improve satisfaction of patients.
作者
徐成
吐尔干艾力·阿吉
郭强
冉博
蒋铁民
邵英梅
Xu Cheng;Tuerganaili Aji;Guo Qiang;Ran Bo;Jiang Tiemin;Shao Yingmei(Department of Liver and Laparoscopic Surgery,the FirstAffiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中华普通外科学文献（电子版）》
2019年第3期213-218,共6页
Chinese Archives of General Surgery(Electronic Edition)
基金
国家自然科学基金项目(81560098)
自治区“十三五”重点学科(高峰学科)[新教研(2016)7号]
关键词
胆总管结石
加速康复外科
日间住院医疗
内镜逆行胰胆管造影
Choledocholithiasis
Enhanced recovery after surgery
Day care
Endoscopic retrogradecholangiopancreatography
