摘要
目的探讨以“少痛(less pain)”“早动(early move)”“早食(early eat)”和“安心(reassuring)”为最终目标的“LEER”加速康复外科模式在原发性肝癌行腹腔镜下解剖性肝切除术围手术期的临床应用价值和经验。方法回顾性分析2017年5月至2020年3月期间98例在笔者所在医院行腹腔镜解剖性肝切除术的原发性肝癌患者的临床资料,分别对在围术期采用传统模式处理的40例(传统组)和采用“LEER”模式快速康复外科(ERAS)方案处理的58例(“LEER”-ERAS组)2组患者在术后并发症发生率、术后恢复情况及患者满意度方面进行比较。结果“LEER”-ERAS组较传统组术后疼痛评分更低(t=2.925,P=0.004),术后肛门排气、排便时间及恢复正常饮食时间更早(t=3.071、t=3.770、t=3.232,均P<0.005),术后下床活动时间更早(t=5.025,P<0.001),术后拔除引流管时间更早(t=3.232,P=0.001),术后住院时间更短(t=4.831,P<0.001),住院费用更低(t=3.062,P=0.003),患者就医满意度更高(χ2=9.267,P=0.002)。2组患者在手术时间、术中出血量、中转开腹率、肝门阻断时间、术后并发症情况和术后不良事件情况方面的差异均无统计学意义(P>0.05)。结论“LEER”模式ERAS方案在围术期应用于原发性肝癌患者行腹腔镜下解剖性肝切除术与传统模式组比较,具备相同的安全性和有效性,但有术后更轻的疼痛、更快的康复、更短的住院时间、更节约的费用和更高的患者就医满意度,具有进一步研究和推广的前景。
Objective To explore the clinical value and experience of enhanced recovery after surgery(ERAS)of“LEER”model with“less pain”“early move”“early eat”and“reassuring”as its ultimate goal in perioperative periodof laparoscopic anatomical hepatectomy of patients with primary liver cancer.Methods The basic clinical data of 98patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer andunderwent laparoscopic anatomical hepatectomy were retrospectively analyzed.The incidence of postoperativecomplications,postoperative recovery and patients’satisfaction were compared between 40 patients managed withtraditional model(traditional group)and 58 patients managed with measures of ERAS of“LEER”model(“LEER”-ERAS group).Results Compared with the traditional group,the“LEER”-ERAS group had lower postoperative pain scores(t=2.925,P=0.004),earlier postoperative anal exhaustion,bowel movement and normal diet(t=3.071,t=3.770,t=3.232,allP<0.005),shorter time to postoperative off-bed activity(t=5.025,P<0.001)and earlierpostoperative removal time of drainage tube(t=3.232,P=0.001).Postoperative hospital stay was shorter(t=4.831,P<0.001),the cost of hospitalization was lower(t=3.062,P=0.003),and the patient’s satisfaction with medical treatmentwas higher(χ2=9.267,P=0.002).There were no statistical difference in the operative time,intraoperative blood loss,rate ofconversion to laparotomy,blocking time of porta hepatis,postoperative complications and postoperative adverse eventsbetween the two groups(P>0.05).Conclusions Compared with the traditional model,the measures of ERAS of“LEER”model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer,is safe andeffective,and can relieve postoperative pain,accelerate postoperative rehabilitation,improve satisfaction of patients,shorten hospital stay,and reduce medical costs.It has further promotion and research value.
作者
谢青云
雷泽华
高峰畏
杨洁
鲁恒
蒋康怡
龚杰
赵欣
薛谦
XIE Qingyun;LEI Zehua;GAO Fengwei;YANG Jie;LU Heng;JIANG Kangyi;GONG Jie;ZHAO Xin;XUE Qian(Department of Hepatobiliary Pancreatic Splenic Surgery,Leshan People's Hospital of Sichuan Province,Diagnosis and Treatment Centerof Hepatobiliary Pancreatic Splenic Systemic Disease in Leshan,and The Second Batch of Hepatobiliary and Pancreatic ERAS standardwards of Hubei Chen Xiaoping Science and Technology Development Foundation,Leshan,Sichuan 614000,P.R.China;Department of Surgery and Anesthesia,Leshan people's Hospital,Leshan,Sichuan 614000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2021年第3期322-328,共7页
Chinese Journal of Bases and Clinics In General Surgery
基金
乐山市科学技术局2019年重点科技计划项目(项目编号:19JRK231)
四川省卫生健康委员会2020年卫生健康科研课题项目(项目编号:20PJ296)。
