目的 探讨加速康复外科(ERAS)在开腹肝切除围术期中的应用效果.方法 回顾性分析2015年9月～2017年8月于南华大学附属第一医院肝胆胰外科行开腹肝切除术的120例患者的临床资料,将其分为实验组(开展ERAS)与对照组(未开展ERAS).患者细分为肝内结石亚组(共73例,实验组38例,对照组35例)、肝脏肿瘤亚组(共47例,实验组22例,对照组25例)和肝段切除≤2亚组(共49例,实验组26例,对照组23例)、肝段切除＞2亚组(共71例,实验组34例,对照组37例)分别进行比较.比较各组患者术后白细胞、中重度疼痛发生率、肛门排气时间、进食时间、下床活动时间、引流管拔除时间、并发症发生率、住院时间及费用.结果 四个亚组中,大部分实验组在术后1、3d白细胞峰值、术后肛门排气时间、进食时间、下床活动时间、中重度疼痛发生、住院天数及住院费用方面低于对照组,差异有统计学意义(P＜0.05).结论 ERAS应用于开腹肝切除围术期是安全有效的,能够显著加速患者术后康复.%Objective To investigate the effect of postoperative recovery of the enhanced recovery after surgery (ERAS) in perioperative period of open hepatectomy.Methods Clinical data of 120 patients with open hepatectomy in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of University of South China were retrospectively analyzed,and they were divided into experimental group (EG,Implement ERAS) and control group (CG,Not implement ERAS),the patients were subdivided into subgroups including hepatic stone group (n=73,EG 38 cases and CG 35 cases),hepatic tumor group (n=47,EG 22 cases and CG 25 cases),hepatectomy at least two segments group (n=49,EG 26 cases and CG 23 cases) and at most two segments group (n=71,EG 34 cases and CG 37 cases).The postoperative white blood cell (WBC),the incidence of moderate to severe pain,exhaust time,feeding time,ambulation time,complications,hospital stays and costs of patients in each groups were compared.Results In the four subgroups,compared with CG,most EG had low peak of WBC postoperative 1,3 d,less time of exhaust,feeding,and ambulation,lower incidence of severe pain,shorter hospital stay and less hospital cost,the difference was statistically significant (P ＜ 0.05).Conclusion ERAS programs can safely and effectively accelerate recovery of patient undergoing open hepatectomy.
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