加速康复外科在ERCP治疗胆道结石手术中的临床应用和体会

摘要

Objective To compare the safety and clinical value of enhanced recovery after surgery (ERAS) vs.conventional management in the treatment of common bile duct stones with endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical data of 127 patients who underwent ERCP from May 2014 to May 2017 in Hefei Second People's Hospital were analyzed retrospectively.Among them,there were 57 cases of perioperative management with ERAS (ERAS group,n =57),and 70 cases treated by conventional management (conventional group,n =70).The incidence of intraoperative blood loss,the time of first feeding,the incidence of postoperative complications (such as nausea,vomiting,abdominal pain,hemorrhage,pancreatitis,cholangitis),cholangiography and indwelling time,length of hospital stay and hospitalization costs were compared between two groups.Results In ERAS group and traditional group,the time of first feeding was 32.0 ± 18.3 h and 45.6 ±30.3 h,the nasal cholangiography and indwelling time was 26.5 ± 7.4 and 375.7 ± 19.9 h,the hospital stay was 10.2 ± 2.8 h and 16.3 ± 6.3 h respectively,which were significantly shorter in ERAS group than in traditional group (P＜0.05 for all).The intraoperative hemorrhage was 2.7 ± 1.6 mL,the incidence of postoperative complication was 5.3 ％,which were significantly reduced in the ERAS group as compared with those in the traditional group.The hospitalization costs in the ERAS group (28 981.8 ± 6478.1 Yuan RMB) were also significant decreased as compared with those in the traditional group (P＜0.05 for all).Conclusions The concept of accelerated rehabilitation surgery is a safe,economical and effective method for the treatment of biliary calculi with ERCP.%目的 比较内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)治疗胆道结石手术中应用加速康复外科(enhanced recovery after surgery,ERAS)理念处理的安全性和临床价值.方法 回顾性分析了合肥市第二人民医院2014年5月至2017年5月期间开展ERCP手术的127例病人临床资料.其中应用ERAS理念进行围手术期处理(ERAS组)有57例,按传统方法处理(传统组)有70例.比较两组病人术中出血量、术后首次进食时间、术后并发症(恶心、呕吐、腹痛、出血、胰腺炎、胆管炎等)发生率、鼻胆管造影和留置时间、住院时间、住院费用的差异.结果 ERAS组与传统组相比,术后首次进食时间ERAS组为(32.0±18.3)h,传统组为(45.6±30.3)h;鼻胆管造影和留置时间ERAS组为(26.5±7.4)h,传统组为(375.7±19.9)h;住院时间ERAS组为(10.2±2.8)h,传统组为(16.3±6.3)h,以上指标ERAS组明显短于传统组(P＜0.05).ERAS组术中出血量为(2.7±1.6) ml、术后并发症3例(5.3％),明显少于传统组的(5.3±2.6) ml和12例(17.1％).住院费用ERAS组为(28 981.8±6 478.1)元,较传统组的(36 828.7±11 854.3)元也明显减少(P＜0.05).结论 ERAS理念在ERCP手术治疗胆道结石中是安全、经济、有效的方法.