目的：探讨快速康复外科（FTS）治疗对肝移植患者预后的影响。方法病例纳入标准：（1）病因为肝硬化或符合米兰标准的原发性肝癌；（2）手术方式为改良背驮式肝移植；（3）首次接受肝移植。排除标准：（1）年龄≤16岁；（2）多次肝移植手术；（3）术前或术中行肝动脉插管化疗栓塞或射频消融等治疗手段。本前瞻性随机单盲研究选取2011年1月至2013年12月在南京医科大学第一附属医院由同一医疗小组行肝移植手术且符合上述标准的52例患者。根据围手术期处理的不同分为 FTS 组（21例）和传统治疗（NFTS）组（31例）。FTS 治疗包括完善的术前教育、术前不行肠道准备、术前不放置鼻胃管、术后不放置引流管、术中预防低体温、微创切口、早期运动并加强营养等。比较两组患者术中和术后情况。采用逐步 Logistic 回归模型评估 FTS 治疗和临床观察指标之间的关系，以分析 FTS 治疗对肝移植预后的影响。结果与 NFTS 组比较，FTS 组手术时间和无肝期时间均明显缩短，同时 FTS 组术中出血量和输血率亦明显减少（均为 P ＜0.05）。此外，FTS 组患者恢复较好，术后重症监护室（ICU）住院时间和总住院时间均较 NFTS 组明显缩短（均为 P ＜0.05）。Logistic 回归分析结果显示，FTS 治疗是缩短术后 ICU 住院时间（比值比为0.301，95％可信区间为0.184～0.494，P ＝0.000）和总住院时间（比值比为0.148，95％可信区间为0.085～0.257，P ＝0.000）的有利因素。结论FTS 治疗应用于肝移植围手术期患者，可以有效改善其预后。%Objective To explore the impact of fast-track surgery (FTS)on prognosis of liver transplant patients.Methods Inclusion criterias:(1 )primary disease was cirrhosis or primary liver cancer meeting Milan criteria;(2)surgical method was modified piggyback orthotopic liver transplantation (OLT);(3)no liver transplantation operation was performed before.Exclusion criterias:(1 )age ≤ 1 6 years old;(2)receiving OLT more than 1 time;(3)transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation.From January 201 1 to December 201 3 in First Affiliated Hospital of Nanjing Medical University,52 patients meeting the criteria above were enrolled into this prospective random single-blinded study (all operations were performed by same team) .According to different peri-operative managements,they were divided into FTS group (n =21 )and non-FTS (NFTS)group (n =31 ).Protocol of FTS included comprehensive pre-operative education,no bowel preparation,no usage of nasogastric tube pre-operation and surgical drainage post-operation,prevention of hypothermic during operation, smaller incision,early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups.Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters,in order to analyze the impact of FTS on the prognosis of liver transplantation.Results Compared with NFTS group,operation time and anhepatic phase time decreased significantly in FTS group,as well as intra-operative bleeding and transfusion (all in P <0.05).Besides,intensive care unit (ICU)days and total length of stay in FTS group were shorter than those in NFTS group,which indicated a better prognosis of patients in FTS group (both in P <0.05 ).Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio:0.301 ,95% confidence interval:0.1 84-0.494,P =0.000)and total length of stay (odds ratio:0.1 48,95% confidence interval:0.085-0.257,P =0.000).Conclusions Application of FTS in perioperative period can improve the prognosis of liver transplant patients.
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