加速康复外科理念在肝胆管结石手术治疗中的应用

摘要

目的 探讨加速康复外科(FTS)理念在肝胆管结石手术治疗中的应用,及其对血清学指标的影响.方法 将110例择期手术治疗的肝胆管结石患者按照随机数字表法分为两组,对照组(n=55)采用传统围手术期处理措施,FTS组围手术期实施FTS外科处理流程.比较两组术后恢复情况、并发症及术后血清学指标变化.结果 FTS组术后肛门排气时间、首次排便时间、术后进食时间、住院时间均较对照组明显缩短(P<0.05).术中、术后第1天,对照组C-反应蛋白、皮质醇及血糖水平均明显升高,且明显高于FTS组 (P<0.05);两组术中总胆红素、谷丙转氨酶均较术前第1天明显升高 (P<0.05),术后3d降至术前第1天的水平(P>0.05);两组围手术期肝功能、凝血功能比较,差异均无统计学意义(P>0.05);FTS组C-反应蛋白较术前第1天明显升高,皮质醇、血糖水平围手术期比较均无显著性差异 (P>0.05).FTS组总并发症发生率为12.7%,显著低于对照组29.1%(P<0.05).结论 以FTS理念优化肝胆管患者的围手术期处理,可缓解手术的创伤与应激反应,减少并发症,加速术后康复.%Objective To explore the clinical effect of fast-track surgery (FTS) for surgical treatment of hepatolithiasis,and its impact on serological indicators. Methods 110 cases with hepatolithiasis underwent surgical treatment were divided into two groups with the random number table. FTS group(n=55) was given surgical treatment process based on FTS during perioperative period,and control group(n=55) was given traditional perioperative management measures. Postoperative recovery,complications,and change of serological indicators were compared between two groups. Results Compared with control group,the first time of defecation and flatus,time for dieting,length of hospital stay were all significantly reduced in FTS group(P<0.05). The levels of CRP,cortisol,blood glucose in control group were significantly increased at intraoperative period and 1st day after operation (P<0.05). The level of CRP in FTS group was significantly increased at 1st day before operation,there was no significant difference on the level of perioperative cortisol,blood glucose between two groups(P>0.05). The levels of total bilirubin,alanine aminotransferase in both groups were increased significantly compared with those at 1st day before operation(P<0.05),and fell to the level at 3rd day after operation(P>0.05). There were no statistically significant difference on the liver function,coagulation function in both groups during perioperative period (P>0.05). The total incidence of complications in FTS group was 12.7%,which was remarkably lower than 29.1% in control group(P<0.05). Conclusions Guided by FTS concept,surgical treatment of hepatolithiasis can effectively reduce the surgical trauma and stress,decrease the complications,and accelerate the process of postoperative rehabilitation.