专题研究(Monographic Study)

快速康复原则下行腹腔镜胆道探查取石在老年患者中的疗效分析

Published at: 2017年第26卷第2期

张涛 1 , 郑明友 1 , 黄书明 1 , 陈圣开 1 , 李剑波 1 , 商阳阳 1
1 重庆市人民医院 肝胆外科,重庆 400016
通讯作者 书明 黄 Email: hsm700811@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.02.003
基金:

摘要

目的:探讨快速康复外科(FTS)理念下行腹腔镜胆道探查取石术(LCBDE)在老年患者中疗效。方法:回顾性分析2013年9月—2016年9月35例采用FTS围手术期处理方案(FTS组)与2011年9月—2013年8月31例患者采用传统围手术期处理方案(传统组)行LCBDE老年患者(≥60岁)资料,比较两组患者的相关临床指标。结果:与传统组比较,FTS组术后下床时间(15.34 h vs. 26.94 h)、肛门排气时间(23.09 h vs. 36.65 h)、排便时间(53.83 h vs. 62.03 h)、进食时间(22.91 h vs. 53.29 h)均明显提前,住院时间缩短(6.29 d vs. 9.42 d),住院费用降低(1.72万元vs. 2.54万元)。此外,FTS组术后营养指标、总并发症发生率、镇痛效果均明显优于传统组(均P<0.05)。结论:老年患者在FTS原则下行LCBDE安全、有效,但仍应遵循个体化原则,以提高患者依从性,并需加强多学科合作。


Efficacy analysis of laparoscopic common bile duct exploration under the concept of fast-track surgery in elderly patients

Abstract

Objective: To investigate the efficacy of laparoscopic common bile duct exploration (LCBDE) under the concept of fast-track surgery (FTS) in elderly patients. Methods: The clinical data of 35 elderly patients undergoing LCBDE under FTS perioperative management from September 2013 to September 2016 (FTS group) and 31 patients undergoing LCBDE with traditional perioperative management during September 2011 to August 2013 (traditional group) were retrospectively analyzed. The relevant clinical variables between the two groups of patients were compared. Results: In FTS group compared with traditional group, the time to postoperative ambulation (15.34 h vs. 26.94 h), and time to first anal gas passage (23.09 h vs. 36.65 h), defecation (53.83 h vs. 62.03 h) and food intake (22.91 h vs. 53.29 h) as well as the length of hospital stay (6.29 d vs. 9.42 d) and hospitalization costs (17 200 yuan vs. 25 400 yuan) were all significantly reduced (all P<0.05). In addition, the postoperative nutritional indexes, overall incidence of complications and analgesic effects in the FTS group were all superior to those in traditional group (all P<0.05). Conclusion: LCBDE under the FTS protocol is safe and effective for elderly patients. However, the principle of individuation should also be followed for improving the patients’ compliance, and the multi-disciplinary cooperation should be enhanced.


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引用

引用本文: 涛 张, 明友 郑, 书明 黄, 圣开 陈, 剑波 李, 阳阳 商. 快速康复原则下行腹腔镜胆道探查取石在老年患者中的疗效分析[J]. 中国普通外科杂志, 2017, 26(2): 145-150.
Cite this article as: ZHANG Tao, ZHENG Mingyou, HUANG Shuming, CHEN Shengkai, LI Jianbo, SHANG Yangyang . Efficacy analysis of laparoscopic common bile duct exploration under the concept of fast-track surgery in elderly patients [J]. Chin J Gen Surg, 2017, 26(2): 145-150.