加速康复外科理念在胰十二指肠切除术围手术期的应用
| 作者: |
1王征征,
1周进学,
1李庆军,
1展翔宇,
1陈勋,
1韩风
1 郑州大学附属肿瘤医院 肝胆胰腺外科，河南 郑州 450008 |
| 通讯: |
周进学
Email: zhoujx888@126.com |
| DOI: | 10.3978/.2018.03.004 |
| 基金: | 国家自然科学基金资助项目（U1304818）；河南省科技重点攻关基金资助项目（122102310056）。 |
摘要
目的：探讨加速康复外科（ERAS）理念在胰十二指肠切除术（PD）围手术期的临床应用价值。
方法：回顾性分析郑州大学附属肿瘤医院2015年6月—2016年12月行根治性PD治疗42例患者的临床资料，所有患者围手术期均采用ERAS措施，记录术后并发症、住院时间及再入院情况等。
结果：术后第1天，所有患者行常规尿管拔除，2例因前列腺增生再次留置，22例（52.4%）患者下床活动，10例（23.8%）达预定活动标准；术后第2天，常规拔除胃管，5例因发生胃排空延迟重新留置胃管，30例（71.4%）耐受流质饮食；术后第3天，35例（83.3%）拔除腹腔引流管；术后第4天，33例（78.6%）固体饮食。术后胰瘘3例，胆汁漏1例，出血1例，腹腔积液3例，胃排空延迟4例，肺部感染1例，术后总体并发症发生率31.0%，均经对症治疗治愈，无死亡病例。中位住院时间10（8~35）d。术后30 d再入院3例（7.1%），其中胃功能不全1例，腹腔积液并感染1例，胆道感染1例。
结论：ERAS理念在PD围手术期的应用安全可行，能缩短住院时间的同时不增加术后并发症发生率和再入院率。
关键词：
胰十二指肠切除术；围手术期医护；加速康复外科
方法：回顾性分析郑州大学附属肿瘤医院2015年6月—2016年12月行根治性PD治疗42例患者的临床资料，所有患者围手术期均采用ERAS措施，记录术后并发症、住院时间及再入院情况等。
结果：术后第1天，所有患者行常规尿管拔除，2例因前列腺增生再次留置，22例（52.4%）患者下床活动，10例（23.8%）达预定活动标准；术后第2天，常规拔除胃管，5例因发生胃排空延迟重新留置胃管，30例（71.4%）耐受流质饮食；术后第3天，35例（83.3%）拔除腹腔引流管；术后第4天，33例（78.6%）固体饮食。术后胰瘘3例，胆汁漏1例，出血1例，腹腔积液3例，胃排空延迟4例，肺部感染1例，术后总体并发症发生率31.0%，均经对症治疗治愈，无死亡病例。中位住院时间10（8~35）d。术后30 d再入院3例（7.1%），其中胃功能不全1例，腹腔积液并感染1例，胆道感染1例。
结论：ERAS理念在PD围手术期的应用安全可行，能缩短住院时间的同时不增加术后并发症发生率和再入院率。
Application of enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy
CorrespondingAuthor:ZHOU Jinxue Email: zhoujx888@126.com
Abstract
Objective: To investigate the clinical value of using enhanced recovery after surgery (ERAS) protocols in perioperative period of pancreaticoduodenectomy (PD).
Methods: The clinical data of 42 patients undergoing radical PD in the Affiliated Tumor Hospital of Zhengzhou University from June 2015 to December 2016 were retrospectively analyzed. All patients received ERAS management during perioperative period. The clinical variables that included postoperative complications, length of hospitalization and readmission were recorded.
Results: On postoperative day (POD) 1, all patients underwent routine removal of urinary catheter, of whom, 2 cases had catheter indwelling due to prostatic hyperplasia, 22 patients (52.4%) successfully ambulated and 10 patients (23.8%) achieved the scheduled activity standard. On POD 2, routine gastric tube removal was performed, but the gastric tube was reintroduced in 5 cases for occurrence of delayed gastric emptying and 30 cases (71.4%) tolerated the liquid diet. On POD 3, abdominal drainage tube was removed in 35 cases (83.3%). On POD 4, 33 patients (78.6%) tolerated solid diet intake. The postoperative complications included pancreatic leakage in 3 cases, bile leakage in 1 case, bleeding in 1 case, abdominal fluid collections in 3 cases, delayed gastric emptying in 4 cases, and lung infection in 1 case, with an overall incidence of postoperative complications of 31.0%, which were all resolved after symptomatic treatment. No death occurred. The median length of hospitalization was 10 (8–35) d. Three patients (7.1%) patients required hospital readmission within 30 d of discharge, and of whom, one was for gastric insufficiency, one for abdominal fluid collection with infection and one for biliary tract infection.
Conclusion: Application of ERAS in perioperative period of PD is safe and feasible, which can reduce the length of hospitalization without increase of incidence of postoperative complications and readmission rate.
Keywords：
Pancreaticoduodenectomy; Perioperative Care; Enhanced Recovery After Surgery
Methods: The clinical data of 42 patients undergoing radical PD in the Affiliated Tumor Hospital of Zhengzhou University from June 2015 to December 2016 were retrospectively analyzed. All patients received ERAS management during perioperative period. The clinical variables that included postoperative complications, length of hospitalization and readmission were recorded.
Results: On postoperative day (POD) 1, all patients underwent routine removal of urinary catheter, of whom, 2 cases had catheter indwelling due to prostatic hyperplasia, 22 patients (52.4%) successfully ambulated and 10 patients (23.8%) achieved the scheduled activity standard. On POD 2, routine gastric tube removal was performed, but the gastric tube was reintroduced in 5 cases for occurrence of delayed gastric emptying and 30 cases (71.4%) tolerated the liquid diet. On POD 3, abdominal drainage tube was removed in 35 cases (83.3%). On POD 4, 33 patients (78.6%) tolerated solid diet intake. The postoperative complications included pancreatic leakage in 3 cases, bile leakage in 1 case, bleeding in 1 case, abdominal fluid collections in 3 cases, delayed gastric emptying in 4 cases, and lung infection in 1 case, with an overall incidence of postoperative complications of 31.0%, which were all resolved after symptomatic treatment. No death occurred. The median length of hospitalization was 10 (8–35) d. Three patients (7.1%) patients required hospital readmission within 30 d of discharge, and of whom, one was for gastric insufficiency, one for abdominal fluid collection with infection and one for biliary tract infection.
Conclusion: Application of ERAS in perioperative period of PD is safe and feasible, which can reduce the length of hospitalization without increase of incidence of postoperative complications and readmission rate.