Peng Kun,Zhou Chonggao,Li Bixiang,et al.Application of enhanced recovery after surgery in perioperative managemengt of biliary atresia[J].Journal of Clinical Pediatric Surgery,2019,18(12):1043-1048.[doi:10.3969/j.issn.1671-6353.2019.12.011]
加速康复外科理念在胆道闭锁围手术期的应用研究
- Title:
- Application of enhanced recovery after surgery in perioperative managemengt of biliary atresia
- 分类号:
- R726;R493;R657.4+4
- 摘要:
- 目的 探讨加速康复外科理念在胆道闭锁围手术期应用的效果。方法 选择湖南省儿童医院新生儿外科2018年10月至2019年2月收治的28例经手术探查确诊为胆道闭锁并接受Kasai手术的患儿作为ERAS观察组，在围手术期采用加速康复外科管理模式；选取2018年6月至2018年9月收治并确诊为胆道闭锁的20例患儿作为对照组，采用常规管理模式。比较两组患儿手术时间、术中出血量、术后静脉营养维持时间、术后开始喂养时间、术后并发症（出血、切口感染、吻合口瘘、上呼吸道感染、胆管炎）、住院时间及住院费用。术后随访3个月。结果 两组患儿在年龄、体重、手术时间、术中出血量等方面，差异均无统计学意义（P>0.05）。但ERAS观察组术后开始喂养时间[（61.5±9.78）h vs.（150.7±15.96）h]、术后静脉营养维持时间[（7.82±0.94）d vs.（11.7±1.13）d]、住院时间[（12.04±1.00）d vs.（15.35±1.57）d]，较对照组明显缩短，差异有统计学意义（P<0.05）。ERAS观察组的住院费用较对照组[（4 0431±1 471）元vs.（44 824±3 129）元]也显著减少，差异有统计学意义（t=6.508，P<0.001）。两组患儿术后并发症发生率无统计学差异（P>0.05）。对照组有1例因发生吻合口瘘再次行手术治疗。两组均无死亡患儿。结论 围术期应用加速康复管理模式，可以降低胆道闭锁Kasai手术患儿创伤应激，促进快速康复，减少医疗费用。
- Abstract:
- Objective To investigate the effectiveness of enhanced recovery after surgery in perioperative period of biliary atresia.Methods 28 patients diagnosed with biliary atresia and underwent Kasai operation in Neonatal surgery department,Hunan Children’s Hospital from October 2018 to February 2019 were included as ERAS observation group,and the management mode of enhance drecovery after surgery was adopted during the perioperative period.20 patients who were diagnosed with biliary atresia and underwent the same surgery in Neonatal surgery department,Hunan Children’s Hospital from June 2018 to September 2018 were included as control group,adopt the conventional management mode.Compare the operation time,blood loss,and maintenance time of parenteral nutrition after operation,time recovering to oral-feeding after operation,postoperative complications (bleeding,incision infection,anastomotic fistula,upper respiratory infection and cholangitis),length and cost of hospital stay after surgery between the two groups.Results There is no significant difference between the two group in age,classification,operation time and blood loss.However,the time recovering to oral-feeding after operation[(61.5±9.78)h vs (150.7±15.96)h],maintenance time of parenteral nutrition after operation[(7.82±0.94)d vs (11.7±1.13)d],length of hospital stay[(12.04±1.00)d vs (15.35±1.57)d] and hospitalization expense[(40 431±1471)yuan vs (44 824±3 129)yuan] are significantly shortened in ERAS observation group.There is 1 case in the control group underwent reoperation because of anastomotic fistula,but there is no significant difference in postoperative complications between two groups.There is no patients readmission and death cases in both groups.Conclusion ERAS therapy in perioperative period of biliary atresia patients underwent Kasai operation can reduce trauma stress,enhance recovery and reduce hospitalization expense.
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备注/Memo
收稿日期:2019-06-26。
基金项目:湖南省科技重大专项（编号：2019SK1015）；湖南省自然科学基金（编号：2017JJ2141）
通讯作者:周崇高,Email:zhouchonggao@sina.com