摘要
目的探讨快速康复外科(FTS)在腹腔镜再次胆道探查术中的应用价值。方法将52例有胆道结石手术史需行腹腔镜再次胆道探查术的胆总管结石患者分为FTS组(28例)和对照组(24例)。FTS组采用快速康复的围术期处理方法,对照组采用传统的围术期处理方法。记录两组患者术后下床时间、排气排便时间、恢复进食时间、住院时间及费用,对比血清前清蛋白(PA)、体重下降情况等营养指标,观察术后并发症发生情况和镇痛效果。结果与对照组比较,FTS组术后排便时间、下床时间、排气时间、进食时间明显提前,住院时间明显缩短,住院费用大幅降低,差异均有统计学意义(P<0.05)。两组术前、术后第3天PA水平无明显差异(P>0.05),FTS组术后第5天体重下降较对照组小(P<0.05)。FTS组并发症发生率低于对照组(P<0.05)。两组患者镇痛效果比较差异有统计学意义(P<0.05),FTS组患者恶心、呕吐的发生率明显低于对照组(P<0.05)。结论FTS联合腹腔镜再次胆道探查术可降低并发症发生率,缩短住院时间,减少住院费用,手术安全性较高,患者康复较快。
Objective To investigate the application value of fast track surgery(FTS)in laparoscopic biliary tract re-exploration.Methods Fifty-two patients with history of biliary calculi surgery requiring laparoscopic biliary tract re-exploration were divided into the FTS group(28 cases)and control group(24 cases).The FTS group adopted the perioperative treatment method of rapid rehabilitation,and the control group adopted the traditional perioperative treatment method.The postoperative time of getting out of bed,exhausting defecation time,time to recovering taking food,hospitalization time and costs were recorded in the two groups.The nutritional indexes such as serum PA and body weight decrease were compared between the two groups.The occurrence situation of postoperative complications and analgesic effect were observed.Results Compared with the control group,the postoperative defecation time,time of getting out of bed,exhausting time and time for recovering taking food in the FTS group were significantly advanced,the hospitalization time was significantly shortened,the hospitalization costs were significantly reduced,and the differences were statistically significant(P<0.05).The PA level before operation and on postoperative 3 d had no significant difference between the two groups(P>0.05),the body weight decrease on postoperative 5 d in the FTS group was less than that in the control group(P<0.05).The occurrence rate of complications in the FTS group was lower than that in the control group(P<0.05).The analgesic effect had statistical difference between the two groups(P<0.05).The occurrence rates of nausea and vomiting in the FTS group was significantly lower than that in the control group(P<0.05).Conclusion FTS combined with laparoscopic biliary tract re-exploration can reduce the occurrence rate of complications,shorten the hospitalization time,reduce the hospitalization costs,has high operation safety and rapid recovery.
作者
张涛
郑明友
黄书明
樊大明
李剑波
商阳阳
谭明达
陈圣开
ZHANG Tao;ZHENG Mingyou;HUANG Shuming;FAN Daming;LI Jianbo;SHANG Yangyang;TAN Mingda;CHEN Shengkai(Department of Hepatobiliary Surgery,Chongqing Hospital,University of Chinese Academy of Sciences,Chongqing 401121,China)
出处
《重庆医学》
CAS
2021年第12期2025-2029,共5页
Chongqing medicine
基金
重庆市科卫联合医学科研项目(2018QNXM031)
重庆市人民医院医学科技创新项目(Y2017MSXM06)。
关键词
快速康复外科
腹腔镜手术
再次胆道手术
胆总管结石病
fast track surgery
laparoscopy operation
biliary tract reoperation
choledocholithiasis
