快速康复外科在胆道结石手术中的应用
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摘要
目的探讨快速康复外科在胆道结石手术中的应用效果。方法方便选取在该院2017年3月—2018年9月期间治疗肝外胆道结石病的347例患者作为分析对象,快速康复组(172例,以下简称FTS组)接受快速康复治疗方案,对照组(175例)接受传统治疗方案。对比两组患者术后临床效果的各项指标及术后并发症发生率。结果 FTS组患者的下床活动时间、首次排便时间、首次排气时间和住院时间分别为(11.23±2.45)h、(21.34±5.21)h、(16.57±2.39)h、(3.47±0.58)h;均少于对照组的(21.61±3.23)h、(35.49±6.53)h、(24.34±4.75)h、(5.64±0.35)h,差异有统计学意义(t=5.025、6.334、5.158、5.216,P<0.05);FTS组患者术后腹胀、疼痛、恶心呕吐、切口感染、尿路感染、以及肺部感染的并发症发病率分别为43.60%、23.84%、39.53%、4.07%、2.33%、3.49%,均低于对照组的51.43%、65.71%、52.57%、9.14%、7.43%、10.29%,差异有统计学意义(P<0.05)。结论在胆道结石手术中应用快速康复外科治疗方案可有效提高临床效果,降低并发症发生率并缩短患者住院时间,有较高的应用价值,值得推广。
Objective To investigate the application effect of rapid rehabilitation surgery in biliary calculi surgery. Methods A total of 347 patients with extrahepatic biliary calculi were treated in our hospital from March 2017 to September 2018.The rapid rehabilitation group(172 patients, hereinafter referred to as FTS group) received rapid rehabilitation treatment and control group(175 cases received a traditional treatment plan). The indexes of postoperative clinical effects and the incidence of postoperative complications were compared between the two groups. Results The time of getting out of bed, the time of first defecation, the time of first defecation and the length of stay in the FTS group were(11.23±2.45)h,(21.34±5.21)h,(16.57±2.39)h,(3.47±0.58)h, less than(21.61±3.23) h,(35.49±6.53) h,(24.34±4.75) h,(5.64±0.35) h in the control group,and the difference was statistically significant(t=5.025、6.334、5.158、5.216, P<0.05); The incidence of postoperative abdominal distension, pain, nausea and vomiting, wound infection, urinary tract infection, and pulmonary infection in the FTS group were 43.60%, 23.84%, 39.53%, 4.07%, 2.33%, and 3.49%, respectively, lower than the control group of 51.43%,65.71%, 52.57%, 9.14%, 7.43%, 10.29%, the difference was statistically significant(P<0.05). Conclusion The application of rapid rehabilitation surgical treatment in biliary calculi can effectively improve the clinical effect. It can reduce the incidence of complications and shorten the hospitalization time of patients. It has a high application value and is worth promoting.
Objective To investigate the application effect of rapid rehabilitation surgery in biliary calculi surgery. Methods A total of 347 patients with extrahepatic biliary calculi were treated in our hospital from March 2017 to September 2018.The rapid rehabilitation group(172 patients, hereinafter referred to as FTS group) received rapid rehabilitation treatment and control group(175 cases received a traditional treatment plan). The indexes of postoperative clinical effects and the incidence of postoperative complications were compared between the two groups. Results The time of getting out of bed, the time of first defecation, the time of first defecation and the length of stay in the FTS group were(11.23±2.45)h,(21.34±5.21)h,(16.57±2.39)h,(3.47±0.58)h, less than(21.61±3.23) h,(35.49±6.53) h,(24.34±4.75) h,(5.64±0.35) h in the control group,and the difference was statistically significant(t=5.025、6.334、5.158、5.216, P<0.05); The incidence of postoperative abdominal distension, pain, nausea and vomiting, wound infection, urinary tract infection, and pulmonary infection in the FTS group were 43.60%, 23.84%, 39.53%, 4.07%, 2.33%, and 3.49%, respectively, lower than the control group of 51.43%,65.71%, 52.57%, 9.14%, 7.43%, 10.29%, the difference was statistically significant(P<0.05). Conclusion The application of rapid rehabilitation surgical treatment in biliary calculi can effectively improve the clinical effect. It can reduce the incidence of complications and shorten the hospitalization time of patients. It has a high application value and is worth promoting.
引文
[1]江志伟,李宁.结直肠手术应用加速康复外科中国专家共识(2015版)[J].中华胃肠外科杂志,2015(8):785-787.
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[3]马先仕,王雄彪,肖绪鹏,等.快速康复外科在腹腔镜下胆总管结石手术的临床应用[J].中华实验外科杂志,2015,32(2):425-426.
[4]陈晓鹏,王东,崔巍,等.加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究[J].中华消化外科杂志,2015,14(1):47-51.
[5]李奇男,张玉怀,耿婕.快速康复外科在胆道结石患者围手术期护理中安全性和有效性的Meta分析[J].临床肝胆病杂志,2015,31(10):1660-1664.
[6] Podda M, Polignano FM, Luhmann A, et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis[J]. Surg Endosc,2016, 30(3):845-861.
[7]林树文,方颖华,袁智明,等. 3镜联合同期治疗内镜取石失败的胆道结石[J].中国内镜杂志,2016,22(3):101-104.
[8] Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery:Enhanced Recovery After Surgery(ERAS)Society Recommendations[J]. World J Surg, 2013, 37(2):285-305.
[9]董宝利.多镜联合在胆道结石临床治疗中的应用研究进展[J].医学理论与实践,2016,29(5):594-595.
[10]田伟国,李军.肝外胆管结石患者的快速康复治疗[J].吉林医学,2013,34(26):5414-5415.
[2]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6
[3]马先仕,王雄彪,肖绪鹏,等.快速康复外科在腹腔镜下胆总管结石手术的临床应用[J].中华实验外科杂志,2015,32(2):425-426.
[4]陈晓鹏,王东,崔巍,等.加速康复外科联合腹腔镜胆总管探查术治疗胆总管结石的前瞻性研究[J].中华消化外科杂志,2015,14(1):47-51.
[5]李奇男,张玉怀,耿婕.快速康复外科在胆道结石患者围手术期护理中安全性和有效性的Meta分析[J].临床肝胆病杂志,2015,31(10):1660-1664.
[6] Podda M, Polignano FM, Luhmann A, et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis[J]. Surg Endosc,2016, 30(3):845-861.
[7]林树文,方颖华,袁智明,等. 3镜联合同期治疗内镜取石失败的胆道结石[J].中国内镜杂志,2016,22(3):101-104.
[8] Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery:Enhanced Recovery After Surgery(ERAS)Society Recommendations[J]. World J Surg, 2013, 37(2):285-305.
[9]董宝利.多镜联合在胆道结石临床治疗中的应用研究进展[J].医学理论与实践,2016,29(5):594-595.
[10]田伟国,李军.肝外胆管结石患者的快速康复治疗[J].吉林医学,2013,34(26):5414-5415.