胆道闭锁Kasai手术加速康复外科理念实施
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摘要
胆道闭锁并非罕见,围术期管理较复杂。日前,ERAS理念已在小儿外科诸多疾病中得到广泛开展。本文论述Kasai手术过程中引用ERAS理念,在不影响Kasai手术效果前提下,优化胆道闭锁患儿治疗流程,可以达到快速康复的目的。
Biliary atresia( BA) is not uncommon. However,its perioperative management is rather complicated. Recently ERAS concept has been widely applied for numerous pediatric surgical procedures. This article discusses the concept of ERAS during Kasai's operation for optimizing the treatment flows for BA and achieving a rapid recovery without compromising its operative efficacy.
Biliary atresia( BA) is not uncommon. However,its perioperative management is rather complicated. Recently ERAS concept has been widely applied for numerous pediatric surgical procedures. This article discusses the concept of ERAS during Kasai's operation for optimizing the treatment flows for BA and achieving a rapid recovery without compromising its operative efficacy.
引文
1詹江华,王立.科技创新推动小儿肝胆外科发展[J].临床小儿外科杂志,2017,16(6):521-522.DOI:10.3969/j.issn.1671-6353.2017.06.001.Zhan JH,Wang L.Innovation of science and technology accelerates the development of pediatric hepatic surgery[J].JClin Ped Sur,2017,16(6):521-522.DOI:10.3969/j.issn.1671-6353.2017.06.001.
2熊希倩,詹江华,余晨,等.胆道闭锁自体肝生存时间与胆管反应的关系研究[J].临床小儿外科杂志,2018,17(11):814-820.DOI:10.3969/j.issn.1671-6353.2018.11.004.Xiong XQ,Zhan JH,Yu C,et al.Relationship between native liver survival and ductular reaction in biliary atresia[J].JClin Ped Sur,2018,17(11):814-820.DOI:10.3969/j.issn.1671-6353.2018.11.004.
3赵玉沛,熊利泽.加速康复外科中国专家共识及路径管理指南(2018+版)[J].中华实用外科杂志,2018,38(1):1-20.DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.Zhao YP,Xiong LZ.Chinese expert consensus and path management guidelines for enhanced recovery after surgery[J].Chinese Journal of Practical Surgery,2018,38(1):1-20.DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.
4舒强,钭金法.加速康复外科在小儿外科中的应用与展望[J].临床小儿外科杂志,2019,18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001.Shu Q,Tou JF.Applications and future prospects of enhanced recovery after surgery during pediatric surgery[J].JClin Ped Sur,2019,18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001.
5 Asklid D,Segelman J,Gedda C,et al.The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery-Aprospective cohort study within an ERAS protocol[J].Eur JSurg Oncol,2017,43(8):1433-1439.DOI:10.1016/j.ejso.2017.04.003.
6 Li D,Chen X,Fu K,et al.Preoperative nutritional status and its impact on cholangitis after Kasai portoenterostomy in biliary atresia patients[J].Pediatr Surg Int,2017,33(8):901-906.DOI:10.1007/s00383-017-4118-z.
7 Nygren J,Thorell A,Ljungqvist O.Preoperative oral carbohydrate therapy[J].Curr Opin Anaesthesiol,2015,28(3):364-369.DOI:10.1097/ACO.0000000000000192.
8 Alnaami I,Lam FC,Steel G,et al.Arteriovenous fistula and pseudoaneurysm of the anterior spinal artery caused by an epidural needle in a 5-year-old patient[J].J Neurosurg Pediatr,2013,11(3):340-345.DOI:10.3171/2012.12.PEDS12247.
9 Zhu Y,Wang Y,Du B,et al.Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients?A systematic review and meta-analysis[J].Crit Care,2017,21(1):206.DOI:10.1186/s13054-017-1789-8.
10 Zhou ZJ,Wang X,Song Z,et al.Effect of sevoflurane anaesthesia on hepatic blood flow in infants with obstructive hepatobiliary disease[J].Acta Anaesthesiol Scand,2016,60(8):1067-1074.DOI:10.1111/aas.12733.
11郎荣蓉.预防婴幼儿围手术期低体温的研究进展[J].天津护理,2016,24(4):360-361.DOI:10.39690.issn.1006-9143.2016.08.046.Lang RR.Research advances in the prevention of hypothermia in infants and toddlers[J].Tianjin Journal of Nursing,2016,24(4):360-361.DOI:10.39690.issn.1006-9143.2016.08.046.
12 Sun Z,Honar H,Sessler DI,et al.Intraoperative core temperature patterns,transfusion requirement,and hospital duration in patients warmed with forced air[J].Anesthesiology,2015,122(2):276-285.DOI:10.1097/ALN.0000000000000551.
13 Samoila G,Ford RT,Glasbey JC,et al.The significance of hypothermia in abdominal aortic aneurysm repair[J].Ann Vasc Surg,2017,8:323-331.DOI:10.1016/j.avsg.2016.05.121.
14 Navarro LH,Bloomstone JA,Auler JO Jr,et al.Perioperative fluid therapy:a statement from the international Fluid Optimization Group[J].Perioper Med(Lond),2015,4(1):1-20.DOI:10.1186/s13741-015-0014-z.
15 Hubner M,Sehafer M,Demartines N,et al.Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program[J].J Surg Res,2012,173(1):68-74.DOI:10.1016/j.jss.2010.08.051.
16 Sun X,Diao M,Wu X,et al.A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia[J].J Pediatr Surg,2016,51(3):374-378.DOI:10.1016/j.jpedsurg.2015.10.045.
17向波,谢小龙.胆道闭锁的“Kasai手术-肝移植”序贯治疗[J].临床小儿外科杂志,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.Xiang B,Xie XL.Sequential treatment of“Kasai surgeryliver transplantation”for biliary atresia[J].J Clin Ped Sur,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.
18侯文英,李龙,刘树立,等.微小切口肝门空肠Roux-en-Y吻合术治疗Ⅲ型胆道闭锁[J].中国微创外科杂志,2011,11(8):683-684,693.DOI:10.3969/j.issn.1009-6604.2011.08.004.Hou WY,Li L,Liu SL,et al.Mini-incision hepaticojejunostomy for typeⅢbiliary atresia[J].Chin J Min Inv Surg,2011,11(8):683-684,693.DOI:10.3969/j.issn.1009-6604.2011.08.004.
19 Kyoden Y,Imamura H,Sano K,et al.Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection[J].J Hepatobiliary Pancreat Sci,2010,17(2):186-192.DOI:10.1007/s00534-009-0161-z.
20 Fisher WE,Hodges SE,Silberfein EJ,et al.Pancreatic resection without routine intraperitoneal drainage[J].HPB(Oxford),2011,13(7):503-510.DOI:10.1111/j.1477-2574.2011.00331.x.
21詹江华.婴幼儿胆汁淤积性黄疸的外科诊疗决策[J].临床小儿外科杂志,2016,15(1):1-3.DOI:10.3969/j.issn.1671-6353.2016.01.001.Zhan JH.Decision-making in surgical diagnosis and treatment of infantile cholestasis jaundice[J].J Clin Ped Sur,2016,15(1):1-3.DOI:10.3969/j.issn.1671-6353.2016.01.001.
22 Ng Jessica,Paul A,Wright N.Vitamin D Levels in Infants With Biliary Atresia:Pre-and Post-Kasai Portoenterostomy[J].J Pediatr Gastroenterol Nutr,2016,62(5):746-750.DOI:10.1097/MPG.0000000000001074.
2熊希倩,詹江华,余晨,等.胆道闭锁自体肝生存时间与胆管反应的关系研究[J].临床小儿外科杂志,2018,17(11):814-820.DOI:10.3969/j.issn.1671-6353.2018.11.004.Xiong XQ,Zhan JH,Yu C,et al.Relationship between native liver survival and ductular reaction in biliary atresia[J].JClin Ped Sur,2018,17(11):814-820.DOI:10.3969/j.issn.1671-6353.2018.11.004.
3赵玉沛,熊利泽.加速康复外科中国专家共识及路径管理指南(2018+版)[J].中华实用外科杂志,2018,38(1):1-20.DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.Zhao YP,Xiong LZ.Chinese expert consensus and path management guidelines for enhanced recovery after surgery[J].Chinese Journal of Practical Surgery,2018,38(1):1-20.DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.
4舒强,钭金法.加速康复外科在小儿外科中的应用与展望[J].临床小儿外科杂志,2019,18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001.Shu Q,Tou JF.Applications and future prospects of enhanced recovery after surgery during pediatric surgery[J].JClin Ped Sur,2019,18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001.
5 Asklid D,Segelman J,Gedda C,et al.The impact of perioperative fluid therapy on short-term outcomes and 5-year survival among patients undergoing colorectal cancer surgery-Aprospective cohort study within an ERAS protocol[J].Eur JSurg Oncol,2017,43(8):1433-1439.DOI:10.1016/j.ejso.2017.04.003.
6 Li D,Chen X,Fu K,et al.Preoperative nutritional status and its impact on cholangitis after Kasai portoenterostomy in biliary atresia patients[J].Pediatr Surg Int,2017,33(8):901-906.DOI:10.1007/s00383-017-4118-z.
7 Nygren J,Thorell A,Ljungqvist O.Preoperative oral carbohydrate therapy[J].Curr Opin Anaesthesiol,2015,28(3):364-369.DOI:10.1097/ACO.0000000000000192.
8 Alnaami I,Lam FC,Steel G,et al.Arteriovenous fistula and pseudoaneurysm of the anterior spinal artery caused by an epidural needle in a 5-year-old patient[J].J Neurosurg Pediatr,2013,11(3):340-345.DOI:10.3171/2012.12.PEDS12247.
9 Zhu Y,Wang Y,Du B,et al.Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients?A systematic review and meta-analysis[J].Crit Care,2017,21(1):206.DOI:10.1186/s13054-017-1789-8.
10 Zhou ZJ,Wang X,Song Z,et al.Effect of sevoflurane anaesthesia on hepatic blood flow in infants with obstructive hepatobiliary disease[J].Acta Anaesthesiol Scand,2016,60(8):1067-1074.DOI:10.1111/aas.12733.
11郎荣蓉.预防婴幼儿围手术期低体温的研究进展[J].天津护理,2016,24(4):360-361.DOI:10.39690.issn.1006-9143.2016.08.046.Lang RR.Research advances in the prevention of hypothermia in infants and toddlers[J].Tianjin Journal of Nursing,2016,24(4):360-361.DOI:10.39690.issn.1006-9143.2016.08.046.
12 Sun Z,Honar H,Sessler DI,et al.Intraoperative core temperature patterns,transfusion requirement,and hospital duration in patients warmed with forced air[J].Anesthesiology,2015,122(2):276-285.DOI:10.1097/ALN.0000000000000551.
13 Samoila G,Ford RT,Glasbey JC,et al.The significance of hypothermia in abdominal aortic aneurysm repair[J].Ann Vasc Surg,2017,8:323-331.DOI:10.1016/j.avsg.2016.05.121.
14 Navarro LH,Bloomstone JA,Auler JO Jr,et al.Perioperative fluid therapy:a statement from the international Fluid Optimization Group[J].Perioper Med(Lond),2015,4(1):1-20.DOI:10.1186/s13741-015-0014-z.
15 Hubner M,Sehafer M,Demartines N,et al.Impact of restrictive intravenous fluid replacement and combined epidural analgesia on perioperative volume balance and renal function within a Fast Track program[J].J Surg Res,2012,173(1):68-74.DOI:10.1016/j.jss.2010.08.051.
16 Sun X,Diao M,Wu X,et al.A prospective study comparing laparoscopic and conventional Kasai portoenterostomy in children with biliary atresia[J].J Pediatr Surg,2016,51(3):374-378.DOI:10.1016/j.jpedsurg.2015.10.045.
17向波,谢小龙.胆道闭锁的“Kasai手术-肝移植”序贯治疗[J].临床小儿外科杂志,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.Xiang B,Xie XL.Sequential treatment of“Kasai surgeryliver transplantation”for biliary atresia[J].J Clin Ped Sur,2018,17(11):805-808.DOI:10.3969/j.issn.1671-6353.2018.11.002.
18侯文英,李龙,刘树立,等.微小切口肝门空肠Roux-en-Y吻合术治疗Ⅲ型胆道闭锁[J].中国微创外科杂志,2011,11(8):683-684,693.DOI:10.3969/j.issn.1009-6604.2011.08.004.Hou WY,Li L,Liu SL,et al.Mini-incision hepaticojejunostomy for typeⅢbiliary atresia[J].Chin J Min Inv Surg,2011,11(8):683-684,693.DOI:10.3969/j.issn.1009-6604.2011.08.004.
19 Kyoden Y,Imamura H,Sano K,et al.Value of prophylactic abdominal drainage in 1269 consecutive cases of elective liver resection[J].J Hepatobiliary Pancreat Sci,2010,17(2):186-192.DOI:10.1007/s00534-009-0161-z.
20 Fisher WE,Hodges SE,Silberfein EJ,et al.Pancreatic resection without routine intraperitoneal drainage[J].HPB(Oxford),2011,13(7):503-510.DOI:10.1111/j.1477-2574.2011.00331.x.
21詹江华.婴幼儿胆汁淤积性黄疸的外科诊疗决策[J].临床小儿外科杂志,2016,15(1):1-3.DOI:10.3969/j.issn.1671-6353.2016.01.001.Zhan JH.Decision-making in surgical diagnosis and treatment of infantile cholestasis jaundice[J].J Clin Ped Sur,2016,15(1):1-3.DOI:10.3969/j.issn.1671-6353.2016.01.001.
22 Ng Jessica,Paul A,Wright N.Vitamin D Levels in Infants With Biliary Atresia:Pre-and Post-Kasai Portoenterostomy[J].J Pediatr Gastroenterol Nutr,2016,62(5):746-750.DOI:10.1097/MPG.0000000000001074.