摘要
目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)在小儿胆总管囊肿围手术期应用中的效果和安全性.方法 本研究采用多中心前瞻性随机对照方法,共纳入273例患儿,其中ERAS组123例、传统组150例,分别按照ERAS模式和传统模式进行围手术期的管理.比较两组患儿术后首次排气时间、开始进食时间、术后住院时间和总住院时间、并发症发生率和术后30 d再入院率及相关检验指标差异.结果 与传统组相比,ERAS组术后肝功能和应激指标恢复快,开始排气的中位时间(2.0 d 比 3.0 d,P＜0.001)、开始进食的中位时间(5.0 d比7.0 d,P＜0.001)、术后住院的中位时间(6.0 d比9.0d,P＜0.001)、总住院的中位时间(13.0 d比15.0 d,P＜0.001)均较短,中位住院费用低(3.7万比4.3万,P＜0.001).两组术后并发症的发生率和30 d再入院率差异均无统计学意义.结论 ERAS在小儿胆总管囊肿围手术期实施安全可行,能够减少围手术期应激反应,达到快速康复和节约医疗费用的效果.
Abstract
Objective To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS)in the perioperative period of congenital choledochal cysts in children.Methods This is a multicenter prospective randomized controlled study.The clinical data of 273 pediatric congenital choledochal cysts(CCC)patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform.Among them,123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode,and 150 cases in conventional group were managed according to traditional mode.The length of hospital stay,time to first farting,time to complete feeding,the incidence of complications,cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results Compared with the conventional group,median time to start farting(2.0 d vs.3.0 d,P＜0.001),median time to complete feeding(5.0 d vs.7.0 d,P＜0.001),median postoperative hospitalization time(6.0 d vs.9.0 d,P＜0.001),the median total length of stay(13.0 d vs.15.0 d,P＜0.001)were shorter,the median hospitalization cost(37,000 yuan vs.43,000 yuan P＜0.001)was lower,and stress indexes recovered quickly.The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups.Conclusion It is safe and feasible to implement ERAS for children with CCC in the perioperative period,which can reduce stress response,speed up recovery,and save medical costs.
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