Departments of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Br J Surg. 2013 Jan;100(1):138-43. doi: 10.1002/bjs.8996. Epub 2012 Nov 20.
Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and to decrease morbidity and hospital stay for several major surgical procedures. The aim of this study was to investigate the effect of introducing fast-track principles for perioperative care in unselected patients undergoing open or laparoscopic liver resection.
This was a prospective study involving the first 100 consecutive patients who followed fast-track principles for liver resection. Catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated complications.
Median length of stay (LOS) for all patients was 5 days, with 2 days after laparoscopic versus 5 days following open resection (P < 0·001). Median LOS after minor open resections (fewer than 3 segments) was 5 days versus 6 days for major resections (3 or more segments) (P < 0·001). Simple right or left hemihepatectomies had a median LOS of 5 days. The readmission rate was 6·0 per cent and 30-day mortality was zero.
Fast-track principles for perioperative care were introduced successfully and are safe after liver resection. Routine discharge 2 days after laparoscopic resection and 4-5 days after open liver resection may be feasible.
围手术期病理生理学和护理的最新进展已经证明，多模式康复（快速通道）可以加速恢复，降低几种主要手术的发病率和住院时间。本研究旨在探讨将快速通道原则引入择期行开腹或腹腔镜肝切除术患者的围手术期护理中的效果。
这是一项前瞻性研究，涉及 100 例连续接受肝切除术快速通道原则的患者。引流管和导管被系统地早期移除，患者在手术当天开始活动并进食。在前一周给予阿片类药物节约型多模式疼痛治疗。出院标准为：仅口服镇痛药即可充分控制疼痛、患者对出院感到舒适且无未治疗的并发症。
所有患者的中位住院时间（LOS）为 5 天，腹腔镜组为 2 天，开腹组为 5 天（P < 0·001）。少于 3 个肝段的小开腹切除的中位 LOS 为 5 天，3 个或更多肝段的大切除的中位 LOS 为 6 天（P < 0·001）。简单的右半肝或左半肝切除术的中位 LOS 为 5 天。再入院率为 6.0%，30 天死亡率为 0。
快速通道围手术期护理原则成功引入且安全，腹腔镜肝切除术后 2 天，开腹肝切除术后 4-5 天常规出院可能是可行的。
