Kobayashi Shinjiro, Ooshima Ryuiti, Koizumi Satoshi, Katayama Masafumi, Sakurai Joe, Watanabe Taiji, Nakano Hiroshi, Imaizumi Toshihide, Otsubo Takehito
Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan,
World J Surg. 2014 Sep;38(9):2430-7. doi: 10.1007/s00268-014-2548-5.
It has been considered that allowing patients to return to daily life earlier after surgery helps recovery of physiological function and reduces postoperative complications and hospital stay. We investigated the usefulness of fast-track management in perioperative care of patients undergoing pancreaticoduodenectomy (PD).
Patients (n = 90) who received conventional perioperative management from 2005 to 2009 were included as the 'conventional group' (historical control group), and patients who received perioperative care with fast-track management (n = 100) from 2010 to March 2013 were included as the 'fast-track group'. To evaluate the efficacy of perioperative care with fast-track management, the incidence of postoperative complications and the length of hospital stay were compared between the two groups (comparative study). For statistical analysis, univariate analysis was performed using the χ (2) test or Fisher's exact test.
There was no significant difference between the two groups in sex, mean age, presence/absence of diabetes mellitus, preoperative drainage for jaundice, previous disease, operative procedure, mean duration of operation, or blood loss (p < 0.01). The incidence of surgical site infection in the conventional group and fast-track group was 28.9 and 14.0 %, respectively, with a significant difference between the two groups (p = 0.019). In addition, the incidence of pancreatic fistula (grade B, C) significantly differed between the two groups (27.8 % in the conventional group, 9.0 % in the fast-track group; p = 0.001). The mean postoperative hospital stay was 36.3 days in the conventional group and 21.9 days in the fast-track group (p < 0.001).
Perioperative care with fast-track management may reduce postoperative complications and decrease the length of hospital stay in patients undergoing PD.
人们认为，让患者术后更早回归日常生活有助于生理功能恢复，并减少术后并发症及住院时间。我们研究了快速康复管理在胰十二指肠切除术（PD）患者围手术期护理中的作用。
将2005年至2009年接受传统围手术期管理的患者（n = 90）纳入“传统组”（历史对照组），将2010年至2013年3月接受快速康复管理围手术期护理的患者（n = 100）纳入“快速康复组”。为评估快速康复管理围手术期护理的效果，比较两组患者术后并发症发生率及住院时间（对比研究）。统计分析采用χ²检验或Fisher精确检验进行单因素分析。
两组在性别、平均年龄、是否患有糖尿病、术前黄疸引流、既往疾病、手术方式、平均手术时长或失血量方面无显著差异（p < 0.01）。传统组和快速康复组手术部位感染发生率分别为28.9%和14.0%，两组间存在显著差异（p = 0.019）。此外，两组间B、C级胰瘘发生率也有显著差异（传统组为27.8%，快速康复组为9.0%；p = 0.001）。传统组术后平均住院时间为36.3天，快速康复组为21.9天（p < 0.001）。
快速康复管理的围手术期护理可能会减少PD患者术后并发症并缩短住院时间。
