Pecorelli Nicolò, Capretti Giovanni, Balzano Gianpaolo, Castoldi Renato, Maspero Marianna, Beretta Luigi, Braga Marco
Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
HPB (Oxford). 2017 Mar;19(3):270-278. doi: 10.1016/j.hpb.2016.10.014. Epub 2016 Nov 30.
Enhanced recovery (ER) pathways have improved outcomes across multiple surgical specialties, but reports concerning their application in distal pancreatectomy (DP) are lacking. The aim of this study was to assess compliance with an ER protocol and its impact on short-term outcomes in patients undergoing DP.
Prospectively collected data were reviewed. One hundred consecutive patients undergoing DP were treated within an ER pathway comprising 18 care elements. Each patient was matched 1:1 with a patient treated with usual perioperative care. Match criteria were age, BMI, ASA score, lesion site, and type of disease.
Adherence to ER items ranged from 15% for intraoperative restrictive fluids to 100% for intraoperative warming, antibiotic and anti-thrombotic prophylaxis. Patients in ER group experienced earlier recovery of gastrointestinal function (2 vs. 3 days, p < 0.001), oral intake (2 vs. 4 days, p < 0.001), and suspension of intravenous infusions (3 vs. 5 days, p < 0.001). Overall morbidity was similar in the two groups (72% vs. 78%). Length of hospital stay (LOS) was reduced in ER patients without postoperative complications (6.7 ± 1.2 vs. 7.6 ± 1.6 days, p = 0.041).
An ER pathway for DP yielded an earlier postoperative recovery and shortened LOS in uneventful patients. Postoperative morbidity and readmissions were similar in both groups.
强化康复（ER）方案已改善了多个外科专业的治疗效果，但关于其在胰体尾切除术（DP）中的应用报告尚缺乏。本研究的目的是评估ER方案的依从性及其对接受DP患者短期结局的影响。
回顾前瞻性收集的数据。连续100例接受DP的患者在包含18项护理要素的ER方案下接受治疗。将每位患者与接受常规围手术期护理的患者按1:1配对。配对标准为年龄、体重指数、美国麻醉医师协会（ASA）评分、病变部位和疾病类型。
ER项目的依从率从术中限制性液体管理的15%到术中保暖、抗生素和抗血栓预防的100%不等。ER组患者的胃肠功能恢复更早（2天对3天，p<0.001）、开始经口进食更早（2天对4天，p<0.001）、停止静脉输液更早（3天对5天，p<0.001）。两组的总体发病率相似（72%对78%）。无术后并发症的ER组患者住院时间缩短（6.7±1.2天对7.6±1.6天，p=0.041）。
DP的ER方案使恢复顺利的患者术后恢复更早且住院时间缩短。两组的术后发病率和再入院率相似。
