Department of Surgical Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, China.
J BUON. 2020 Mar-Apr;25(2):965-971.
To explore the efficacy and reliability of enhanced recovery after surgery (ERAS) applied in the perioperative period of precise hepatectomy for hepatocellular carcinoma (HCC).
The propensity score matching and a retrospective cohort study were employed. The clinical and pathological data of 122 hepatocellular carcinoma (HCC) patients with surgical indications admitted to our hospital from March 2014 to March 2016 were collected. These 122 patients were subjected to propensity score matching and divided into ERAS group and Control group. The surgical situation, postoperative recovery [postoperative alanine aminotransferase (ALT), total bilirubin (TBiL) and C-reactive protein (CRP) levels], postoperative complications, postoperative hospital stay, hospitalization costs and patient satisfaction score were observed and compared between the two groups. All patients were followed up to record their postoperative survival.
The average drainage tube removal time, bowel sound time, postoperative flatus time and postoperative hospital stay of patients were overtly shorter in ERAS group than in Control group. Besides, the postoperative numerical rating scale (NRS) score and the incidence rate of moderate and severe pain after surgery were lower in ERAS group than in Control group. The total hospitalization cost was significantly lower in ERAS group than in Control group. The patient satisfaction score was obviously higher in ERAS group than in Control group. ERAS group had fewer cases of postoperative vomiting, abdominal distension, biliary fistula, intestinal obstruction, large-volume ascites, liver failure, wound infection, pulmonary infection and abdominal infection than Control group, but the differences were not statistically significant. The ALT, TBiL and CRP levels of patients were notably lower in ERAS group than in Control group at d 7 after surgery. Based on the follow-up results, there was no significant difference in overall survival between the two groups.
ERAS applied in the perioperative period of HCC patients receiving precise hepatectomy is reliable and effective and has positive significance for the promotion of postoperative rehabilitation, which is worthy of popularization in clinical practice.
探讨加速康复外科（ERAS）在肝癌（HCC）精准肝切除围手术期的应用效果及可靠性。
采用倾向性评分匹配和回顾性队列研究。收集我院 2014 年 3 月至 2016 年 3 月期间 122 例有手术适应证的 HCC 患者的临床病理资料，采用倾向性评分匹配法将其分为 ERAS 组和对照组。观察比较两组患者的手术情况、术后恢复情况[术后丙氨酸氨基转移酶（ALT）、总胆红素（TBiL）和 C 反应蛋白（CRP）水平]、术后并发症、术后住院时间、住院费用和患者满意度评分。所有患者均进行随访，记录术后生存情况。
ERAS 组患者的引流管拔除时间、肠鸣音恢复时间、肛门排气时间和术后住院时间均明显短于对照组；术后数字评分量表（NRS）评分和术后中重度疼痛发生率均明显低于对照组；ERAS 组总住院费用明显低于对照组；ERAS 组患者满意度评分明显高于对照组。ERAS 组术后呕吐、腹胀、胆瘘、肠梗阻、大量腹水、肝功能衰竭、伤口感染、肺部感染和腹部感染的例数少于对照组，但差异无统计学意义。术后第 7 天，ERAS 组患者的 ALT、TBiL 和 CRP 水平明显低于对照组。随访结果显示，两组患者的总生存情况无明显差异。
ERAS 应用于 HCC 患者精准肝切除围手术期是可靠有效的，对促进术后康复具有积极意义，值得在临床实践中推广。
