| Objective: To observe the safety and effectiveness of enhanced recovery after surgery within precise hepatectomy.Enhanced recovery after surgery theory(ER AS)enhance perioperative management,reducing the patients’ surgery stre ss,reducing hospital stay time,reducing hospitalization costs,promoting post operative recovery,by adopting a series of preoperative,intraoperative,postoper ative measures optimized management.This paper expects to evaluate the applic ation of enhanced recovery after surgery within precise hepatectomy and to pro vide reliable basis for clinical application trough analysis the data of 101 liver cancer patients who underwent precise hepatectomy in Affiliated Anhui Provi ncial Hospital.With the development of society,the improvement of medical technology,medical concepts have also changed,the center of medical care has been trans formed from disease to patients,people-oriented concept requires that the purp ose of medical treatment is not only the cure of disease,but also should consi der the quality of life of patients,mental health,economic conditions and othe r factors and their relationship and influence.With the progress of medical technology and the innovation of medical eq uipment,liver surgery has made great progress and entered the era of accurate liver surgery.Accurate hepatectomy is a brand-new theory and technical syste m of liver surgery,which is based on the current medical information technolo gy to accurately assess the relevant pathological and physiological conditions,and based on this,combined with the support of fine and accurate surgical tech nology,with the purpose of complete resection of lesions with minimal tissue damage.The concept of enhanced recovery after surgery(ERAS)is the optimi zation theory of perioperative period through a series of preoperative,intraoper ative and postoperative measures to strengthen the management of perioperative period,reduce the stress response of patients,shorten the hospital stay,reduce hospitalization costs,accelerate the recovery of patients.In recent years,enhanced recovery after surgery has been adopted in vario us surgical fields and has achieved remarkable results.The application of the c oncept of accelerated rehabilitation surgery in the field of traditional open hepa tectomy has been proved to be safe and effective,and can accelerate the posto perative rehabilitation of patients.The concept of rapid rehabilitation surgery is applied to liver resection in the era of accurate liver surgery,which can redu ce the trauma of patients,accelerate the recovery of patients,and has good cli nical value.However,the application of the concept of enhanced recovery afte r surgery in the field of precision liver surgery is seldom reported in the litera ture.This study reviewed the clinical data of 101 patients with hepatocellular c arcinoma(HCC)undergoing precision hepatectomy who underwent conventio nal perioperative management and ERAS in Affiliated Anhui Provincial Hospita l,to explore the feasibility and clinical effect of enhanced recovery after surge ry concept in precision hepatectomy perioperative application,and to provide t he basis for its clinical application.Methods: The clinical data of 101 consecutive patients with precision hepatectomy admitted to Affiliated Anhui Provincial Hospital from December 2015 to September 2017 were retrospectively studied.50 patients in the standard care group(SC group) and 51 patients in the accelerated recovery surgery group(ERAS group)were enrolled in the study.The postoperative condition,hospitalization time,hospitalization expenses,complication rate and postoperative quality of life were compared between the two groups.Results: Compared with SC group,the time of extubation of the peritoneal drainage tube and anal exhaust in ERAS group were significantly lower than those in SC group(t=5.304,P < 0.001;t=4.257,P < 0.001);The hospital stay time and total hospitalization expenses of ERAS group were significantly lower than SC group(t=5.685,P<0.001;t=4.128,P<0.001);Postoperative complications in ERAS group were pulmonary infection in 1 case,pleural effusion in 3 cases,peritoneal effusion in 1 case,abscess in operation area in 1 case,the incidence of complications was 11.76 %.Postoperative complications in SC group were pulmonary infection in 2 cases,pleural effusion in 3 cases,peritoneal effusion in 1 case,postoperative bleeding in 1 case,the incidence of complications was 14.00 %,the difference between the two groups was not statistically significant(χ2=0.088,P=0.767);Serum CRP,TBil,ALT,Ch E were 33±12(mg/L),21±3(μmg/L),61±13(U/L)and 3715±136 in ERAS group three days after operation.Serum CRP,TBil,ALT,Ch E were 68±17(mg/L),26±7(μmg/L),193±36(U/L)and 2391±763 in SC group three days after operation,there was significant difference in serum indexes between the two groups(t=11.972,<0.001;t=4.682,<0.001;t=24.602,<0.001;t=12.197,<0.001);The Qo R-40 scores of patients in ERAS group were 175.81±2.46,166.53±1.02,173.65±4.32 before,three days after and three weeks after operation.The Qo R-40 scores of patients in SC group were 176.18±2.51,147.06±2.41,162.35±1.65.There was no significant difference between ERAS group and SC group(t=0.748,P=0.456).There was significant difference in Qo R-40 score between ERAS group and SC group(t=53.055,P<0.001;t=17.299,P<0.001).Conclusion: In the perioperative management of patients with precise hepatectomy,the enhanced recovery after surgery theory can reduce the postoperative hospital stay,postoperative functional recovery time,and reduce the total cost of hospitalization without increasing the incidence of complications.The enhanced recovery after surgery theory is safe and effective,and can be widely used in patients with precise hepatectomy. |
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