Study On The Application Of Enhanced After Recovery Surgery In Laparoscopic Common Bile Duct Exploration

Objective To explore the application value of optimized accelerated rehabilitation(EARS)in laparoscopic choledocholithotomy(LCBDE).Methods The subjects of this study were patients who underwent laparoscopic choledocholithotomy(LCBDE)in the Department of Hepatobiliary Surgery,Chifeng Hospital,Inner Mongolia,from January 2018 to January 2019.All patients were randomly divided into two groups.The experimental group was treated with optimized accelerated rehabilitation program as EARS group,while the control group was treated with traditional treatment program.T test or X~2 test were performed on the perioperative related indicators of the two groups.Results A total of 48 patients were enrolled in the EARS group,including 13 males and 11females,with an average age of(60±13)years.The control group(24 cases)consisted of10 males and 14 females,with an average age of(67±17)years.The pain scores of EARS group at the second hour after operation,eighth hour after operation,fourteenth hour after operation,8:00 on the first day,17:00 on the first day,8:00 on the second day,17:00 on the second day,8:00 on the third day,and 17:00 on the third day were(4.3±2.3),(5.2±2.4),(4.9±2.5),(3.6±1.9),(2.5±2.0),(1.5±1.8),(0.5±0.9),(0.3±0.7)respectively,scores were significantly lower than those in the control group(5.5±1.7),(6.1±1.6),(6.1±1.6),(4.6±1.4),(4.0±1.2),(2.7±1.1),(1.7±1.2),(1.0±1.1),(0.5±0.9).There were significant differences in the eighth hour after operation,in the fourteenth hour after operation,17:00 on the first day,8:00 on the second day,8:00 on the third day,and 17:00 on the third day(t=-1.625,-1.95,-3.141,-2.923,-2.001,-1.242,P<0.05).The nausea and vomiting scores of ERAS group on the two hours after operation,10:00 on the first day after operation,10:00 on the second day after operation and 10:00 on the third day after operation were(2.9±2.0),(1.7±1.4),(0.6±1.0),(0.3±0.9).The scores of ERAS group were significantly lower than those of control group(4.9±1.7),(3.3±3.1),(1.8±2.7),(1.1±1.7).There were significant differences 10:00 on the first day after operation,10:00 on the second day after operation and 10:00 on the third day(t=-2.425,-2.081,-2.107;P<0.05).In EARS group,the first exhaust time after operation(27.2±7.9)h,the standard time of discharge(4.8±1.2)d,the time of drainage tube removal(4.2±1.1)d,the time of hospitalization after operation(6.9±2.1)D and the cost of hospitalization were(24910±2988)yuan,respectively,which were significantly less than those in control group(55.2±13.6)h,(9.0±4.2)d,(6.7±4.1)d,(11.3±4.5)d,(37393±8775)yuan(t=-8.686,4.766,2.906,-4.318,-6.597,P<0.05).The post-operative satisfaction score of EARS group was(0.83±0.38),which was significantly higher than that of control group(0.29±0.46)(t=4.42,P<0.05).There were no perioperative death and complications in both groups,and no re-hospitalized patients within 30 days.Conclusion The application of optimized acceleration scheme in LCBDE is safe,effective and feasible.It has the advantages of fewer complications,faster recovery and lower cost.