| Objective: Preliminarily analyze the effect of Enhanced Recovery After Surgery(ERAS)in the perioperative period of liver cancer resection.Method: Use the clinical data of 125 cases of liver cancer concurrent liver resection from the Department of hepatobiliary surgery of the General Hospital of Ningxia Medical University from January 2015 to December 2016 as the abservational object,compare the difference of incidence of postoperative complications,liver function,the length of hospital stay after surgery and cost between ERAS group and control group by using the retrospective analysis method.Preliminary investigate the implementation of ERAS in the perioperative period of liver cancer resection.Result: 1.General description:In this study,125 cases with liver cancer resection were strictly accordance with the inclusion criteria.The gender ratio was 2.4:1,the average age is 54 years old.ERAS group included 72 cases,of which 37 cases aged >54 years old,older than 54 years of age were 35 cases.The control group included 53 patients,aged >54 years old in 22 cases,aged less than 54 years of the 31 cases.2.Comparison of the incidence of complications after liver cancer resection:Logistic regression analysis showed that perioperative management(P =0.000,OR =7.021),intraoperative bleeding(P =0.007,OR =2.884),surgical procedure(P=0.023,OR=0.198)were the risk factors for postoperative complications.Log linear model analysis showed that there was no interaction between the perioperative management,surgical procedure and intraoperative bleeding(P>0.05);Chi-square analysis showed:(1)Compared with the control group,the rate of complications was reduced in ERAS group and the difference was statistically significant(P=0.047<0.05);(2)There was no difference in the incidence of complications between different surgical procedures;(3)The incidence of complications was different when bleeding volumes were different.3.Comparison of biochemical indexes of liver function in serum after hepatectomy:Multiple linear regression analysis showed that perioperative management(β=0.396,P=0.000)and intraoperative bleeding(β=-0.196,P=0.047)were the risk factors for biochemical indexes of liver function,include ALB,TBIL,AST,ALT,while age,surgical procedure,blood transfusion and mass size were not(P>0.05).The results of factorial analysis of variance showed that the relationship between perioperative management and the changes of liver function dependent on intraoperative bleeding(F=1.34,P=0.01<0.05).Variance analysis of the randomized block showed that there’s no significant difference between control group and ERAS group in the event of a small amount of bleeding during surgery(P=0.162>0.05),while the reduction of serum TBIL,AST and ALT in ERAS group was much less than that in control group(P<0.05).Furthermore,there was no significant difference in ALB,TBIL,AST and ALT of postoperative between ERAS group and control group both in the event of a medium amount and large amount of bleeding during surgery(P>0.05).4.Comparison of the length of hospital stay after surgery and cost between ERAS group and control group:The average hospitalization cost was ￥38535.12 and the average hospital stay after surgery was 9.5 days in ERAS group.And in control group.,they were ￥43621.96 and 11.4 days.T-test showed that there was no statistically significant difference in the average hospitalization cost between the two groups of patients(P>0.05).However,compared with control group,hospital stay after surgery significantly reduced in ERAS group(P<0.05).Conclusion: 1.Both management of perioperative period and intraoperative bleeding are crucial elements leading to postoperative complications of hepatectomy in liver cancer,and there exists no interaction between them in terms of contributing to postoperative complications.Furthermore,the implement of EARS decrease the incidence rate of postoperative complications for patients with liver cancer undergoing hepatectomy.2.Both procedure of perioperative period and intraoperative bleeding are crucial elements that have effect on facilitating liver function after liver resection.And further is that the application of ERAS much effectively lower level of TBIL,AST and ALT after operation when smaller bleeding volume happens,facilitating liver function of intraoperative patients.However,effect of treatment after larger bleeding volume happens is in further research.3.The hospital stay for postoperative patients is significently decrease after the application of ERAS during perioperative period of hepatectomy,while the costs benefit remains further observation.Summary: The security and validity certainly occur when EARS is implemented during perioperative period of hepatectomy for patients with primary liver cancer.However,the clinical effect still remains to be tracked in a long-term time though it is worthy of being further advocation. |
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