Clinical Application Research Of Enhanced Recovery After Surgery In Laparoscopic Hepatectomy

Objective:To explore the application of laparoscopic hepatectomy combined with Enhanced recovery after surgery,investigated its feasibility,safety and clinical significance,and optimized perioperative management.Materials and Methods:Our prospective randomized controlled study was performed on patients in Qilu Hospital of Shandong University who were undergone laparoscopic hepatectomy from July 2017 to December 2018.After patients were screened for inclusion and exclusion criteria.,they were randomly divided into the ERAS group(54 cases)and the control group(53 cases).the ERAS group were treated with ERAS perioperative management,while the control group received routine management.Compared two groups of patients with the changes of ALT,AST,TBIL,ALB and PT of 1,3 and 6 days after operation,the time of exhaust and defecation after operation,the complications after operation,the length of hospitalization after operation and the cost of hospitalization.Results:There was no significant difference in sex,age,weight,underlying diseases,tumor type,tumor diameter,operation method,operation time,intraoperative bleeding volume and hepatic portal occlusion time between the two groups.The laboratory indexes of ALT,AST,TBIL,ALB and PT between the two groups on the 1st,3rd and 6th day after operation showed no significant difference.The time of exhaust and defecation in ERAS group was earlier than that in control group(t=7.588,5.733;P<0.001,<0.001),the days of hospitalization after operation were less than those in control group(t=3.792,P<0.001),and the hospitalization expenses were less than those in control group(t=3.493,P<0.001).Compared with control group,ERAS group had lower incidence of total complications after operation(?2=23.135,P<0.001).According to Clavien-Dindo classification of complications,Grade I complications were the main difference between the two group,which ERAS group was significantly lower than that in control group(x2=15.939,P<0.001).However Grade II-IV complications in ERAS group had no significant difference.Conclusion:ERAS concept is safe and effective in perioperative management of laparoscopic hepatectomy.It can accelerate the recovery of gastrointestinal function after operation,Promote patients early eating and ambulation,reduce the incidence of complications,shorten the length of hospital stay,reduce hospitalization costs,improve hospitalization satisfaction rate,and achieve the goal of speeding up the recovery of patients after operation.