Clinical Study Of PTCSL Combined With ERAS Clinical Pathway In The Treatment Of Regional Hepatolithiasis

Objective:The study analyzes the application of percutaneous transhepatic choledochoscopic lithotripsy(PTCSL)combined with enhanced recovery after surgery(ERAS)clinical pathway in regional hepatolithiasis.Explore whether this method can further safely and effectively reduce the patient’s surgical pain,shorten the length of hospitalization,and accelerate their recovery.Methods:Using a two-way cohort study method,the patients in our hospital who applied PTCSL and ERAS clinical pathways in the treatment of regional hepatolithiasis from December 2019 to December 2020 were used as the ERAS group,and collected from Hunan Provincial People’s Hospital from June 2016 to 2018.Patients who underwent PTCSL and traditional perioperative treatment for regional hepatolithiasis in June2008 served as the control group.The differences between the two groups in terms of residual stone rate,operation time,intraoperative blood loss,postoperative complication rate,postoperative anal exhaust time,postoperative 4h,12h,24h visual analogue score,postoperative hospital stay,etc.were statistically analyzed.The measurement data is expressed by((?)±S),and the t test is used for comparison;the count data is expressed by the rate(%),and theX~2test is used for comparison;P<0.05,the difference is considered to be statistically significant.Results:Compared with the control group(n=14,35%)in the ERAS group(n=12,30%),the residual stone rate in the ERAS group was slightly reduced,P=0.633,the difference was not statistically significant;the average intraoperative in the ERAS group The blood loss was(19.75±37.11)ml,compared with the control group(46.25±82.11)ml,P=0.068,the difference was not statistically significant;the average operation time in the ERAS group was(126.50±11.11)min,compared with the control group(157.50)±12.35)min shortened,P<0.001,the difference was statistically significant;the average postoperative anal exhaust time in the ERAS group was(23.30±2.79)h,which was shorter than the control group(34.02±5.70)h,P<0.001,the difference was significant Statistical significance:4h VAS(1.28±0.55)points,12h VAS(1.68±0.76)points,and 24h VAS(1.30±0.46)points after surgery in the ERAS group,compared with 4h VAS(3.12±0.34)points after surgery in the control group.The postoperative 12h VAS(3.55±0.71)score and the postoperative24h VAS(3.38±0.63)score were lower,P<0.001,the difference was statistically significant;the average postoperative hospital stay in the ERAS group was(4.75±2.77)days,compared with The control group(7.90±2.12)days were significantly reduced,P<0.001;the difference was statistically significant.The total postoperative complication rate between the two groups was 3 cases(7.5%)and 10 cases(25%)respectively,P=0.034,the difference was statistically significant.PTCSL combined with ERAS clinical pathway for the treatment of regional hepatolithiasis can effectively reduce the operation time of patients,promote postoperative anal exhaust,reduce postoperative pain,reduce the incidence of postoperative complications,shorten postoperative hospital stay,and promote patient acceleration Recovery.Conclusion:1.The application of PTCSL and ERAS clinical pathway in the treatment of regional hepatolithiasis can effectively reduce the postoperative pain of patients,reduce the incidence of postoperative complications,and shorten the postoperative hospital stay.2.The application of the ERAS concept in PTCSL surgery is beneficial to accelerate the recovery of patients after surgery and benefit the patients,which is worthy of clinical application and promotion.