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J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (5): 474-480    DOI: 10.3785/j.issn.1008-9292.2019.10.02
    
Application of enhanced recovery after surgery in the treatment of children with congenital choledochal cyst
ZHAO Hangyan(),CAI Duote,GAO Zhigang*(),CHEN Qingjiang,ZHU Jihua,HUANG Jinjin
The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang Provincial Clinical Research Center for Minimally Invasive Diagnosis and Treatment of Abdominal Organs, Hangzhou 310052, China
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Abstract  

Objective: To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst. Methods: One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (n=65) and control group (n=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups. Results: Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation, time required for the volume of peritoneal drainage fluid to be less than 50 mL, time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (P < 0.05 or P < 0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (P < 0.01), but the incidence of edema after operation was lower (P < 0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (P < 0.05) and the total cost of hospitalization was reduced (P < 0.01). Conclusion: ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.



Key wordsCholedochal cyst/surgery      Perioperative care      Rehabilitation      Cohort studies     
Received: 30 July 2019      Published: 04 January 2020
CLC:  R726.09  
Corresponding Authors: GAO Zhigang     E-mail: 6200021@zju.edu.cn;ebwk@zju.edu.cn
Cite this article:

ZHAO Hangyan,CAI Duote,GAO Zhigang,CHEN Qingjiang,ZHU Jihua,HUANG Jinjin. Application of enhanced recovery after surgery in the treatment of children with congenital choledochal cyst. J Zhejiang Univ (Med Sci), 2019, 48(5): 474-480.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.10.02     OR     http://www.zjujournals.com/med/Y2019/V48/I5/474


加速康复外科理念在儿童先天性胆总管囊肿治疗中的应用

目的: 探讨加速康复外科(ERAS)理念应用于儿童先天性胆总管囊肿围手术期管理中的可行性。方法: 将浙江大学医学院附属儿童医院2017年6月至2019年6月收治的先天性胆总管囊肿患儿设为队列目标人群,按入院顺序纳入ERAS组和对照组,各65例。分别在术前准备、术中麻醉管理、术后管理三个阶段观察ERAS组和对照组术中肠道情况、手术所需时间、术后差异操作结果、术后开始进食时间、术后腹腔引流液、术后住院时间、住院总费用、术后并发症等情况。结果: 与对照组比较,ERAS组术中肠道情况满意度,术后胃肠功能恢复时间、腹腔引流液量少于50 mL所需时间、腹腔引流管拔除时间和住院时长均有所改善(P < 0.05或P < 0.01);ERAS组拔除腹腔引流管后腹腔积液量多(P < 0.01),但术后浮肿发生率低(P < 0.05);两组家长满意度相近(P>0.05),但ERAS组家长配合度提高(P < 0.05),住院总费用降低(P < 0.01)。结论: ERAS理念应用于儿童先天性胆总管囊肿临床治疗具有一定的优势。


关键词: 胆总管囊肿/外科学,  围手术期医护,  康复,  队列研究 
组别n年龄(岁)女性ALT异常直接胆红素异常淀粉酶异常腹痛
“—”无相关数据;ERAS:加速康复外科;ALT:丙氨酸转氨酶.
ERAS组651.51±1.4356(86.2)11(16.9)10(15.4)14(21.5)31(47.7)
对照组651.41±1.3158(89.2)13(20.0)4(6.2)12(18.5)40(61.5)
t/χ20.3960.2850.2042.8820.1922.514
P>0.05>0.05>0.05>0.05>0.05>0.05
Tab 1 Comparison of baseline characteristics between ERAS group and control group  [$\bar x \pm s$或n(%)]
组别术前准备术中麻醉管理术后管理
术前宣教方法营养评估方法禁食情况肠道准备方法留置胃管时间、地点麻醉诱导方法预防术后疼痛胃管拔除时间进食时间腹腔引流管拔除时间导尿管拔除时间早期下床活动时间
ERAS:加速康复外科.
ERAS组个体化宣教营养专科评估术前2 h禁清饮料,4 h禁母乳,6 h禁奶粉,8 h禁固体食物术前清洁灌肠入手术室麻醉后插胃管入手术室前家长陪护下,右美托咪定滴鼻镇静手术结束前,由主刀医生对切口实施局部浸润麻醉肛门排气,无明显腹胀时即拔除胃管拔除8 h后进流质,24 h后进半流质进食后腹腔引流液少于50 mL/d,且引流液性状无异常即予拔除手术结束时拔除鼓励手术当日即下床活动,低龄儿童指导家长抱抚
对照组集中宣教主管医生评估术前4 h禁水,6 h禁奶粉、母乳,8 h禁固体食物术前不清洁灌肠病房插胃管入手术室后开始麻醉诱导(无家长陪护)无措施术后至少留置4 d胃管拔除1 d后进流质,2 d后进半流质进食后腹腔引流液少于10 mL/d,予拔除术后1~2 d拔除术后1~2 d拔除尿管后下床活动,低龄儿童指导家长抱抚
Tab 2 Perioperative management of ERAS group and control group
组别n术中肠道情况满意度*手术时长(h)胃肠功能恢复时间(d)腹腔引流液量少于50 mL所需时间(d)腹腔引流管拔除时间(d)术后住院时长(d)
“—”无相关数据;ERAS:加速康复外科.*衡量指标包括横结肠、十二指肠、全小肠是否扩张影响视野.
ERAS组6564(98.5)2.8±0.43.0±0.94.2±1.14.2±1.19.4±1.5
对照组6552(80.0)2.9±0.45.2±0.45.6±0.86.7±0.512.7±2.6
t11.52-1.381-16.793-2.871-5.402-8.813
P<0.01>0.05<0.01<0.05<0.01<0.01
Tab 3 Operation related indexes of ERAS group and control group  [$\bar x \pm s$或n(%)]
组别n拔除胃管后(进食前)进食后
呕吐误吸腹胀需重插胃管呕吐误吸腹胀需重新禁食血清淀粉酶增高
“—”无相关数据;ERAS:加速康复外科.
ERAS组651(1.5)0(0)5(7.7)0(0)3(4.6)0(0)4(6.2)1(1.5)3(4.6)
对照组650(0.0)0(0)2(3.1)0(0)1(1.5)0(0)1(1.5)1(1.5)2(3.1)
χ21.0081.3591.0321.8720.208
P>0.05>0.05>0.05>0.05>0.05
组别n术后浮肿腹腔引流管拔除后尿潴留术后并发症
腹腔积液>2 cm包裹性积液腹腔感染胰腺炎胆漏乳糜性腹水
ERAS组653(4.6)15(23.1)1(1.5)0(0)0(0)0(0.0)1(1.5)2(3.1)
对照组6512(18.5)3(4.6)1(1.5)0(0)0(0)1(1.5)2(3.1)1(1.5)
t6.1049.2861.0080.3410.341
P<0.05<0.01>0.05>0.05>0.05
Tab 4 Perioperative features of ERAS group and control group  [n(%)]
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