贵州医科大学学报

2017, v.42;No.205(10) 1215-1218

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老年人胰十二指肠切除术围手术期应用加速康复外科的效果
The Effect of Application of Accelerated Rehabilitation Surgery during Perioperative Period of Pancreaticoduodenectomy in Elderly Patients

周永平;戴途;华志元;丁文周;金慧涵;
ZHOU Yongping;DAI Tu;HUA Zhiyuan;DING Wenzhou;JIN Huihan;Department of Hepatobiliary Surgery of Wuxi Second Hospital Affiliated to Nanjing Medical University;

摘要(Abstract):

目的:探讨老年胰十二指肠切除术(PD)病人围手术期实施快速康复外科(ERAS)的安全性和临床价值。方法:113例接受PD的病人,75例在围手术期实施ERAS,34例年龄≥70岁的患者设为老年ERAS组,41例年龄<70岁的患者设为普通ERAS组,38例接受传统围手术期处理且年龄≥70岁的患者设为老年非ERAS组,对比3组患者术后并发症发生率、住院时间、术后肠功能恢复时间及90 d再住院率;比较3组患者术后第3、5天血清中C反应蛋白(CRP)、总胆红素及白蛋白水平。结果:老年非ERAS组术后肺部感染、泌尿道感染、术后胃排空障碍发生率高于其余两组,C反应蛋白、术后肠功能恢复时间、住院时间也高于其余两组,差异有统计学意义(P<0.05);术后3组间总胆红素、白蛋白水平、胰瘘、胆漏、出血发生率及90 d再住院率比较,差异无统计学意义(P>0.05)。结论:老年患者PD的围手术期实施ERAS可减轻术后炎症反应及并发症发生率,促进肠功能回复。
Objective: Investigate the safety and clinical value of the rapid rehabilitation surgery on pancreaticoduodenectomy( PD) implementation in elderly patients during perioperative period( ERAS). Methods: 75 patients underwent ERAS during the perioperative period among 113 patients undergoing PD. 34 patients over 70 years were enrolled in the elderly ERAS group; 41 Patients less than 70 years were selected as normal ERAS group; 38 patients over 70 years with traditional perioperative treatment were allocated as the elderly non-ERAS group. The postoperative complication rate,hospitalization time,postoperative intestinal function recovery time and the 90 day readmission rate in the 3 groups were compared. The levels of serum C reactive protein( CRP),total bilirubin and albumin in the 3 groups were compared in the 3 groups after operation of 3 and 5 days. Results: The incidence of postoperative lung infection,urinary tract infection,postoperative gastric emptying disorder,C reactive protein,postoperative intestinal function recovery time and hospitalization time in the nonERAS group were higher than those in the other two groups,and the difference was statistically significant( P < 0. 05). The total bilirubin,albumin level,pancreatic fistula,bile leakage,bleeding rate and rehospitalization rate were compared after operation in the 3 groups,and the difference was not sta-tistically significant( P > 0. 05). Conclusion: The perioperative implementation of ERAS in elderly patients with PD can reduce postoperative inflammatory response and complications,and promote the recovery of intestinal function.

关键词(KeyWords): 胰十二指肠切除术;老年人;康复;手术后并发症;安全性
Elderly patient;Pancreaticoduodenectomy;accelerated rehabilitation surgery;complication;security

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作者(Author): 周永平;戴途;华志元;丁文周;金慧涵;
ZHOU Yongping;DAI Tu;HUA Zhiyuan;DING Wenzhou;JIN Huihan;Department of Hepatobiliary Surgery of Wuxi Second Hospital Affiliated to Nanjing Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2017.10.024

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