Efficacy and prognosis of enhanced recovery after surgery in patients with resection of hepatocellular carcinoma

doi:10.3877/cma.j.issn.1674-0793.2018.05.010

Abstract

Abstract:

Objective

To analyze the effect of enhanced recovery after surgery (ERAS) in patients with hepatectomy.

Methods

From January 2016 to July 2017, one hundred and twelve patients with hepatectomy in People’s Hospital of Guizhou Province were divided into conventional group (routine hepatectomy perioperative treatment) and ERAS group (accelerated rehabilitation surgery procedure), with 56 cases in each group. The operation related indexes including the amount of intraoperative bleeding, postoperative ambulation time, exhaust time and hospital stay, recovery time of liver function and medical expenses in hospital were compared between the two groups. Visual analogue scale (VAS) was used to observe postoperative pain at 7 d after operation. Liver function indexes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) were detected at 7 d after operation. The complications within 3 months after operation and the readmission rate within 30 d were observed, and the satisfaction rate of patients was investigated by questionnaire.

Results

In ERAS group, the time of ambulation, exhaust, hospitalization, the recovery time of liver function and the cost of hospitalization were all less than those of the conventional group, and the degree of pain was lighter, the differences were statistically significant (t=2.025, 9.371, 14.024, 4.952, 7.394, 11.019, all P<0.05). The levels of ALT, AST, TBIL and AFP in ERAS group were significantly lower than those in the conventional group, with statistically significant differences (t=3.123, 3.394, 3.973, 3.987, all P<0.01). The incidence of complications within 3 months after operation and readmission rate within 30 d in ERAS group were 7.14% (4/56) and 3.57% (2/56), respectively, which were significantly lower than 21.43% (12/56) and 14.29% (8/56) in the conventional group (χ²=4.667, 3.953, P=0.031, 0.047). Service satisfaction of ERAS group was (98.20±1.50), significantly higher than that of the conventional group (80.56±2.50), and the difference was statistically significant (t=45.278, P<0.01).

Conclusion

Perioperative ERAS can improve the therapeutic effect of liver cancer patients and should be applied in clinical practice.

Key words: Liver neoplasms, Hepatectomy, Enhanced recovery after surgery, Comparative effectiveness research, Prognosis

Liuping Liu, Jiangfu Guo. Efficacy and prognosis of enhanced recovery after surgery in patients with resection of hepatocellular carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 328-331.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2018.05.010

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2018/V12/I05/328

Figures/Tables 3

References 15

[1]	凡昀霏，柳杨，范伟. 加速康复外科在肝切除术中应用的前瞻性随机对照研究[J]. 贵州医药, 2017,41(12):1315-1316.
[2]	中华医学会外科学分会外科手术学学组，中国医疗保健国际交流促进会加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识(2017版)[J/CD]. 中华肝脏外科手术学电子杂志, 2017,6(4):254-260．
[3]	赵艳，仪维武. 加速康复外科理念对原发性肝癌行肝切除术患者的影响[J]. 齐鲁护理杂志, 2017,23(24):89-91.
[4]	荚卫东，骆鹏飞. 加速康复外科在精准肝脏外科中的应用[J]. 中华消化外科杂志, 2015,14(1):25-28.
[5]	Takamoto T, Hashimoto T, Inoue K, et al. Applicability of enhanced recovery program for advanced liver surgery[J]. World J Surg, 2014,38(10):2676-2682.
[6]	Butte JM, Grendar J, Bathe O, et al. The role of peri-hepatic drain placement in liver surgery: a prospective analysis[J]. HPB (Oxford), 2014,16(10):936-942.
[7]	宋伟，邹书兵. 加速康复外科在肝脏手术围手术期应用的Meta分析[J]. 中国普通外科杂志, 2016,25(1):115-125.
[8]	黄松，华福洲，郎海丽, 等. 加速康复外科策略对肝切除术患者术后早期认知功能的影响[J]. 临床麻醉学杂志, 2016,32(7):633-637.
[9]	荚卫东，乔晓斐. 加速康复外科理念在精准肝切除治疗肝细胞癌中的应用策略[J]. 中国实用外科杂志, 2016,36(6):692-694+698.
[10]	李乐，陈金明，刘中华, 等. 加速康复外科与传统康复方案在肝切除术中应用比较的Meta分析[J]. 临床肝胆病杂志, 2018,34(2):303-308.
[11]	李盛，胡炎军，朱求实, 等. 快速康复外科联合精准肝切除对非选择性肝切除患者的应用价值[J/CD]. 中华普通外科学文献（电子版）, 2015,9(4):296-299.
[12]	谭艳琼，杨宝仙，胡燕. 加速康复外科理念在肝部分切除术患者中的应用[J/CD]. 实用临床护理学电子杂志, 2018,3(12):93+95.
[13]	彭浪，王恺，樊友文, 等. 加速康复外科理念在原发性肝癌肝切除术围手术期管理的应用价值[J]. 中国普通外科杂志, 2017,26(2):218-222.
[14]	邓国荣，陈博艺，张玉胜, 等. 加速康复外科理念在原发性肝癌患者肝切除围术期中的应用与安全性评价[J/CD]. 消化肿瘤杂志（电子版）, 2016,8(4):243-248.
[15]	王洪超. 加速康复外科对肝癌切除术患者治疗的影响[J]. 医疗装备, 2016,29(19):118-119.

组别	例数	性别(男/女,例)	年龄(岁)^a	肿瘤直径(cm)^a	ALT(U/L)^a	AST(U/L)^a	TBIL(μmol/L) ^a	AFP(ng/ml) ^a	ECOS评分^a
ERAS组	56	29/27	46~69(54.0±6.5)	4~8(5.0±1.2)	52.5±4.5	53.6±2.8	13.5±2.0	200.5±10.5	42.5±6.5
常规组	56	31/25	47~68(55.6±6.7)	5~8(5.3±1.0)	53.0±4.8	53.8±2.0	13.7±2.2	208.5±6.8	42.0±6.0
统计值	?	0.144	1.283	1.437	0.569	0.435	0.503	0.489	0.476
P值	?	0.705	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	性别(男/女,例)	年龄(岁)^a	肿瘤直径(cm)^a	ALT(U/L)^a	AST(U/L)^a	TBIL(μmol/L) ^a	AFP(ng/ml) ^a	ECOS评分^a
ERAS组	56	29/27	46~69(54.0±6.5)	4~8(5.0±1.2)	52.5±4.5	53.6±2.8	13.5±2.0	200.5±10.5	42.5±6.5
常规组	56	31/25	47~68(55.6±6.7)	5~8(5.3±1.0)	53.0±4.8	53.8±2.0	13.7±2.2	208.5±6.8	42.0±6.0
统计值	?	0.144	1.283	1.437	0.569	0.435	0.503	0.489	0.476
P值	?	0.705	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	术中出血量(ml)	术后下床活动时间（d）	术后排气时间(d)	住院时间(d)	肝功能恢复时间(d)	住院费用(万元)	术后疼痛评分(分)
ERAS组	56	310.0±49.5	1.5±0.3	1.8±0.5	9.5±2.0	14.5±5.5	4.5±1.0	2.5±1.0
常规组	56	319.5±38.0	3.6±0.4	3.2±1.0	15.5±2.5	19.0±4.0	6.2±1.4	4.8±1.2
t值	?	1.139	31.430	9.371	14.024	4.952	7.394	11.019
P值	?	0.257	<0.05	<0.01	<0.01	<0.01	<0.01	<0.01

组别	例数	术中出血量(ml)	术后下床活动时间（d）	术后排气时间(d)	住院时间(d)	肝功能恢复时间(d)	住院费用(万元)	术后疼痛评分(分)
ERAS组	56	310.0±49.5	1.5±0.3	1.8±0.5	9.5±2.0	14.5±5.5	4.5±1.0	2.5±1.0
常规组	56	319.5±38.0	3.6±0.4	3.2±1.0	15.5±2.5	19.0±4.0	6.2±1.4	4.8±1.2
t值	?	1.139	31.430	9.371	14.024	4.952	7.394	11.019
P值	?	0.257	<0.05	<0.01	<0.01	<0.01	<0.01	<0.01

组别	例数	ALT（U/L）	AST（U/L）	TBIL（μmol/L）	AFP（μg/L）
ERAS组	56	70.5±25.5	38.5±12.6	20.2±6.3	49.5±2.0
常规组	56	84.0±19.9	47.7±15.9	25.4±7.5	84.5±4.5
t值	?	3.123	3.394	3.973	3.987
P值	?	<0.01	<0.01	<0.01	<0.01

Please choose a citation manager

Content to export