加速康复外科理念辅助治疗小婴儿先天性巨结肠的有效性和安全性研究

目的:探讨加速康复外科(Enhanced recovery after surgery,ERAS)理念用于治疗小婴儿先天性巨结肠(Hirschsprung's,HSCR)的临床疗效和安全性。方法:选择2016年01月至2017年12月在我院新生儿外科接受手术治疗并临床病理确诊的79例HSCR患儿并将其分为对照组和ERAS组。对照组26例给予经腹巨结肠根治术,ERAS组44例入院后据患儿病情进行宣教ERAS,再采用腹腔镜巨结肠根治术。比较两组手术时间、术后肠功能恢复时间、留置管道情况、平均住院日、住院费用、血清C反应蛋白(C-reactive protein,CRP)、降钙素原、白介素-6(Interleukin,IL-6)、皮质醇水平的变化及围手术期并发症的发生情况。结果:ERAS组手术时间、术中出血量、肠功能恢复时间、术前平均住院天数、术后平均住院天数、平均住院天数、平均费用、留置胃管时间、留置尿管时间均显著短于对照组。术后,ERAS组血清CRP、降钙素原、IL-6、皮质醇水平均明显低于对照组。ERAS组术中并发症发生率显著低于对照组(2.27%vs. 23.08,P0.05)。结论:加速康复外科理念辅助治疗小婴儿先天性巨结肠可促进患者术后病情恢复,减少患者医疗费用并提高治疗安全性。

Efficacy and Safety of Accelerated Rehabilitation Surgery in the Treatment of Hirschsprung's Disease in Infants

ABSTRACT Objective: To investigate the clinical efficacy and safety of concept of accelerated recovery after surgery (ERAS) in the treatment of Hirschsprung''s (HSCR) infants. Methods: From January 2016 to December 2017, 79 cases of infants with HSCR who under- went surgical treatment and diagnosed by the clinical pathology in our hospital were selected and divided into the control group and the ERAS group. In the control group, 26 patients underwent radical operation of abdominal megacolon, 44 patients in the ERAS group were enrolled in the hospital under the condition of ERAS, and then treated by laparoscopic megacolon radical surgery. The operation time, postoperative intestinal function recovery time, indwelling catheter status, average hospitalization stay, hospitalization cost, the changes of serum C-reactive protein (CRP), procalcitonin, interleukin (IL-6) and cortisol levels as well as the incidence of perioperative complica- tions were compared between the two groups. Results: The operation time, intraoperative blood loss, intestinal function recovery time, average hospital stay, average postoperative hospital stay, average cost, indwelling gastric tube time, and indwelling catheter time were significantly lower or shorter in the ERAS group than those in the control group(P<0.05). After operation, the levels of serum CRP, pro- calcitonin, IL-6 and cortisol in the ERAS group were significantly lower than those in the control group(P<0.05). The incidence of intra- operative complications in the ERAS group was significantly lower than that in the control group (2.27% vs. 23.08, P<0.05). Conclusion: Accelerated rehabilitation surgery concept can promote the recovery of congenital megacolon in THE infants after surgery, reduce the medical expenses and improve the safety of treatment.