Clinical Application Of Enhanced Recovery After Surgery In Treatment For Choledocholithiasis By ERCP In Ambulatory Surgery Ward

Objective: with the rapid development of medical technology,endoscopic technology has brought the treatment of choledocholithiasis into a minimally invasive era.In recent years,some traditional perioperative management modes,such as long preoperative fasting with water,have been questioned by more and more clinicians.In order to reduce patients’ long postoperative treatment time in hospital,Kehlet and Wilmore first proposed the concept of rapid recovery after surgery(ERAS)in 2001.ERAS has been successfully carried out in several clinical departments and has been recognized to some extent.However,there are few studies on ERCP in the daytime wards with less trauma in the treatment of common bile duct stones,and there is a lack of studies in which the ERAS concept is fully applied to improve the perioperative measures of ERCP.In this study,ERAS idea was made a characteristic change that was more consistent with daytime ERCP treatment,and its application value in the daytime ERCP treatment of choledocholithiasis was discussed.Whether it is safe and feasible to apply the idea of rapid rehabilitation surgery in the perioperative period of daytime ERCP patients.Methods: A retrospective analysis was performed concerning 211 patients who underwent ERCP surgery for CBDS in the First Affiliated Hospital of Xinjiang Medical University from April 2015 to April 2018.Eighty-five patients who were treated from April 2015 to March 2016 were divided into traditional treatment group(Group T),and 126 patients who were treated from April 2016 to April 2018 were divided into ERAS day care group(Group E).Perioperative period and follow-up status of patients between the two groups were compared and analyzed.Results: The first feeding time and the time of getting out of bed in Group E were significantly earlier than that in Group T(P<0.05).The average postoperative hospital stay,medical expenses,thirst hunger,the incidence of postoperative nausea and vomiting(PONV),the occurrence of abdominal distension and abdominal pain,and the serum amylase level at 3h and 12 h after surgery in Group E were significantly lower than that of Group T(P<0.05);the satisfaction of patients in Group E was 96.66±3.39),which was higher than Group T(90.25±4.87),with significant difference(t=10.54,P<0.05).The pain scores in Group E were significantly lower(Z=-5.12,P<0.05).None of the patients in the two group were re-admitted within 30 days.There was no significant difference in the incidence of complications and white blood cell count after operation between the two groups.Conclusion: It is safe and feasible to treat CBDS with ERCP under ERAS mode in ambulatory surgery ward,which can significantly reduce the occurrence of postoperative discomfort such as thirst,hunger,PONV and abdominal pain,increase the comfort level of patients,and accelerate the recovery of patients.