Application Of Enhanced Recovery After Suegery In Laparoscopic Anatomical Hepatectomy For Hepatolithiasis

Objective: To explore the safety and effect of enhanced recovery after surgery(ERAS)applied to laparoscopic anatomical liver resection of hepatolithiasis,and to provide evidence-based evidence for the perioperative management of the concept of enhanced recovery after surgery in clinical hepatectomy patients.Methods: A retrospective analysis of 115 patients with hepatobiliary calculi undergoing laparoscopic anatomical liver resection treated in the Department of Hepatobiliary Medicine,First Affiliated Hospital of Jishou University from August 2017 to August 2019.Of these,59 cases were treated with the concept of enhanced recovery after surgery Surgical management plan,56 cases were managed perioperatively according to the traditional model,and the basic information(gender,age,liver function classification,ASA classification)and inflammatory indicators(C-reactive protein,white blood cells,middle Percentage of neutrophils),main indicators of liver function(alanine transferase,aspartate aminotransferase,total bilirubin),whether hepatitis B virus is carried;intraoperative data(intraoperative blood loss,operation time,hilar obstruction Time,number of blood transfusion cases,surgical methods);inflammatory indexes(C-reactive protein,white blood cells,neutrophils percentage),postoperative first,third,and sixth days after operation;Main liver function indicators(alanine transferase,aspartate transferase,total bilirubin),postoperative pain scores of two groups of patients,and recovery of two groups(drainage time,anal exhaust time,surgery Comparative analysis of related indicators such as post-hospitalization date,complications,etc.,using SPSS 23.0 software for data analysis,comparison of measurement data following normal distribution between groups using independent sample t test,using x ± s;Comparisons between groups were performed using a rank sum test and described by M(lower quartile to upper quartile).The comparison of count data between groups was made using the chi-square test 2,Fisher’s exact probability method,or 2 test’s correction formula.P<0.05 indicates that the difference is statistically significant.Results: The patients in both groups recovered and were discharged without any perioperative death.In the ERAS group,the pain score was lower than that in the traditional group for 5 consecutive days after surgery,and the difference was statistically significant(P<0.05);the basic conditions before surgery(gender,age,liver function classification,ASA classification),and liver function before surgery There were no statistically significant differences in the main indicators(ALT,AST,TBIL),preoperative main inflammatory indicators(WBC,CRP,NEU%)and whether they carried hepatitis B virus(P> 0.05);A comparative statistical analysis of the main inflammatory indicators(WBC,CRP,NEU%)and the main indicators of liver function on the third,sixth,and sixth days revealed that the first day after surgery was significantly higher than before,and the third and sixth days after surgery were significantly higher.Gradually decreased,but the rate of decline in the ERAS group was more significant than the traditional group,and the difference was statistically significant(P<0.05);intraoperative indicators(intraoperative blood loss,surgical time,number of blood transfusion cases,and surgical methods))The statistical difference was not statistically significant(P> 0.05);the postoperative drainage tube extraction time,anal exhaust time,and postoperative hospitalization days were compared between the two groups of patients.The ERAS group was significantly different from the traditional group(P<0.05),and postoperative complications No significant difference(P<0.05)between the two groups.Conclusion: The ERAS concept is safe and effective in the management of laparoscopic anatomical hepatectomy during the perioperative period.Without increasing the postoperative complications of the patients,the postoperative hospitalization days are significantly reduced,the gastrointestinal function is restored,and the patients are reduced.Postoperative stress and inflammatory response accelerate patients’ postoperative recovery.