Application And Research Of Enhanced Recovery After Surgery In The Treatment Of Large Hepatocellular Carcinoma

Objective:This study will explore and evaluate the feasibility,efficacy and safety of ERAS procedure in the perioperative period of large livercancer resection.Methods :The patients with large liver cancer resection were selected as the research object at Southwest Medical University Affiliated Hospital,a total of 101 cases,male in 58 cases,female in 43 cases,the patients were randomly divided into ERAS group and traditional perioperative management group,ERAS group guided by the concept of ERAS under the guidance of the perioperative optimization of treatment measures,the control group was treated with traditional perioperative treatment,two groups of patients with a common discharge criteria.A comparative analysis of two groups of patients with postoperative hospitalization time,confining stress index changes in operative period,postoperative pain,recovery of gastrointestinal function after surgery,nasogastric tube indwelling time after surgery,surgery,postoperative abdominal drainage tube indwelling time,postoperative complications.Results:(1)basic information:two groups of patients in age,gender,weight,height,BMI,preoperative hemoglobin,preoperative ALT,preoperative AST,preoperative ASA score,preoperative ECOG score,preoperative BCLC score,preoperative liver function Child-pugh difference was not statistically significant.(2)The type of intraoperative hepatic lobectomy:there was no significant difference between the two groups.(3)In preoperative evaluation,the incidence of hunger and thirst was significantly lower in the ERAS group than in the traditional treatment group;there was no significant difference between the ERAS group and the traditional treatment group in panic and anxiety.(4)Two groups of patients in the operation time,intraoperative blood loss,the first hepatic portal blocking time,intraoperative blood transfusion was not statistically significant.(5)After the intervention,the CRP level in the ERAS group was significantly lower than that in the conventional treatment group on the first day after operation,and the difference between the two groups was statistically significant(1,3,5);two groups of patients in the postoperative IL-6,white blood cells,blood glucose,no systematic differences in juice.(6)Postoperative pain : the VAS score of the ERAS group was significantly lower than that of the conventional treatment group on the same day after operation and 1,3 days after operation,and the difference between the two groups was statistically significant,there was no significant difference in VAS score between two groups before and after the operation on the fifth day.(7)The time of extubation after operation: ERAS group of patients with postoperative nasogastric tube,catheter,drainage tube removal time was significantly shorter than the conventional treatment group,the difference was statistically significant between the two groups.(8)Postoperative rehabilitation:ERAS,group of patients after the start of feeding,time,postoperative ambulation time,postoperative anal exhaust time,postoperative anal defecationtime was significantly shorter than the traditional treatment group,the difference between the two groups was statistically significant.(9)90 days after operation,complications and readmission rate : postoperative complications were classified by Dindo-Clavien classification,ERAS group and conventional therapy group patients within 90 days after the occurrence of complications was not statistically significant and the rate of readmission rate difference between the two groups.(10)TRD and postoperative hospital stay,total cost of hospitalization:(ERAS)group in patients with TRD,postoperative hospitalization days were significantly shorter than the traditional treatment group,the difference between the two groups was statistically significant,the total cost of hospitalization in ERAS group was significantly less than that in the traditional treatment group,and the difference between the two groups was statistically significant.Conclusion:The application of ERAS principle in large liver resection can accelerate the recovery process in the operation,reduce the postoperative stress,shorten hospitalization time,reduce hospitalization costs,however,the ERAS group and the traditional group management in the control of postoperative complications had no significant difference;in short,perioperative quasi feasible in large resection of hepatocellular carcinoma by ERAS program,effectiveness and safety.