| Objective: To explore the safety and value of implementing enhanced recovery after surgery(ERAS)at the perioperative of pancreatoduodenectomy(PD).Methods: A retrospective study was conducted to collect the clinical data of 122 patients undergoing PD from Sep.2015 to Aug.2017 in the Department of General Surgery,First Hospital of Lanzhou University.The patients were divided into ERAS groups(64 cases)and traditional group(58 cases)according to different perioperative management plans.In the perioperative of the ERAS group,controlled rehydration,multimodal analgesia,early extubation,early feeding,and early activities were implemented.The traditional group used a traditional management program during the perioperative.The changes in intraoperative blood loss,operation time,number of blood transfusions,intraoperative fluid volume,postoperative complications,length of hospital stay,hospitalization costs,reoperation rate,and hospital return rate were observed.Results: The ages of patients in the ERAS group and the traditional group was(56.36±6.74 years vs 54.69±7.88 years);54.7%(33:58)were males in ERAS group,and 56.9%(33:58)in traditional group;the BMI of the ERAS group and the traditional group was(22.05±2.68 vs 22.39±2.18);21 patients(32.8%)with basic disease in the ERAS group,and 23 patients(39.7%)in the traditional group;the preoperative bilirubin levels in the ERAS group and the traditional group was(128.28±102.59 mmol/L vs 151.81±99.57 mmol/L);11 patients(17.2%)had preoperative biliary drainage in the ERAS group,and 13 patients(22.4%)in the traditional group;the Alb in the ERAS group and the traditional group was(37.71±4.43 g/L vs 36.74±7.18 g/L);the preoperative pancreatic duct diameter in the ERAS and traditional group was(3.05±0.93 mm vs 2.97±0.84 mm);preoperative bile duct diameter in the ERAS and traditional groups was(13.97±5.35 mm vs 36.74±7.18mm);there was no significant difference in ASA score and tumor location between the two groups(P>0.05).Compared to the traditional group,the ERAS group had shortersurgical time(5.85±0.69 h vs 6.09±1.17 h),less blood loss(256.40±103.84 ml vs283.83±135.58 ml),and less blood transfusion(9.4% vs 12.1%),but there was no significant difference(P>0.05),as well as less intraoperative fluid volume(3245±364.36 ml vs 3767±484.99 ml),the difference was statistically significant(P<0.05).Compared with the traditional group,the ERAS group had early gastric tube removal(3.11±1.09 d vs 5.19±1.90 d),rapid recovery of gastrointestinal function(3.86±0.91 d vs 4.36±1.00 d),and early postoperative food intake(4.72±0.72 d vs7.59±1.32 d),early removal of the drainage of biliary and intestinal anastomosis(5.88±1.34 d vs 8.35±1.75 d),early removal of the drainage of pancreaticojejunostomy anastomosis(11.38±2.97 d vs 17.14±2.64 d).The differences were statistically significant(P<0.05).The incidence of DGE was decreased(3.1% vs15.5%),and the incidence of overall complications was decreased(20.3% vs 44.8%)in the ERAS group.The difference was statistically significant(P<0.05).Also,the incidence of pulmonary infections was reduced(3.1% vs 12.1%),the incidence of urinary tract infections was reduced(1.6% vs 6.9%),the incidence of deep venous thrombosis in both lower limbs was decreased(0 vs 3.4%),the incidence of bile leakage was reduced(4.7% vs 1.7%),the incidence of intra-abdominal infection was reduced(12.5% vs 13.8%),the incidence of Class B pancreatic fistulas was decreased(4.7% vs 6.9%),and the incidence of Class C pancreatic fistulas was increased(1.6%vs 0),the incidence of grade A bleeding decreased(3.1% vs 6.9%),grade B hemorrhage increased(1.6% vs 3.4%),and the incidence of grade C hemorrhage was low(0 vs 1.7%),the rate of reoperation decreased(3.1% vs 5.2%),but the difference was not statistically significant(P>0.05).In the ERAS group,the LOS shortened(16.91±4.28 d vs 19.66±4.11 d)and the hospitalization cost decreased(7.35±2.01ten-thousand-yuan vs 8.24±2.26 ten-thousand-yuan),and the difference was statistically significant(P<0.05).119 patients were followed up.Three patients(4.7%)in ERAS group returned to the hospital within 30 days after discharge,and 1 patient(1.7%)in the traditional group;8 patients(12.5%)had local recurrence in the ERAS group,and 10 patients(17.2%)in the traditional group;3 patients(4.7%)had distant metastasis in the ERAS group,and 8 patients(13.8%)in the traditional group;There were 11 patients(17.2%)with late complications in the ERAS group,including 6patients with diabetes,2 patients with gastrostomy anastomotic ulcer,3 patients with postoperative cholangitis.And 9 patients with late complications in the traditionalgroup(15.5%),including 4 patients with diabetes,1 patients with gastrostomy anastomotic ulcer,4 patients with postoperative cholangitis.There were 2 deaths(3.1%)in the ERAS group and 8 deaths(13.8%)in the traditional group.Conclusions: The application of ERAS in PD perioperative is safe and effective.It could accelerate postoperative recovery,reduce complications,shorten hospital stay,and reduce hospitalization costs. |
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