The Application Study Of Enhanced Recovery After Surgery(ERAS) Programs In Perioperative Period Of Hepatectmony

Objiective: To investigate the clinical application of enhanced recovery after surgery(ERAS)and its efficacy evaluation in the perioperative period of hepatectomy,and then provide references for the application of ERAS in perioperative period of patients who undergoing hepatectomy.Method: A controlled study was carried out in the first ward of department of hepatopancreatobiliary surgery of the First Affiliated Hospital of University of South China during September 2015 to December 2017,259 patients were divided into laparoscopic surgery group and open surgery group.The postoperative recovery might not be the same due to the different types of diseases and the number of patients with different hepatectomy,subgroups comparison were more accurate.So patients were subdivided into subgroups incuding hepatolithiasis subgroup,hepatic tumor subgroup,hepatectomy at least two segments subgroup and at most two segments subgroup.Every subgroup was divided into experimental group(EG,Implement ERAS)and control group(CG,Not implement ERAS),then we made a comparative analysis of two groups about the value of postoperative day(POD)1 and 4 white blood cell(WBC),alanine transaminase(ALT)and albumin(ALB),also compared the time of exhaust,oral feeding,ambulation and extubation time,the hospital stays and costs,the number of moderate to severe pain and the incidence of complications.Results: 1.There were no significant differences in age,gender,Child-Pugh class,American Standards Association(ASA)class,hepatitis B carrier,operation time and intraoperative blood loss in both laparoscopic surgery group and open surgery group(P>0.05),which had comparability in groups.2.Laparoscopic surgery group: 1)In hepatolithiasis subgroup,compared with CG,EG had lower number of WBC in POD1,ALT in POD1,4(P<0.05),but had higher number of ALB in POD4(P=0.005),had less number of patients who had suffered postoperative moderate to severe pain(P<0.001),had less time of postoperative exhaust,oral feeding and ambulation(P<0.001),had less hospital stays and costs(P<0.05);2)In hepatic tumor subgroup,compared with CG,EG had lower number of ALT in POD1,4(P<0.05),but had higher number of ALB in POD4(P=0.026),had less time of postoperative exhaust,oral feeding and ambulation(P<0.01);3)In at least two segments subgroup,compared with CG,EG had less time of postoperative exhaust,oral feeding and ambulation(P<0.01),had less hospital costs(P=0.030);4)In at most two segments subgroup,compared with CG,EG had lower number of WBC in POD1,ALT in POD1,4(P<0.01),but had higher number of ALB in POD4(P=0.001),had less number of patients who had suffered postoperative moderate to severe pain(P<0.001),had less time of postoperative exhaust,oral feeding and ambulation(P<0.001),had less hospital stays(P=0.047).3.Open surgery group: 1)In hepatolithiasis subgroup,compared with CG,EG had lower number of WBC in POD1(P<0.001),but had higher number of ALB in POD4(P=0.005),had less number of patients who had suffered postoperative moderate to severe pain(P=0.012),had less time of postoperative oral feeding,ambulation and extubation(P<0.01),had less hospital stays(P=0.006);2)In hepatic tumor subgroup,compared with CG,EG had lower number of ALT in POD1,4(P<0.05),but had higher number of ALB in POD1(P=0.025),had less number of patients who had suffered postoperative moderate to severe pain(P=0.006),had less time of postoperative oral feeding,ambulation and extubation(P<0.01),had less hospital stays and costs(P<0.01);3)In at least two segments subgroup,compared with CG,EG had lower number of WBC in POD1,ALT in POD1,4(P<0.05),but had higher number of ALB in POD4(P=0.019),had less number of patients who had suffered postoperative moderate to severe pain(P=0.045),had less time of postoperative ambulation and extubation(P<0.01),had less hospital stays and costs(P<0.01);4)In at most two segments subgroup,compared with CG,EG had lower number of WBC in POD1(P=0.013),but had higher number of ALB in POD4(P=0.012),had less time of postoperative oral feeding and ambulation(P<0.05),had less hospital stays and costs(P<0.01).4.Comparison of the incidence of complications: 1)In laparoscopic surgery group,compared with CG,EG had the lower incidence of the overall complications(P<0.05),there were no significant differences in general complications,surgical complications and Clavien-Dindo I-V class complications(P>0.05).2)In open surgery group,compared with CG,EG had the lower incidence of the overall complications and general complications(P<0.05),there were no significant differences in surgical complications and Clavien-Dindo I-V class complications(P>0.05).Conclusion: 1.ERAS process applied in patients with hepatectomy by optimizing the perioperative treatment measures,can safely and effectively relief trauma surgical stress,promote the early feeding and ambulation,accelerate the body function recovery,improve the effect of postoperative analgesia and reduce the incidence of postoperative non-surgery complications.2.The application of the ERAS procedure in the perioperative period of hepatectomy can accelerate the recovery of patients after surgery,reduce the hospitalization time and the cost of hospitalization,also save the medical resources.