Laparoscopic Cholecystectomy Under The Guidance Of Enhanced Recovery After Surgery

Objective:This study observed the recovery status,complication,analgesic effect and stress reaction of patients after LC under the guidance of ERAS,to discuss the safety,feasibility and effectiveness of ERAS used in perioperation of LC.And to provide reference for the extensive application of ERAS in LC.Methods:This essay analyses the clinical data of 87 patients after LC in the second department of hepatobiliary surgery of the second affiliated hospital of Kunming Medical University,from 2017.10 to 2018.03.A total of 83 patients were selected into the group,excluding those who did not meet the criteria.All patients were divided into ERAS group and conventional group.The data of clinical index(operation time,blood loss,first flatus time,first defecation time,first feeding time,the first time to get out of bed,length of hospital stay and cost of hospitalization),complications,pain index of VAS,stress Index(C-reactive protein results before and the first day after the surgery)and degree of satisfaction were compared among the two groups.Results:Compared with the conventional group,ERAS group shortened the first flatus time(22.3 ± 8.430,36.1 ± 16.75,P=0.035),first defecation time(32.31±14.83,44.62±16.32,P=0.021),first feeding time(15.24±6.11,24.02±5.51,P=0.013),the first time to get out of bed(10.44±2.67,15.10±5.14,P=0.018),length of hospital stay(2.15±1.32,3.60±1.42,P=0.022)and cost of hospitalization(7850.91±1496.02,9973.14±1586.31,P=0.011).There was no significant difference in operation time(90.88±12.21,93.32±11.61,P=0.460)and blood loss(15.68±12.21,19.11±11.53,P=0.421)between the two groups(P>0.05).There was no significant difference in the total number of complications between the two groups(P>0.05).The VAS score of postoperative rest time and sports at 6h,12h,24h,36h,48h was recorded to evaluate the postoperative analgesic effect of the two groups.ERAS group shortened the VAS score of postoperative sports at 24h,36h,48h.There was significant difference in analgesic effect between the two groups(P<0.05).There was no significant difference in the C-reactive protein results before surgery(P>0.05).C-reactive protein levels were lower in the ERAS group on POD1(P<0.05).ERAS group had a higher degree of satisfaction for postoperative analgesia and operation result(P<0.05),Conclusion:This study proves that the application of ERAS in LC perioperative period is safe and feasible.It can promote the recovery of early postoperative gastrointestinal function,reduce the cost of hospitalization,shorten postoperative hospital stay,provide better pain management results and reduce the stress level of perioperative period.Ultimately,ERAS accelerates the recovery of the patients.At the same time it brings better medical experience to patients.The implementation of the ERAS concept is beneficial to avoid the assembly line mode in clinical diagnosis and treatment.It is also beneficial for medical staff to pay attention to individualized treatment and make individualized scheme during medical treatment.We must avoid pursuing only cost reduction and time reduction.The ultimate goal of ERAS is to accelerate the recovery only when the safety of patients is ensured.The application of the ERAS concept in LC of primary hospitals benefits more patients.In the implementation process,the coordination and cooperation between the departments should be emphasized.