Clinical Study On The Application Of Enhanced Recovery After Surgery In The Surgical Treatment Of Internal Capsule Removal Of Hepatic Cystic Echinococcosis

Objective To explore the safety,feasibility and effect of the Enhanced Recovery After Surgery(ERAS)in the surgical treatment of internal capsule removal of hepatic cystic echinococcosis in Tibet,so as to provide reference for the clinical application of the Enhanced Recovery After Surgery(ERAS)in Tibet.Methods A total of 100 cases of hepatic cystic echinococcosis patients admitted to the general surgery department of the people's hospital of the Tibet autonomous region were collected,and all of them were selected for excision of the internal capsule and resection of most of the external capsule by same group of therapists.According to different perioperative treatment measures(see below for details),they were randomly divided into the accelerated recovery group of 52 cases and the traditional control group of 48 cases.Record of two groups of patients with gender,age,Body Mass Index(BMI),education level,the cyst number,operation time(min),intraoperative blood loss(ml),preoperative alanine aminotransferase(ALT),preoperative aspartic acid transaminase(AST),preoperative total protein(TP),preoperative albumin(ALB),preoperative globulin(GLO),preoperative Albumin/Globulin(A/G),preoperative total bilirubin(TBIL),preoperative direct bilirubin(DBIL),preoperative indirect bilirubin(IBLI),alanine aminotransferase(ALT)on the third day after surgery,aspartic acid transaminase(AST)on the third day after surgery,total protein(TP)on the third day after surgery,albumin(ALB)on the third day after surgery,globulin(GLO)on the third day after surgery,Albumin/Globulin(A/G)on the third day after surgery,total bilirubin(TBIL)on the third day after surgery,direct bilirubin(DBIL)on the third day after surgery,indirect bilirubin(IBLI)on the third day after surgery,preoperative pain score(using numerical scoring of pain,NRS),postoperative pain scoreon the same day(NRS),postoperative pain score after a week(NRS),fasting blood glucose level one day before operation(mmol/L),fasting blood glucose level one day after operation(mmol/L),activity time after operation(h),time of first eating after operation(h),time of first anal exhaust after operation(h),postoperative hospital stay(days),postoperative complications,Clavien system was used to classify the postoperative complications,and SPSS 25 statistical software was used to analyze the data.Results 1.There was no significant difference in gender,age,body mass index and education level of the two groups(p>0.05);2.There was no significant difference in number of cysts,operation time(min)and bleeding volume(ml)between the two groups(p>0.05);3.Two groups of patients with preoperative alanine aminotrans ferase(ALT),preoperative aspartic acid transaminase(AST),preoperative total protein(TP),preoperative albumin(ALB),preoperative globulin(GLO),preoperative Albumin/Globulin(A/G),preoperative total bilirubin(TBIL),preoperative direct bilirubin(DBIL),preoperative indirect bilirubin(IBLI)the comparison of differences had no statistical significance(p>0.05);Two groups of patients with alanine aminotransferase(ALT)on the third day after surgery,aspartic acid transaminase(AST)on the third day after surgery,total protein(T P)on the third day after surgery,albumin(ALB)on the third day after surgery,globulin(GLO)on the third day after surgery,Albumin/Globulin(A/G)on the third day after surgery,total bilirubin(TBIL)on the third day after surgery,direct bilirubin(DBIL)on the third day after surgery,indirect bilirubin(IBLI)on the third day after surgery the comparison of differences had no statistical significance(p>0.05);4.There was no statistically significant difference in preoperative pain score(NRS)between the two groups(p>0.05).There was significant difference between the pain score of the day after operation and the pain score of the week after operation in the accelerated rehabilitation group(group A)(p<0.01),and there was significant difference between the pain score of the day after operation and the pain score of the week after operation in the traditional control group(group B)(p<0.01).The differences of postoperative pain scoreon the same day(NRS)and postoperative pain score after a week(NRS)between the two groups were statistically significant(p<0.01).There was a positive correlation between postoperative pain scoreon the same day(NRS)and postoperative pain score after a week(NRS)in the traditional controlgroup(group B)(r_s=0.668,P<0.01);5.There was A statistically significant difference in fasting blood glucose between the patients in the accelerated rehabilitation group(group A)(p<0.01)and the patients in the traditional group(group B)before and one day after the operation(p<0.01).There was no statistically significant difference between the two groups in fasting blood glucose on one day before surgery(p>0.05),and there was a statistically significant difference between the two groups in fasting blood glucose on one day after surgery(p<0.01);6.There were statistically significant differences between the two groups in the time of postoperative discontinuation(h),time of postoperative first feeding(h),time of postoperative first anal exhaust(h),and time of postoperative hospitalization(day)(p<0.01),there was a statistically significant difference between the two groups in the incidence of postoperative complications(Clavien system classification of postoperative complications)(p<0.01).Conclusion It is safe and feasible to apply the Enhanced Recovery After Surgery(ERAS)in the surgical treatment of internal capsule removal of hepatic cystic echinococcosis in Tibet.Which plays a certain role in reducing postoperative stress response and alleviating insulin resistance,it can speed up the recovery of patients,shorten the hospital stay,and reduce the incidence of postoperative complications.It is worth popularizing in Tibet.