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Objective To observe the safety and clinical efficacy of enhanced recovery after surgery in the perioperation period of hepatectomy.Methods 92 patients with primary hepatic cancer who underwent surgical resection in our hospital from December 2014 to May 2016 were divided into two groups,50 patients received well-organized and consecutive clinical interventions guided by ERAS.42 patients underwent traditional perioperative management.Results Compared with traditional group,ERAS group had reduced hospital cost [(40 633.12 ± 6 336.46) RMB vs.(46 139.23 ± 9 605.88) RMB,P ＜ 0.05],shorter postoperative hospital stay[(10.24 ± 1.6) d vs.(13.35 ± 4.86) d,P ＜ 0.05],earlier flatus and defecation [(33.34 ±6.01) h vs.(50.31 ± 3.53) h,P ＜ 0.05],and improved satisfaction rate for pain management[45/50(90％) vs.22/42(52.4％),P ＜ 0.05];while the postoperative adverse events and complications of the two groups showed no difference (P ＞ 0.05).Conclusion The application of ERAS in the perioperation period of hepatectomy is safe and effective,reducing hospital cost,postoperative hospital stay,improving satisfaction rate to pain management,and facilitating recovery in hepatic surgery.
ABSTRACT
Objective To compare the therapeutic efficacy of combined biliary stent and 125I seed intracavity irradiation with palliative surgery in the treatment of extrahepatic ductal cholangiocarcinoma.Methods A prospective analysis was conducted on 142 patients with cholangiocarcinoma who were treated in The First Affiliated Hospital of Bengbu Medical College from January 2012 to December 2015.There were 80 patients who underwent percutaneous biliary metal stenting combined with 125I particles implantation (the stenting-particle group) and 62 patients who were treated by palliative biliary drainage (the surgical group).The surgical group included R1 resection in 17 patients,R2 resection in 26 patients and biliary enteric drainage in 19 patients).The levels of jaundice,liver function,survival time,hospitalization time and hospitalization cost before and after therapy were analyzed.Results Jaundice was effectively alleviated in the two groups after a short period.The liver function in the 2 groups improved significantly at 1,3 and 6 months when compared with that before operation,(P ＜ 0.05).The average hospitalization time of the stenting-particle group and the surgery group were (16.5 ± 5.0) days and (25.5 ± 10.5) days,respectively,(P ＜ 0.01).The average hospitalization cost of the stenting-particle group and the surgery group were (39 622.0 ± 7 666.4) yuan and (59 562.0 ± 24 218.2) yuan,respectively,(P ＜ 0.05).The average survival time of the stenting-particle group and the surgery group were (12.2 ± 5.1) months and (12.69 ± 7.46) months,respectively,and the difference was not significantly different (P ＞ 0.05).Conclusions For patients with extrahepatic ductal cholangiocarcinoma who were not suitable for radical surgery,percutaneous biliary stenting combined with 125I seed brachytherapy effectively reduced jaundice,improved liver function,shortened average length of hospital stay and reduced average cost of hospitalization.When compared with palliative surgery,it was a minimally invasive,easy,safe and efficacious treatment,especially for elderly patients with poor physical conditions.