探讨腹腔镜胆总管探查术 (LCBDE)患者应用快速康复外科 (FTS)理念实施围手术期处理的效果。

回顾性分析咸阳市中心医院肝胆外科2014年3月至2015年5月行LCBDE患者76例的资料，随机分为FTS组 (39例)和传统处理组 (37例)。计算两组术前术后的胰岛素抵抗指数、C反应蛋白变化、术后应用镇痛药次数、术后首次排气时间、术后腹腔引流管拔除时间、术后住院时间、术后住院总费用、术后并发症和患者满意度调查等。

两组患者均临床治愈出院。对其术前至术后7 d的胰岛素抵抗指数与C反应蛋白水平变化趋势比较，差异有统计学意义 (F＝12.93, 17.74, P<0.05); 术后应用镇痛药次数、术后首次排气时间、术后拔除腹腔引流管时间、术后住院时间、术后住院总费用比较，差异均有统计学意义 (t＝2.488, 2.165, 14.996, 2.188, 2.183, P<0.05); 术后并发症发生率分别为15.4% (6/39)和32.4% (12/37)，差异有统计学意义 (χ²＝5.361, P<0.05); 患者满意度调查比较，差异有统计学意义 (χ²＝6.829, P<0.01)。

FTS能降低LCBDE患者的术后应激反应及并发症的发生率，加速其康复进程，缩短住院时间，改善临床效果。

To investigate the effect of management by fast tract surgery (FTS)in perioperative period of laparscopic common bile duct exploration (LCBDE).

The perioperative management data of 76 patients who were hospitalized from Mar. 2014 to May 2015 in department of hepatobiliary surgery, the center hospital of Xianyang City and received LCBDE were retrospectively analyzed. All the patients were randomly divided into the FTS group (39 patients) and the routine nursing group (37 patients). Before and after surgery the insulin resistance(IR) index and level of serum C-reactive protein (CRP) were calculated. The indexes such as postoperative times of analgesic medication, first time to anal exsufflation, time for removal of abdominal cavity drainage tube, hospitalization time and total cost, postoperative complications and satisfaction of patients by the third party survey were compared.

All patients were cured. Their IR and CRP level change trend have been compared from preoperative day to postoperative 7 days, differences wered statistically significant (F=12.93, 17.74, P<0.05); Comparison of two groups of patients after surgery: times of analgesic medication, first time to anal exsufflation, time for removal of abdominal cavity drainage tube, hospitalization time, total cost, with statistically significant differences (t=2.488, 2.165, 14.996, 2.188, 2.183, P<0.05); incidence of postoperative complications wered 15.4% (6/39)and 32.4% (12/37), respectively, showing statistically significant differences (χ²=5.361, P<0.05). Two groups of patients satisfaction survey, respectively, showing statistically significant differences (χ²=6.829, P<0.01).

The perioperative management by FTS in patients who received LCBDE could alleviate the postoperative stress reaction, reduce the incidence of postoperative complications, accelerate the recovery process, reduce the duration of hospital stay, improve clinical results.