Abstract: Objective:To explore the application value of enhanced recovery after surgery (ERAS) in patients with hepatolithiasis and malnutrition after bilioenteric anastomosis.
Methods:The clinical data of 60 patients with hepatolithiasis and malnutrition who were admitted to the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from July 2013 to February 2015 were prospectively analyzed. A randomized controlled trial was conducted. All the patients were randomly divided into the 〖HJ〗ERAS group (30 patients) and the control group (30 patients) according to the random number table. The perioperative managements of patients were guided by the ERAS in the ERAS group and traditional methods in the control group. RouxenY cholangiojejunostomy was used for digestive tract reconstruction in the 2 groups. The time to flatus and defecation, time to outofbed activity, time of drainage tube removal, duration of postoperative hospital stay and postoperative complications were compared and analyzed, and serum Creactive protein (CRP), prealbumin (PA) and total bilirubin (TBil) at the postoperative day 1, 3, 6 were detected. Followup of daily telephone interview was performed for mastering the patients condition by attending doctor between discharge from hospital and 1 month postoperatively. Measurement data with normal distribution were presented as ±s, and comparison between groups was evaluated with an independent sample t test. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were analyzed using the chisquare test or Fisher exact probability.
Results:Sixty patients were screened for eligibility with an average age of 48 years (range, 21-65 years), including 25 males and 35 females, and were allocated into the ERAS group (30 patients) and the control group (30 patients). The total score of nutritional risk assessment in all the patients was less than 3 after preoperative nutritional support therapy. The postoperative time to flatus, time to defecation, time to outofbed activity, time of drainage tube removal and duration of postoperative hospital stay were (54±12)hours, (72±14) hours, (19±5) hours, (3.9±0.9)days, (7.4±0.9)days in the ERAS group and (84±12)hours, (104±13)hours, (53±8)hours, (6.7±1.1)days, (10.5±1.4)days in the control group, with significant differences between the 2 groups (t=9.969, 9.385, 19.328, 10.521, 10.307, P<0.05). The number of patients with postoperative wound infection, pulmonary infection and bile leakage in the ERAS group and control group were 2 and 3, 1 and 3, 1 and 2 respectively, showing no significant difference (P>0.05). The number of patients with throat pain and nausea and vomiting were 2 and 14 in the ERAS group, which were significantly different from 3 and 10 in the control group (χ²=12.273, 4.812, P<0.05). Levels of CRP at postoperative day 1, 3, 6 were (62.2±8.3)mg/L, (110.0±6.8) mg/L and (21.9±2.9)mg/L in the ERAS group and (183.0±7.4)mg/L, (135.4±7.0)mg/L and (28.9±3.5)mg/L in the control group, with a significant difference between the 2 groups (F=1 563.318, P<0.05). Levels of PA at postoperative day 1, 3, 6 were (178±5)mg/L, (232±7)mg/L and (258±7)mg/L in the ERAS group and (177±5) mg/L, (190± 6)mg/L and (248±7)mg/L in the control group, with a significant difference of the changing trend between the 2 groups (F=153.907, P<0.05). Levels of TBil at postoperative day 1, 3, 6 were (98±19)μmol/L, (56±15)μmol/L and (25±9)μmol/L in the ERAS group and (98±17)μmol/L, (58±15)μmol/L and (29± 8)μmol/L in the control group, with a significant difference between the 2 groups (F=0.339, P>0.05). All the patients were cured without perioperative death and loss to followup, and no reoperation and rehospitalization occurred during the followup.
Conclusion:Application of ERAS in the perioperative management of patients with hepatolithiasis and malnutrition after bilioenteric anastomosis is safe and effective, meanwhile, it could accelerate recovery of patients.