实施大肝切除术后增强恢复 (ERAS) 途径的挑战:一项回顾性队列研究
Lorenzo Bernardi1, Gaëtan-Romain Joliat2, Shu Sasaki3
1Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland; Department of Visceral Surgery, Lugano Regional Hospital, Lugano, Switzerland.
Surgery
|July 18, 2025
概括
在大肝切除术中实施手术后增强恢复 (ERAS) 是一个挑战,需要超过140个病例来改善遵守. 最少侵入性手术提高了ERAS的合规性,可能减少并发症和住院时间.
科学领域:
- 肝胆道手术 肝胆道手术
- 手术结果研究研究.
- 患者恢复协议 患者恢复协议
背景情况:
- 手术后增强恢复 (ERAS) 计划可以改善肝脏手术的结果.
- 对于接受重大肝切除术的患者来说,高ERAS合规性可能是困难的.
- 本研究评估了ERAS实施的挑战和主要肝切除术的合规性.
研究的目的:
- 调查主要肝切除术ERAS实施的挑战.
- 在这个人群中评估患者是否遵守ERAS协议.
- 评估ERAS遵守对临床结果的影响.
主要方法:
- 在ERAS计划中对连续的大型肝切除术 (≥3个Couinaud段) 的审查.
- 主要终点:实现高ERAS合规性 (≥70%) 的患者比例.
- 二级终点:机构学习曲线,临床结果,以及遵守/并发症的预测因素.
主要成果:
- 平均ERAS合规率为59%;只有17.1%的人最初实现了高合规率.
- 确定了机构学习曲线 (143个案例);高合规度增加了学习后曲线的10倍.
- 高度遵守与更少的并发症 (69.1%对53.1%) 和更短的住院时间 (12对8天) 相关联.
- 最少侵入性手术是高ERAS合规性最强的预测因素 (OR 6.7).
结论:
- 在大肝切除术中实施ERAS具有挑战性,需要显著的学习曲线 (>140例).
- 最少侵入性手术提高了ERAS的合规性,可能导致更好的结果.
- 高ERAS合规性与减少并发症和更短的住院时间有关,特别是在轻微的并发症.
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