Objective: To investigate the efficacy and safety of enhanced recovery after surgery (ERAS) in perioperative management of patients with gallbladder carcinoma. Methods: The data of the patients with gallbladder carcinoma admitted at Peking Union Medical College Hospital between January 2017 and December 2021 were analyzed retrospectively. There were 69 males(42.1%) and 95 females(57.9%),with age of (64.0±10.3) years(range:37 to 89 years). Patients were divided into ERAS group(n=53) and normal group(n=111) according to whether they were treated with ERAS measures during the perioperative period.The basic characteristics of the two groups were matched by propensity score matching,and then the perioperative information was compared between the two groups. Categorical variables were presented as absolute numbers or frequencies. Differences between study groups were analyzed using χ2 test, Fisher's exact test, t-test, or Mann-Whitney U test, as appropriate. Results: Each group had 45 patients after propensity score matching with well-balanced basic characteristics. There was no difference in basic characteristics, operation time,bleeding,complication,and hospitalization expenses between two groups(all P>0.05). Compared with the normal group,time of ambulation (M(IQR)) (1(1) day vs. 2(2) days;Z=-3.839,P<0.01),postoperative anal exhaust time (2(1) days vs. 3(1) days;Z=-3.013,P=0.003),feeding time(2(1) days vs. 2(1) days;Z=-3.647,P<0.01),postoperative (5(2) days vs. 7(4) days;Z=-3.984,P<0.01) and total(8(4) days vs. 13(6) days;Z=-3.605,P<0.01) hospitalization time were shorter in ERAS group. Postoperative complications occurred in 12 patients. According to the Clavien-Dindo classification,6,4,and 2 patients were classified as grade Ⅰ,Ⅱ,and Ⅲa,respectively. Conclusion: The ERAS measures is safe and effective for perioperative management of patients with gallbladder carcinoma, enhancing patient recovery and shortening hospitalization time without increasing complication or hospitalization cost.
目的： 探讨加速康复外科（ERAS）理念在胆囊癌患者围手术期应用的有效性和安全性。 方法： 回顾性分析2017年1月至2021年12月北京协和医院连续收治的164例胆囊癌患者的临床和病理学资料。男性69例（42.1%），女性95例（57.9%），年龄（64.0±10.3）岁（范围：37~89岁）。按照是否在围手术期应用ERAS理念进行管理，将患者分为ERAS组（53例）和常规组（111例）。应用倾向性评分匹配法对两组患者的基本信息进行平衡，并对匹配后两组患者的围手术期资料进行分析比较。分类资料用χ²检验或Fisher确切概率法进行组间比较；符合和不符合正态分布的定量资料分别以t检验和Mann-Whitney U检验进行组间比较。 结果： ERAS组和常规组各有45例患者匹配成功。两组患者的基本信息保持平衡，手术时间、出血量、并发症和住院费用等方面的差异均无统计学意义（P值均>0.05）。ERAS组患者下床时间更早［1（1）d比2（2）d；Z=-3.839，P<0.01］，排气时间更早［2（1）d比3（1）d；Z=-3.013，P=0.003］，饮水时间更早［2（1）d比2（1）d；Z=-3.647，P<0.01］，并且术后住院时间［5（2）d比7（4）d；Z=-3.984，P<0.01］和总住院时间［8（4）d比13（6）d；Z=-3.605，P<0.01］更短。两组共有12例患者发生术后并发症，根据Clavien-Dindo并发症分级标准，Ⅰ级6例、Ⅱ级4例、Ⅲa级2例。所有并发症均经积极治疗后好转。 结论： ERAS理念用于胆囊癌患者的围手术期处理是安全且有效的，可加快患者康复、缩短住院时间，且未增加并发症和住院费用。.