加速康复外科在肝细胞癌肝移植术中的应用效果分析

Efficacy of Enhanced Recovery after Surgery in Liver Transplantation for Hepatocellular Carcinoma

摘要: 目的：探究围术期实施加速康复外科(Enhanced Recovery after Surgery, ERAS)对肝细胞癌患者肝移植术后康复质量的影响，并评估其有效性及安全性。方法：选取2020年8月至2024年6月于山东省千佛山医院因肝细胞癌接受同种异体原位肝移植术92例患者的临床资料，根据围术期管理模式不同，将患者分为ERAS组(52例)与常规组(40例)，分析比较两组患者的术后首次排气时间、首次下床时间、ICU停留天数、术后并发症发生率、住院时间及住院费用等指标。结果：与常规组患者相比，ERAS组术后首次排气时间[3.5 (3.1, 3.9)天 vs 4.2(3.6, 4.5)天，Z = −4.702，P < 0.001]、首次下床活动时间[(6.29 ± 1.85)天 vs (9.02 ± 2.26)天，t = −6.852，P < 0.001]、住院时间[16.0 (15.0, 19.0)天 vs 20.0 (18.0, 21.5)天，Z = −4.497，P = 0.001]以及住院费用[23.46 (22.46, 25.08)万元 vs 27.38 (25.96, 29.69)万元，Z = −6.675，P = 0.001]均显著缩短/降低，差异均有统计学意义。两组术后总并发症发生率(30.8% vs 62.5%, χ² = 9.214, P = 0.002)及谵妄发生率(7.7% vs 25.0%, χ² = 5.249, P = 0.022)比较，也均有统计学意义。结论：围术期应用ERAS路径与肝细胞癌肝移植患者术后恢复进程加速、并发症发生率降低和医疗成本减少相关，本研究结果提示其具有良好的安全性和临床推广价值。

Abstract: Objective: This paper aims to investigate the impact of perioperative Enhanced Recovery after Surgery protocols on the quality of recovery following liver transplantation in patients with hepatocellular carcinoma, and to evaluate its efficacy and safety. Methods: A total of 92 patients who received allogeneic orthotopic liver transplantation for hepatocellular carcinoma at Qianfoshan Hospital of Shandong Province from August 2020 to June 2024 were included in this study. According to the perioperative management protocol, the patients were divided into an ERAS group (n = 52) and a conventional care group (n = 40). The following outcome measures were compared between the two groups: time to first flatus, time to first ambulation, ICU length of stay, postoperative complication rate, total hospital stay, and hospitalization costs. Results: Compared with the conventional group, the ERAS group demonstrated statistically significant reductions in time to first flatus [3.5 (3.1, 3.9) days vs 4.2 (3.6, 4.5) days, Z = −4.702, P < 0.001], time to first ambulation [(6.29 ± 1.85)days vs (9.02 ± 2.26) days, t = −6.852, P < 0.001], total hospital stay [16.0 (15.0, 19.0) days vs 20.0 (18.0, 21.5) days, Z = −4.497, P = 0.001], and hospitalization costs [23.46 (22.46, 25.08) ten thousand yuan vs 27.38 (25.96, 29.69) ten thousand yuan, Z = −6.675, P = 0.001]. Significant differences were also observed in the overall postoperative complication rate (30.8% vs 62.5%, χ² = 9.214, P = 0.002) and the incidence of delirium (7.7% vs 25.0%, χ² = 5.249, P = 0.022) between the two groups. Conclusion: Implementation of the ERAS pathway during the perioperative period is associated with significantly accelerated postoperative recovery, reduced incidence of complications, and lower medical costs in patients undergoing liver transplantation for HCC. This pathway demonstrates favorable safety and possesses significant clinical application value.