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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (05) : 732 -739. doi: 10.3877/cma.j.issn.2095-3232.2025.05.011

临床研究

MDT协作下ERAS临床路径在肝切除围手术期中的应用
丹增阿旺, 王超, 杨振华, 何正为, 张必翔, 张斌豪, 王婷†()   
  1. 430030　武汉，华中科技大学同济医学院附属同济医院肝胆胰外科
  • 收稿日期:2025-04-15 出版日期:2025-10-10
  • 通信作者: 王婷
  • 基金资助:
    湖北陈孝平科技发展基金会(CXPJJH122005-20，CXPJJH11900001-2019325，CXPJJH121001-2021004)

Application of ERAS clinical pathway in the perioperative period of hepatectomy under MDT cooperation

Awang Danzeng, Chao Wang, Zhenhua Yang, Zhengwei He, Bixiang Zhang, Binhao Zhang, Ting Wang†()   

  1. Department of Hepatobiliary and pancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
  • Received:2025-04-15 Published:2025-10-10
  • Corresponding author: Ting Wang
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引用本文：

丹增阿旺, 王超, 杨振华, 何正为, 张必翔, 张斌豪, 王婷. MDT协作下ERAS临床路径在肝切除围手术期中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(05): 732-739.

Awang Danzeng, Chao Wang, Zhenhua Yang, Zhengwei He, Bixiang Zhang, Binhao Zhang, Ting Wang. Application of ERAS clinical pathway in the perioperative period of hepatectomy under MDT cooperation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(05): 732-739.

目的

探讨MDT协作下加速康复外科（ERAS）临床路径在肝切除围手术期中的应用价值。

方法

回顾性分析2018年1月至2019年12月在华中科技大学同济医学院附属同济医院行肝切除术的1 046例患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男764例，女282例；年龄18~84岁，中位年龄52岁。根据是否纳入MDT协作下的ERAS临床路径进行分组，其中ERAS组416例，非ERAS组630例。采用倾向性评分匹配（PSM）方法降低两组潜在的选择性偏倚。两组术后住院时间、留置鼻胃管、尿管、引流管时间比较采用秩和检验，术后并发症发生率等比较采用χ2检验。

结果

经过1∶1的PSM后，两组各匹配到253例患者，两组术前基线指标比较差异无统计学意义（P>0.05）。PSM后ERAS组的术后住院时间为9（7，12）d，明显短于非ERAS组的11（8，13）d（Z=-3.610，P<0.001）；ERAS组在术后留置鼻胃管、尿管及引流管的时间分别为4（2，12）h、27（21，44）h、4（3，6）d，均明显短于非ERAS组的21（16，24）h、41（21，56）h、5（4，7）d（Z=-14.150，-2.235，-5.202；P<0.05）。ERAS组和非ERAS组术后并发症发生率分别为5.9%（15/253）、8.3%（21/253），差异无统计学意义（χ2=1.077，P>0.05）。

结论

MDT协作下ERAS临床路径在肝切除围手术期中的应用能够明显缩短患者术后住院时间，加快术后康复。

关键词: 肝切除术, 加速康复外科, 多学科诊疗, 围手术期管理
Objective

To evaluate the application value of clinical pathway of enhanced recovery after surgery (ERAS) in liver resection under multi-disciplinary team (MDT) cooperation.

Methods

Clinical data of 1 046 patients who underwent liver resection in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 764 patients were male and 282 female, aged from 18 to 84 years, with a median age of 52 years. According to the implementation of clinical pathway of ERAS under MDT cooperation, 416 patients were assigned into the ERAS group and 630 cases into the non-ERAS group. The potential selection bias between two groups was minimized by propensity score matching (PSM). The length of postoperative hospital stay, indwelling time of gastric tube, urinary catheter and drainage tube between two groups were compared by rank-sum test. The incidence of postoperative complications was compared by Chi-square test.

Results

After 1:1 PSM, 253 patients were matched in each group. There was no significant difference in baseline indexes between two groups (all P>0.05). After PSM, the length of postoperative hospital stay in the ERAS group was 9(7,12) d, significantly shorter than 11(8,13) d in the non-ERAS group (Z=-3.610, P<0.001). Postoperative indwelling time of gastric tube, urinary catheter and drainage tube in the ERAS group was 4(2,12) h, 27(21,44) h and 4(3, 6) d, significantly shorter than 21(16,24) h, 41(21,56) h and 5(4,7) d in the non-ERAS group (Z=-14.150,-2.235,-5.202; all P<0.05). The incidence of postoperative complications in the ERAS and non-ERAS groups was 5.9%(15/253) and 8.3%(21/253), with no statistical significance (χ2=1.077, P>0.05).

Conclusions

The application of ERAS clinical pathway in liver resection under MDT cooperation can significantly shorten the length of postoperative hospital stay and accelerate postoperative recovery.

Key words: Hepatectomy, Enhanced recovery after surgery (ERAS), Multi-disciplinary team (MDT), Perioperative management
图1 ERAS组和非ERAS组肝切除患者的疾病谱 注：HCC为肝细胞癌，ICC为肝内胆管癌，cHCC-CCA为混合型肝细胞癌-胆管癌，Hemangioma为肝血管瘤，Liver Metastasis为转移性肝癌，FNH为局灶结节性增生，ERAS为加速康复外科
图2 ERAS优化流程管理系统 注：ERAS为加速康复外科
表1 肝切除患者ERAS实施项目和具体内容
时间 项目 内容 参与学科
术前 全身状况评估 营养状况评估：NRS 2002；心血管系统：ECG、心脏彩超、血压等；呼吸系统：肺康复风险初筛量表、肺功能测定、血气分析等；肾功能：内生肌酐清除率等；糖代谢：空腹及餐后血糖；心理状况评估：SAS量表；深静脉血栓风险评估 外科、内科、营养科、麻醉科
基础肝病状况评估 肝炎病毒感染、肝硬化程度、门静脉高压、梗阻性黄疸、治疗相关肝损伤、术前对症治疗 外科、内科
肝脏可切除性评估 Child-Pugh分级，MELD评分，ICGR15 外科
宣教及准备 术前疾病知识宣教；适应性训练：呼吸训练、有效咳嗽训练等；术前准备知识宣教：包括疼痛、术后康复、ERAS内容；术前禁食水：术前禁食6 h，禁水2 h；无糖尿病患者术前2 h口服碳水化合物350 ml，糖尿病患者服用350 ml温开水；不常规进行机械性灌肠 外科、麻醉科
术中 精细手术操作，采用低中心静脉压技术，预防性使用抗生素，预防术中低体温，目标导向液体治疗，预防性镇痛，视具体情况放置腹腔引流管（非必须） 外科、麻醉科、手术室
术后 预防性镇痛及多模式镇痛，预防恶心呕吐，过度炎症反应和应激反应调控，并发症的预防及治疗，早期拔除鼻胃管及经口进食，营养支持，早期活动，深静脉血栓预防，术后血糖控制，早期拔除尿管及引流管，促进肠道功能恢复，心理睡眠管理 外科、麻醉科、营养科、康复科、内科
出院护理 出院评估：生活能基本自理；疼痛缓解或口服止痛药能良好控制疼痛；能正常进食，不需要静脉补液；通畅排气排便；肝功能 Child-Pugh 分级A级或胆红素恢复正常或接近正常； 切口愈合良好无感染（不必等待拆线）；出院指导：心态、活动、饮食、用药等出院随访 外科、康复科
表2 ERAS组与非ERAS组肝切除患者基线资料比较
指标 PSM前 PSM后
ERAS组 非ERAS组 统计值 P值 ERAS组 非ERAS组 统计值 P值
男性(例) 305 459 χ2=0.027 0.870 185 186 χ2=0.010 0.920
年龄[岁, M(Q1, Q3)] 51(44, 58) 53(46, 61) Z=-2.834 0.005 51(44, 57) 53(45, 61) Z=-1.600 0.110
吸烟史(例) 128 193 χ2=0.002 0.963 76 72 χ2=0.153 0.696
饮酒史(例) 96 98 χ2=9.382 0.002 53 55 χ2=0.047 0.828
HBV感染(例) 197 312 χ2=0.471 0.492 121 122 χ2=0.008 0.929
HCV感染(例) 2 7 χ2=1.167 0.280 1 1 χ2=0.000 1.000
高血压(例) 57 13 χ2=54.351 <0.001 15 12 χ2=0.352 0.553
糖尿病(例) 29 16 χ2=11.951 0.001 13 9 χ2=0.760 0.383
腹部手术史(例) 82 44 χ2=38.308 <0.001 29 34 χ2=0.453 0.501
BMI[kg/m2, M(Q1, Q3)] 23(21, 25) 23(21, 25) Z=-2.144 0.032 23(21, 25) 23(21, 25) Z=-0.028 0.978
ASA分级1~2级(例) 315 393 χ2=20.386 <0.001 186 184 χ2=0.040 0.841
恶性肿瘤(例) 316 492 χ2=0.649 0.420 192 199 χ2=0.551 0.458
肝硬化(例) 138 286 χ2=16.919 <0.001 86 86 χ2=0.030 0.985
表3 ERAS组与非ERAS组肝切除患者PSM后术前检验指标比较[M（Q1, Q3)]
指标 ERAS组 非ERAS组 Z值 P值
RBC(×1012/L) 4(4, 5) 4(4, 5) -0.862 0.388
Hb(g/L) 137(124, 149) 138(126, 152) -0.952 0.341
Plt(×109/L) 173(131, 231) 182(135, 229) -0.557 0.578
ALT(U/L) 24(15, 37) 21(14, 32) -1.510 0.121
AST(U/L) 25(19, 34) 25(19, 35) -0.431 0.667
ALB(g/L)) 41(38, 443) 42(39, 45) -1.460 0.144
TB(μmol/L) 11(8, 14) 12(9, 15) -1.731 0.083
DB(μmol/L) 4(3, 6) 4(3, 6) -0.268 0.788
Scr(μmol/L) 70(61, 81) 70(61, 78) -0.500 0.617
BUN(μmol/L) 5(4, 6) 5(4, 6) -0.537 0.592
PT(s) 14(13, 14) 14(13, 14) -1.319 0.187
PTA(%) 91(85, 99) 93(84, 99) -1.169 0.242
APTT(s) 38(36, 40) 37(35, 41) -0.098 0.922
表4 两组肝切除患者PSM后肿瘤特征及术中指标比较
指标 ERAS组 非ERAS组 统计值 P值
肿瘤最大径[cm, M(Q1, Q3)] 5.3(3.6, 8.1) 5.0(3.0, 8.0) Z=0.532 0.595
多发肿瘤(例) 49 51 χ2=0.050 0.823
PVTT(例) 24 16 χ2=1.737 0.187
胆囊切除(例) 110 103 χ2=0.397 0.528
腹腔镜肝切除(例) 150 152 χ2=0.033 0.856
大范围肝切除(例) 93 96 χ2=0.076 0.783
中转开腹(例) 5 5 χ2=0.000 1.000
手术时间[min, M(Q1, Q3)] 205(165, 269) 210(160, 272) Z=-0.308 0.758
术中出血量[ml, M(Q1, Q3)] 200(100, 400) 200(100, 300) Z=-1.772 0.076
Pringle法(例) 156 135 χ2=3.235 0.072
Pringle法阻断时间[min, M(Q1, Q3)] 18(13, 30) 16(10, 30) Z=-1.371 0.169
术中输血(例) 30 25 χ2=0.326 0.568
术中输血量[U, M(Q1, Q3)] 4(2, 4) 2(3, 4) Z=-1.082 0.267
表5 PSM后两组肝切除患者术后结局比较
指标 ERAS组 非ERAS组 统计值 P值
术后住院时间 [d, M(Q1, Q3)] 9(7, 12) 11(8, 13) Z=-3.610 <0.001
术后留置鼻胃管时间[h, M(Q1, Q3)] 4(2, 12) 21(16, 24) Z=-14.150 <0.001
留置尿管时间[h, M(Q1, Q3)] 27(21, 44) 41(21, 56) Z=-2.235 0.025
留置引流管时间[d, M(Q1, Q3)] 4(3, 6) 5(4, 7) Z=-5.202 <0.001
术后并发症(例) 15 21 χ2=1.077 0.299
严重并发症(例) 3 4 χ2=0.145 0.703
肝衰竭(例) 2 3 χ2=0.202 0.653
出血(例) 1 1 - -
胆漏(例) 1 3 χ2=1.008 0.315
胸腔积液(例) 9 16 χ2=2.062 0.151
肺部感染(例) 2 6 χ2=2.032 0.154
腹腔积液(例) 5 11 χ2=2.323 0.127
血栓形成(例) 2 4 χ2=0.675 0.411
切口感染(例) 2 3 χ2=0.202 0.653
[1]
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617. DOI: 10.1093/bja/78.5.606.
[2]
van Dam RM, Hendry PO, Coolsen ME, et al. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection[J]. Br J Surg, 2008, 95(8): 969-975. DOI: 10.1002/bjs.6227.
[3]
Stoot JH, van Dam RM, Busch OR, et al. The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study[J]. HPB, 2009, 11(2): 140-144. DOI: 10.1111/j.1477-2574.2009.00025.x.
[4]
Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations[J]. World J Surg, 2016, 40(10): 2425-2440. DOI: 10.1007/s00268-016-3700-1.
[5]
中华医学会外科学分会肝脏外科学组. 肝切除术围手术期管理专家共识[J]. 中国实用外科杂志, 2017, 37(5): 525-530. DOI: 10.19538/j.cjps.issn1005-2208.2017.05.17.
[6]
中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜肝切除术加速康复外科中国专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(5): 517-524. DOI: 10.19538/j.cjps.issn1005-2208.2017.05.16.
[7]
Popescu I, Câmpeanu I. Surgical anatomy of the liver and liver resection. Brisbane 2000 Terminology[J]. Chirurgia, 2009, 104(1): 7-10.
[8]
Balzan S, Belghiti J, Farges O, et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy[J]. Ann Surg, 2005, 242(6): 824-828, discussion 828-829. DOI: 10.1097/01.sla.0000189131.90876.9e.
[9]
Koch M, James Garden O, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery[J]. Surgery, 2011, 149(5): 680-688. DOI: 10.1016/j.surg.2010.12.002.
[10]
Rahbari NN, James Garden O, Padbury R, et al. Post-hepatectomy haemorrhage: a definition and grading by the International Study Group of Liver Surgery (ISGLS)[J]. HPB, 2011, 13(8): 528-535. DOI: 10.1111/j.1477-2574.2011.00319.x.
[11]
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae.
[12]
Rubin DB, Thomas N. Matching using estimated propensity scores: relating theory to practice[J]. Biometrics, 1996, 52(1): 249-264.
[13]
Joliat GR, Kobayashi K, Hasegawa K, et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations 2022[J]. World J Surg, 2023, 47(1): 11-34. DOI: 10.1007/s00268-022-06732-5.
[14]
Evans DC, Martindale RG, Kiraly LN, et al. Nutrition optimization prior to surgery[J]. Nutr Clin Pract, 2014, 29(1): 10-21. DOI: 10.1177/0884533613517006.
[15]
Pichard C, Kyle UG, Morabia A, et al. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay[J]. Am J Clin Nutr, 2004, 79(4): 613-618. DOI: 10.1093/ajcn/79.4.613.
[16]
Rinninella E, Cintoni M, De Lorenzo A, et al. May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study[J]. Intern Emerg Med, 2019, 14(1): 51-57. DOI: 10.1007/s11739-018-1944-5.
[17]
Ardito F, Lai Q, Rinninella E, et al. The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol[J]. Updates Surg, 2020, 72(3): 681-691. DOI: 10. 1007/s13304-020-00787-6.
[18]
董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版)[J]. 中华消化外科杂志, 2011, 10(1): 20-25. DOI: 10.3760/cma.j.issn.1673-9752.2011.01.006.
[19]
Geoffrion R, Koenig NA, Zheng M, et al. Preoperative depression and anxiety impact on inpatient surgery outcomes: a prospective cohort study[J]. Ann Surg Open, 2021, 2(1): e049. DOI: 10.1097/AS9.0000000000000049.
[20]
Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications[J]. Cochrane Database Syst Rev, 2003(4): CD004423. DOI: 10.1002/14651858.CD004423.
[21]
Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery[J]. Clin Nutr, 2017, 36(3): 623-650. DOI: 10.1016/j.clnu.2017.02.013.
[22]
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American society of anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration[J]. Anesthesiology, 2017, 126(3): 376-393. DOI: 10.1097/ALN. 0000000000001452.
[23]
Ichida H, Imamura H, Yoshimoto J, et al. Randomized controlled trial for evaluation of the routine use of nasogastric tube decompression after elective liver surgery[J]. J Gastrointest Surg, 2016, 20(7): 1324-1330. DOI: 10.1007/s11605-016-3116-0.
[24]
Wen Z, Zhang X, Liu Y, et al. Is routine nasogastric decompression after hepatic surgery necessary? A systematic review and meta-analysis[J]. Int J Nurs Stud, 2019, 100: 103406. DOI: 10.1016/j.ijnurstu.2019.103406.
[25]
Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomized multicenter trial[J]. Ann Surg, 2008, 247(5): 721-729. DOI: 10.1097/SLA.0b013e31815cca68.
[26]
Brower RG. Consequences of bed rest[J]. Crit Care Med, 2009, 37: S422-S428. DOI: 10. 1097/ccm.0b013e3181b6e30a.
[27]
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome[J]. Am J Surg, 2002, 183(6): 630-641. DOI: 10.1016/s0002-9610(02)00866-8.
[28]
Ni CY, Wang ZH, Huang ZP, et al. Early enforced mobilization after liver resection: a prospective randomized controlled trial[J]. Int J Surg, 2018, 54(Pt A): 254-258. DOI: 10.1016/j.ijsu.2018.04.060.
[29]
de Almeida EM, de Almeida JP, Landoni G, et al. Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial[J]. Br J Anaesth, 2017, 119(5): 900-907. DOI: 10.1093/bja/aex250.
[30]
Morris RJ, Woodcock JP. Intermittent pneumatic compression or graduated compression stockings for deep vein thrombosis prophylaxis? A systematic review of direct clinical comparisons[J]. Ann Surg, 2010, 251(3): 393-396. DOI: 10.1097/SLA.0b013e3181b5d61c.
[31]
Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients[J]. Circulation, 2013, 128(9): 1003-1020. DOI: 10.1161/CIRCULATIONAHA.113.002690.
[32]
王润东, 荚卫东. 腹部外科围手术期镇痛进展[J]. 中华普通外科杂志, 2024, 39(11): 822-826. DOI: 10.3760/cma.j.cn113855-20240904-00571.
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