摘要目的 探讨采用术前预康复和加速康复外科(enhanced recovery after surgery,ERAS)程序指导到术后6个月的ERAS程序在婴儿先天性巨结肠症(Hirschsprung'sdisease,HSCR)围手术期应用的安全性及有效性.方法 回顾性分析2016年1月至2017年12月行腹腔镜手术治疗并临床病理确诊的53例HSCR患儿的临床资料.其中,采用术前预康复和ERAS程序到术后6个月的32例患儿为深化ERAS(D-ERAS)组,未进行预康复仅行术后ERAS程序到术后1个月的21例患儿为ERAS组.比较两组患儿术前体重、身高及体质量指数、手术相关资料、留置管道情况、平均住院日、住院费用、炎性相关指标、术后非计划再入院次数等情况.结果 两组手术相关指标及手术前后相关炎性指标比较,差异均无统计学意义.D-ERAS组术前预康复后体重为(7.50±0.14) kg,ERAS组术前体重为(6.91±0.18) kg,组间比较,差异有统计学意义(P=0.01).D-ERAS组术前预康复后体质量指数为(18.75±0.22) kg/m2,ERAS组术前体质量指数为(17.05±0.17) kg/m2,组间比较,差异有统计学意义(P=0.012、0.007).D-ERAS组非计划再入院次数为(0.94±0.21)次,ERAS组为(1.81±0.38)次,组间比较,差异有统计学意义(P=0.034).结论 采用术前预康复和ERAS程序指导到术后6个月的ERAS程序治疗婴儿HSCR安全、有效,完善了传统ERAS程序,使之更加合理.

abstractsObjective To explore the safety and effectiveness of enhanced recovery after surgery for infantile Hirschsprung's disease (HSCR).Methods Retrospective analysis of clinical data was performed for 53 laparoscopic HSCR neonates from January 2016 to December 2017.For 32 cases,deepen enhanced recovery after surgery (D-ERAS) including preoperative pre-rehabilitation and ERAS program after 6 months was carried out.Twenty-one patients without prerehabilitation belonged to ERAS group.Two groups were compared with regards to weight,height and body mass index (BMI) of preoperative pre-rehabilitatio,surgical data,indwelling time of catheter,hospital days,hospitalization expenses,inflammation-related paraeters an number of nonscheduled readimissions.Results No statistically significant difference existed in surgical data or pre/ postoperative inflammation-related parameters.The weight of preoperative pre-rehabilitation was (7.50 ± 0.14) kg in D-ERAS group and (6.91 ± 0.18) kg in ERAS group (P =0.012);BMI was (18.75 ± 0.22) kg/m2 in D-ERAS group and (17.05 ±0.17) kg/m2 in ERAS group (P=0.007).The number of non-scheduled readimissiom had statistically significant inter-group differences [(0.94 ±0.21) vx (1.81 ±0.38),P =0.034].Conclusions D-ERAS is both safe and effective for infantile Hirschsprung's disease.