LEER模式在腹腔镜胰十二指肠切除术患者围手术期的应用研究

吴丹; 夏燕; 申屠敏姣; 徐杨丽; 金晶; 沈丹

doi:10.16766/j.cnki.issn.1674-4152.003735

LEER模式在腹腔镜胰十二指肠切除术患者围手术期的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003735

浙江省人民医院胃肠胰外科，浙江杭州 310014

基金项目:

浙江省医药卫生计划项目 2022KY572

详细信息

通讯作者:
吴丹，E-mail：goodbadnice@163.com

中图分类号: R473.6 R656.6
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- 文章访问数: 20
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-06
- 网络出版日期: 2024-12-28

Application of LEER model in perioperative period of laparoscopic pancreatoduodenectomy

Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People' s Hospital, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的探讨以少痛(less pain)、早动(early move)、早食(early eat)和安心(reassuring)为最终目标的“LEER”模式在腹腔镜胰十二指肠切除术(LPD)患者围手术期的应用。方法利用随机数字表抽取随机样本的抽样方法，选取2021年8月—2023年8月在浙江省人民医院进行LPD治疗的86例患者的临床资料，其中传统康复外科方案(传统组)41例，“LEER”模式方案(LEER组)45例。比较2组围手术期相关指标。结果 LEER组术后首次下床活动时间、肛门排气时间、首次进食时间及总住院时间均短于传统组(P＜0.05)；LEER组术后第1、2、3天的VAS评分均低于传统组(P＜0.05)；LEER组术后第3天血清免疫球蛋白(Ig)A、IgG、IgM以及血清前白蛋白(PA)、白蛋白(ALB)总蛋白(TP)均高于传统组(P＜0.05)。LEER组并发症发生率为11.11%(5/45)，低于传统组的31.71%(13/41，χ²=5.499，P=0.019)。结论 LEER模式能明显减轻患者术后疼痛，改善其营养状况和保护免疫功能，降低并发症的发生风险，加速患者术后康复。
- LEER模式 /
- 腹腔镜胰十二指肠切除术 /
- 围手术期 /
- 术后康复
Abstract: Objective To explore the perioperative application of "LEER" model with less pain, early move, early eat and reassuring as the ultimate goals in patients with laparoscopic pancreaticoduodenectomy (LPD). Methods Using random number table, the clinical data of 86 patients treated with LPD in the Zhejiang Provincial People' s Hospital from August 2021 to August 2023 was randomly selected, including 41 cases of traditional rehabilitation surgery protocol (traditional group) and 45 cases of "LEER" mode protocol (LEER group). The perioperative relevant indexes were compared between the two groups. Results The first time of getting out of bed, the time of anal exhaust, the time of first eating and the total length of hospital stay in LEER group were lower than those in traditional group (P < 0.05). The VAS scores of the LEER group on the first, second and third day after operation were lower than those of the traditional group (P < 0.05). Serum immunoglobulin (Ig) A, IgG, IgM and serum prealbumin (PA), albumin (ALB) total protein (TP) in LEER group were higher than those in traditional group at 3d after surgery (P < 0.05). The complication rate of LEER group was 11.11% (5/45), which was lower than that of traditional group (31.71%, 13/41, χ²=5.499, P=0.019). Conclusion LEER mode can significantly reduce postoperative pain, improve nutritional status, protect immune function, reduce the risk of complications, and accelerate postoperative recovery.
- LEER mode /
- Laparoscopic pancreatoduodenectomy /
- Perioperative period /
- Postoperative rehabilitation

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表 1 2组行LPD治疗患者术中及术后恢复指标比较(x±s)

Table 1. Comparison of intraoperative and postoperative recovery indexes of patients treated with LPD in 2 groups(x±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后首次下床活动时间(d)	术后肛门排气时间(d)	术后首次进食(d)	总住院时间(d)
LEER组	45	475.82±26.87	186.51±23.63	2.23±0.83	2.61±0.85	3.31±0.63	11.29±2.87
传统组	41	478.73±27.62	188.79±29.52	3.19±0.98	3.79±0.68	4.82±0.91	15.95±2.98
t值		0.495	0.377	4.916	7.064	8.864	7.385
P值		0.622	0.707	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 2组行LPD治疗患者术后VAS评分比较(x±s，分)

Table 2. Postoperative VAS scores of LPD patients were compared between the two groups(x±s, points)

组别	例数	术后第1天	术后第2天	术后第3天	F值	P值
LEER组	45	7.25±1.79	4.82±1.55^a	2.18±0.49^ab	148.466	＜0.001
传统组	41	8.58±1.25	6.97±1.78^a	4.17±0.49^ab	123.224	＜0.001
F值		-4.023	-5.986	-18.811
P值		＜0.001	＜0.001	＜0.001
注：与同组术后第1天比较，^aP＜0.05；与同组术后第2天比较，^bP＜0.05。F_交互=5.705，P＜0.001；F_组别=8.758，P＜0.001；F_时间=12.691，P＜0.001。

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表 3 2组行LPD治疗患者围手术期免疫指标比较(x±s，g/L)

Table 3. Perioperative immune indexes of LPD patients were compared between the two groups(x±s, g/L)

组别	例数	IgA(g/L)		IgG(g/L)		IgM(g/L)
组别	例数	术前	术后第3天	术前	术后第3天	术前	术后第3天
LEER组	45	2.45±0.83	2.41±0.52	13.82±1.79	13.81±1.86	1.25±0.26	1.22±0.28
传统组	41	2.43±0.89	2.15±0.58^b	13.87±1.85	11.91±1.73^b	1.24±0.23	1.05±0.28^b
统计量		0.108^a	2.192^c	0.127^a	4.891^c	0.188^a	2.812^c
P值		0.914	0.031	0.899	＜0.001	0.851	0.006
注：^a为t值，^c为F值；与同组术前比较，^bP＜0.05。

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表 4 2组行LPD治疗患者围手术期营养指标比较(x±s)

Table 4. Comparison of perioperative nutritional indexes of LPD patients in 2 groups(x±s)

组别	例数	PA(mg/L)		ALB(g/L)		TP(g/L)
组别	例数	术前	术后第3天	术前	术后第3天	术前	术后第3天
LEER组	45	268.25±26.73	165.62±25.72^b	40.68±4.69	35.78±4.28^b	59.89±5.82	55.87±5.28^b
传统组	41	267.98±25.86	138.78±23.68^b	40.63±4.67	31.75±4.29^b	59.93±5.95	51.92±5.27^b
统计量		0.048^a	5.019^c	0.049^a	4.356^c	0.031^a	3.468^c
P值		0.962	＜0.001	0.961	＜0.001	0.975	0.001
注：^a为t值，^c为F值；与同组术前比较，^bP＜0.05。

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表 5 2组行LPD治疗患者并发症发生情况比较[例(%)]

Table 5. The incidence of complications in LPD patients was compared between the two groups[cases (%)]

组别	例数	腹腔感染	腹腔出血	胃排空障碍	胆瘘	胰瘘	总发生
LEER组	45	0	1(2.22)	2(4.45)	1(2.22)	1(2.22)	5(11.11)
传统组	41	3(7.32)	3(7.32)	4(9.76)	2(4.88)	1(2.43)	13(31.71)
注：2组并发症总发生率比较，χ²=5.499，P=0.019。

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