hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/1995-5464.2023-2-14-23hepato-1007Research ArticleПРОГРАММА УСКОРЕННОГО ВОССТАНОВЛЕНИЯ В ГЕПАТОПАНКРЕАТОБИЛИАРНОЙ ХИРУРГИИПрограмма ускоренного выздоровления в гепатобилиарной хирургии: экспериментальная и клиническая оценкаEnhanced recovery program in hepatobiliary surgery: experimental and clinical assessmenthttps://orcid.org/0000-0002-2506-9798ДарвинВ. В.DarvinV. V.

Дарвин Владимир Васильевич – доктор мед. наук, профессор, заведующий кафедрой хирургических болезней

628412, Ханты-Мансийский автономный округ, г. Сургут, пр. Ленина, д. 1

Vladimir V. Darvin – Doct. of Sci. (Med.), Professor, Head of Department of Surgical Diseases of the Medical Institute Budgetary Institution of Higher Education

1, Lenin Ave., Surgut, Khanti-Mansi Autonomous region-Yugra, 628412

DarvinVV@surgutokb.ruhttps://orcid.org/0000-0002-2849-655XВаргановаА. Н.VarganovaA. N.

Варганова Александра Николаевна – заведующая отделением клинической фармакологии 

628408, г. Сургут, ул. Энергетиков, д. 24/2

Alexandra N. Varganova – Head of Department of Clinical Pharmacology

Energetikov str., 24/2, Surgut, 628408

Alexvarg24@yandex.ruhttps://orcid.org/0000-0002-2013-7587ОнищенкоС. В.OnishchenkoS. V.

Онищенко Сергей Вальдемарович – доктор мед. наук, профессор, доцент кафедры хирургических болезней

628412, Ханты-Мансийский автономный округ, г. Сургут, пр. Ленина, д. 1

Sergey V. Onishchenko – Doct. of Sci. (Med.), Professor, Associate Professor of Hospital Surgery Department of Medical Institution Budgetary Institution of Higher Education

1, Lenin Ave., Surgut, Khanti-Mansi Autonomous region-Yugra, 628412

sergej-on@mail.ruhttps://orcid.org/0000-0002-3623-7996КрасновЕ. А.KrasnovE. A.

Краснов Евгений Анатольевич – канд. мед. наук, заместитель главного врача по хирургической помощи

628408, г. Сургут, ул. Энергетиков, д. 24/2

Evgeniy A. Krasnov – Cand. of Sci. (Med.), Deputy Chief Physician for Surgical Care

Energetikov str., 24/2, Surgut, 628408

krasnovEA@surgutokb.ruhttps://orcid.org/0000-0002-7334-8636БубовичЕ. В.BubovichE. V.

Бубович Елена Владимировна – канд. мед. наук, доцент кафедры общей патологии 

628412, Ханты-Мансийский автономный округ, г. Сургут, пр. Ленина, д. 1

Elena V. Bubovich – Cand. of Sci. (Med.), Associate Professor of Department of General Pathology of Medical Institution Budgetary Institution of Higher Education

1, Lenin Ave., Surgut, Khanti-Mansi Autonomous region-Yugra, 628412

bubovichev@gmail.comhttps://orcid.org/0000-0003-1704-5232СкальскаяН. Т.SkalskayaN. T.

Скальская Нигина Тахирджоновна – врач – клинический фармаколог

628408, г. Сургут, ул. Энергетиков, д. 24/2

Nigina T. Skalskaya – Clinical Pharmacologist

Energetikov str., 24/2, Surgut, 628408

SkalskayaNT@surgutokb.ruБУ ВО Ханты-Мансийского автономного округа – Югры “Сургутский государственный университет”РоссияSurgut State University, Khanty-Mansi Autonomous region – UgraRussian FederationБУ “Сургутская окружная клиническая больница”РоссияSurgut Regional Clinical HospitalRussian Federation2023140620232821423Copyright © Дарвин В.В., Варганова А.Н., Онищенко С.В., Краснов Е.А., Бубович Е.В., Скальская Н.Т., 20232023Дарвин В.В., Варганова А.Н., Онищенко С.В., Краснов Е.А., Бубович Е.В., Скальская Н.Т.Darvin V.V., Varganova A.N., Onishchenko S.V., Krasnov E.A., Bubovich E.V., Skalskaya N.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/1007Цель

Цель. Уточнить обоснованность включения раннего энтерального питания в программу ведения оперированных пациентов и изучить его влияние на продолжительность стационарного лечения, частоту осложнений и госпитальную летальность после операций на печени и желчевыводящих путях.

Материал и методы

Материал и методы. Эксперимент проведен на 20 кроликах-самцах породы шиншилла. Изучена эффективность различных видов нутритивной поддержки при резекции левой латеральной доли печени. Проведен сравнительный анализ результатов лечения 1275 пациентов с острыми и хроническими заболеваниями печени и желчевыводящих путей, из которых 659 (51,7%) соответствовали программе Fast Track, а 616 (48,3%) составили контрольную группу.

Результаты

Результаты. Продолжительность стационарного лечения сократилась с 13,4 ± 4,2 до 9,3 ± 3,0 дней (t = 2,08; р = 0,04), госпитальная летальность – с 0,8 до 0,45% (р = 0,12). Частота послеоперационных осложнений уменьшилась с 4,2 до 3,2%, в их структуре уменьшилась доля осложнений III–V степени по Clavien–Dindo с 48,4 до 19,0% (t = 2,34, р = 0,025).

Заключение

Заключение. Клиническое внедрение основных положений Fast Track в раннем периоперационном периоде при заболеваниях печени и желчевыводящих путей достоверно оптимизирует послеоперационную реабилитацию и уменьшает частоту послеоперационных осложнений. Многообещающие первые результаты применения этой программы позволяют судить о необходимости коррекции традиционных стереотипов, укрепившихся в программах лечения больных гепатобилиарного профиля, для улучшения результатов операций.

Materials and methods

Materials and methods. The experiment was performed on 20 male Chinchilla rabbits. The authors studied the effectiveness of various types of nutritional support in resection of the left lateral lobe of the liver. A comparative analysis was based on the results of treatment of 1275 patients with acute and chronic diseases of the liver and biliary tract, 659 (51.7%) of which corresponded to the Fast Track program, and 616 (48.3%) were the control group.

Results

Results. The duration of inpatient treatment was reduced from 13.4 ± 4.2 to 9.3 ± 3.0 days (t = 2.08; p = 0.04), and hospital mortality decreased from 0.8% to 0.45% (p = 0.12). The postoperative morbidity fell from 4.2% to 3.2%, in particular, the proportion of III–V grade complications (Clavien–Dindo classification) reduced from 48.4% to 19.0% (t = 2.34, p = 0.025).

Conclusion

Conclusion. Clinical implementation of main Fast Track components in the early perioperative period in diseases of the liver and biliary tract reliably optimizes postoperative rehabilitation and reduces the incidence of postoperative complications. First promising results of this program suggest the need to correct traditional stereotypes ingrained in treatment programs for patients with hepatobiliary diseases, in order to improve the results of surgeries.

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The authors declare that there are no conflicts of interest present.