目的    评价临床路径在慢性放射性肠炎合并肠梗阻行肠切除手术治疗中的实施效果。方法    选取南京军区南京总医院2011年1月至2013年3月间因“慢性放射性肠炎合并肠梗阻行肠切除吻合手术”的入院病人为研究对象，分为路径实施前组（非路径组）48例（2011年1~12月），路径实施组（路径组）37例（2012年3月至2013年3月），非路径组采用传统治疗模式，路径组采取基于加速康复外科和围术期营养支持的临床路径模式。对两组病人的住院天数、医疗费用、术后死亡率、术后并发症、肠造口发生率进行比较分析。结果    两组病人在人口统计学、并存疾病、放疗剂量、术前ASA（美国麻醉师协会）评分方面差异无统计学意义（P<0.05）。路径组术后住院日较非路径组明显缩短（8.52 vs. 11.32 d，P = 0.02），总住院日之间差异无统计学意义（21.63 vs. 20.82 d，P=0.589）。路径组平均住院费用为66610元，低于非路径组76546元，但差异无统计学意义（P=0.136）。相比于非路径组，路径组的肠造口率明显下降（21.6% vs. 56%，P=0.033），中重度并发症（ClavienⅢ~Ⅴ）的发生率也明显下降（8.1% vs. 25%，P=0.043），差异有统计学意义。结论    实施临床路径能够降低慢性放射性肠炎合并肠梗阻病人肠造口及术后中重度并发症的发生率，缩短术后住院日和减少住院费用。

Impact of a fast-track clinical pathway on perioperative outcomes in patients undergoing ileal/ileocecal resection for chronic radiation enteritis with intestinal obstruction        ZHANG Liang, GONG Jian-feng, NI Ling , et al.Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command, PLA, Clinical School of Medical College, Nanjing University, Nanjing 210002, China
Abstract    Objective    To evaluate the effect of a fast-track-based clinical pathway on postoperative outcome in patients undergoing ileal/ileocecal resection for chronic radiation enteritis (CRE) with intestinal obstruction.Methods   Between2011.01 and 2013.03, a total of 85 CRE patients with intestinal obstruction admitted to our department for ileal/ileocecal resection were categorized into a prepathway group and a pathway group.This corresponded to the implementation of the clinical pathway in January 2012. The 37 patients in the pathway group were managed according to a multidisciplinary program, while the 48 patients in the prepathway  group were managed conventionally.The clinical outcomes and hospital costs were then assessed and compared. Results    The two groups were similar in terms of demographics, comorbidities, radiation dose and ASA score. The postoperative length of hospital stay(LOS) was 8.52 days for the pathway group and 11.32 days for the prepathway group (P = 0.02), and the total LOS in the two groups were 21.63 and 20.82 days, respectively (P=0.589). The cost of hospitalization for the pathway patients was 66610 RMB, which was lower compared to the 76546 RMB cost for the pre-pathway patients (P=0.136). The pathway group had a lower stoma rate(21.6% vs 56% , P=0.033)and less postoperative moderate to severe(Clavien Ⅲ-Ⅴ) complication(8.1%vs 25%, P=0.043) as compared to prepathway group. Conclusion    A fast-track based clinical pathways may reduce stoma rate, postoperative moderate to severe(Clavien Ⅲ-Ⅴ) complication, postoperative length of hospital stay and costs for patients undergoing ileal/ileocecal resection for the treatment of chronic radiation enteritis (CRE) with intestinal obstruction.