加速康复外科在腹腔镜泌尿外科上尿路手术中的应用效果分析

doi:10.3969/j.issn.1006-7795.2019.01.014

首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (1): 78-83.doi: 10.3969/j.issn.1006-7795.2019.01.014

• 泌尿系统肿瘤：基础研究与临床实践 • 上一篇下一篇

加速康复外科在腹腔镜泌尿外科上尿路手术中的应用效果分析

刘赛¹, 瓦斯里江·瓦哈甫¹, 牛亦农¹, 高建东¹, 崔丽艳¹, 宋黎明¹, 平浩¹, 杨飞亚¹, 王明帅¹, 邢念增^1,2

1. 首都医科大学泌尿外科研究所首都医科大学附属北京朝阳医院泌尿外科, 北京 100020;
2. 国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院, 北京 100021

收稿日期:2018-10-24 出版日期:2019-01-21 发布日期:2019-01-23
通讯作者: 邢念增 E-mail:nianzeng2006@vip.sina.com
基金资助:
北京市医院管理局"青苗"计划专项经费资助（QML20160303），北京市医院管理局"登峰"计划专项经费资助（DFL20150301）。

Application of enhanced recovery after surgery in retroperitoneal laparoscopic upper urinary surgeries

Liu Sai¹, Wasilijiang Wahafu¹, Niu Yinong¹, Gao Jiandong¹, Cui Liyan¹, Song Liming¹, Ping Hao¹, Yang Feiya¹, Wang Mingshuai¹, Xing Nianzeng^1,2

1. Institute of Urology, Capital Medical University;Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2018-10-24 Online:2019-01-21 Published:2019-01-23
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals "Qingmiao" Talent Training Plan (QML20160303), Beijing Municipal Administration of Hospitals "Dengfeng" Talent Training Plan (DFL20150301).

摘要/Abstract

摘要： 目的对比加速康复外科（enhanced recovery after surgery，ERAS）方案和常规康复外科（conventional recovery after surgery，CRAS）方案在腹腔镜泌尿外科上尿路手术中的安全性和有效性。方法收集本中心2016年6月至2017年9月行腹腔镜泌尿外科上尿路手术治疗的患者共62例，其中2016年6月至2017年5月，33例采用CRAS方案，2017年5月至2017年9月29例采用ERAS方案。两组患者年龄、体质量指数、中位查尔森合并症指数、中位麻醉评分及术前实验室检查等差异均无统计学意义。对两组患者的围术期资料和术后30 d内的合并症进行比较。结果所有手术均顺利完成。两组患者在术中入晶体液量[1 000（525~1 100）mL vs 1 100（1 000~1 350）mL]、术中入胶体液量[500（500~500）mL vs 500（500~1 000）mL]、胃管拔出时间[0 d vs 1（1~1）d]、恢复普食时间[1（1~2）d vs 2（1~3）d]差异有统计学意义（P<0.05）。在手术时间、术中出血量、引流管拔出时间、术后住院时间、腹腔镜术式构成比例等方面均差异无统计学意义（P>0.05）。ERAS方案组和CRAS方案组分别有3例（10.3%）和5例（15.2%）Clavien-Dindo 1级合并症，差异不具有统计学意义（P=0.573）。两组均无患者术后再入院。结论 ERAS方案对比CRAS方案可以在不增加合并症的基础上缩短患者恢复普通饮食时间，推进患者术后康复，在腹腔镜泌尿外科上尿路手术中的应用是安全和可行的，但还需要大样本量随机对照研究进行全面评估。

关键词: 加速康复外科, 后腹腔镜, 上尿路手术

Abstract: Objective To compare the efficacy and safety of enhanced recovery after surgery (ERAS) and conventional recovery after surgery (CRAS) in retroperitoneal laparoscopic upper urinary surgeries. Methods From June 2016 to September 2017, 62 cases of retroperitoneal laparoscopic upper urinary surgeries were conducted, in which 33 patients with CRAS between June 2016 and May 2017 and 29 cases with ERAS between May 2017 and September 2017. There were no statistical differences between the two groups in some preoperative parameters, including age, body mass index (BMI), Charlson comorbidity index (CCI), and the American Society of Anesthesiologists (ASA) score. No significant differences were found between the two groups in preoperative laboratory results (P>0.05). The perioperative information and early (30-day) complications of 62 patients were analyzed. Results Twenty-nine patients with ERAS and 33 patients with CRAS were successfully implemented with retroperitoneal laparoscopic upper urinary surgeries. There were significant differences between the two groups in intraoperative crystalloid infusion[1 000(525-1100)mL vs 1 100(1 000-1 350)mL, P=0.027], intraoperative colloid infusion[500(500-500)mL vs 500(500-1 000)mL, P=0.007], duration of gastric tube[0d vs 1(1-1)d, P=0.000], and duration of resumption to normal diet[1(1-2)d vs 2(1-3)d, P=0.023]. No significant differences (P>0.05) was observed between the ERAS and the CRAS group in operative time, estimated blood loss, duration of drainage, postoperative days, and the ratio of surgeries. There were 3 cases (10.3%) and 5 cases (15.2%) of complications in Grade 1 of Clavien-Dindo in the ERAS and CRAS group, respectively. No patients were readmitted to the hospital. Conclusion Compared with CRAS, ERAS can accelerate the resumption to normal diet. The application of ERAS is safe and feasible in retroperitoneal laparoscopic upper urinary surgeries. Randomized controlled trials with large sample size are further needed to evaluate the program comprehensively.

Key words: enhanced recovery after surgery, retroperitoneal laparoscopy, upper urinary surgery

中图分类号:

R699

刘赛, 瓦斯里江·瓦哈甫, 牛亦农, 高建东, 崔丽艳, 宋黎明, 平浩, 杨飞亚, 王明帅, 邢念增. 加速康复外科在腹腔镜泌尿外科上尿路手术中的应用效果分析[J]. 首都医科大学学报, 2019, 40(1): 78-83.

Liu Sai, Wasilijiang Wahafu, Niu Yinong, Gao Jiandong, Cui Liyan, Song Liming, Ping Hao, Yang Feiya, Wang Mingshuai, Xing Nianzeng. Application of enhanced recovery after surgery in retroperitoneal laparoscopic upper urinary surgeries[J]. Journal of Capital Medical University, 2019, 40(1): 78-83.

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加速康复外科在腹腔镜泌尿外科上尿路手术中的应用效果分析

Application of enhanced recovery after surgery in retroperitoneal laparoscopic upper urinary surgeries

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