加速康复外科在小儿结肠病变围手术治疗中的应用

Application of enhanced recovery after surgery in the perioperative period of pediatric colonic lesions

目的回顾性研究小儿结肠病变围手术期治疗中加速康复外科(enhanced recovery after surgery,ERAS)的临床应用价值。方法随机数表法选取2013年7月-2017年5月在河南省儿童医院普通外科二病区接受ERAS治疗的30例结肠息肉或结肠重复畸形的患儿(ERAS组)和接受传统方法治疗的30例结肠息肉或结肠重复畸形的患儿(对照组)作为研究对象。比较2组患儿术后观察指标(首次排便时间、住院时间、治疗费用)及术后相关并发症(上呼吸道感染、咽喉疼痛、尿道疼痛、粘连性肠梗阻、吻合口瘘、切口感染)的发生情况,采用SPSS 17.0统计学软件分析数据。结果 ERAS组首次排便时间[(1.65±0.17)d vs.(2.41±0.19)d]、术后住院时间[7.00(6.00,8.00)d vs. 7.80(6.97,11.00)d]、治疗费用[(12 126.97±1 367.56)元vs.(14 155.67±1 686.22)元]均低于对照组,差异具有统计学意义(均P<0.05)。ERAS组上呼吸道感染(3例vs. 10例)、咽喉疼痛(2例vs. 8例)、尿道疼痛(2例vs. 9例)均低于对照组,差异具有统计学意义(均P<0.05)。2组患儿粘连性肠梗阻、吻合口瘘及切口感染发生率比较差异无统计学意义(均P>0.05)。结论 ERAS在小儿结肠病变围手术期应用安全可行,可有效促进术后胃肠道功能的恢复,减少术后相关并发症的发生。

Objective To investigate the clinical values of enhanced recovery after surgery(ERAS) in the perioperative period of pediatric colonic lesions using retrospective study. Methods Thirty children with colonic polyps or duplication of colonic who underwent ERAS(ERAS group) and 30 children with colonic polyps or duplication of colonic treated by traditional methods(control group) in the second ward of general surgery of He’nan Children’s Hospital from July 2013 to May 2017 were selected using random number table method. Postoperative indicators(defecation time for the first time, length of hospital stay, hospitalization fee) and postoperative relevant complications(upper respiratory tract infection, sore throat, urethral pain, adhesive intestinal obstruction, anastomotic leakage, wound infection) were compared. All data were analyzed using SPSS 17.0 statistical software. Results The defecation time for the first time, the length of hospital stay and the hospitalization fee in the ERAS group were significantly lower than those in the control group(all P<0.05) defecation time for the first time(1.65±0.17) d vs.(2.41±0.19) d, length of hospital stay [7.00(6.00,8.00)d vs. 7.80(6.97,11.00)d], hospitalization fee(12 126.97±1 367.56) yuan vs.(14 155.67±1 686.22) yuan. At the same time, the occurrences of upper respiratory tract infection, sore throat, urethral pain, adhesive intestinal obstruction in the ERAS group were significantly lower than those in the control group(all P<0.05). The occurrences of upper respiratory tract infection 3 cases vs. 10 cases, the occurrences of sore throat 2 cases vs. 8 cases, the occurrences of urethral pain 2 cases vs. 9 cases, the occurrences of adhesive intestinal obstruction 0 case vs. 5 cases. In addition, there were no significant differences in the occurrences of adhesive intestinal obstruction, the occurrences of anastomotic leakage and incision infections(all P>0.05). Conclusion ERAS is safe and reliable in the process of pediatric colon surgery, which can effectively promote the recovery of postoperative gastrointestinal function and reduce the occurrence of complications.