“外科快速康复”在经尿道等离子前列腺剜除术中的应用研究

Application of "Enhanced recovery after surgery" in transurethral bipolar polasmakinetic enucleation of the prostate

目的:研究快速康复外科(ERAS)在经尿道等离子前列腺剜除术(PKEP)中的临床作用。方法:回顾性分析2017年1月-2018年1月收治125例BPH患者的临床资料,所有患者均接受PKEP治疗,根据是否采取ERAS干预,分为ERAS组(72例)和对照组(53例),对比两组患者的手术时间、术中出血量、切除腺体重量、术后肛门首次排气时间、术后进饮时间、术后进食时间、术后24 h补液量、术后首次下床活动时间、术后首次提肛训练时间、留置尿管时间、住院时间、住院费用、手术并发症、术后3个月尿失禁情况等指标。结果:125例患者手术均顺利完成,术后均无膀胱冲洗。两组患者在手术时间、切除腺体重量、术中出血量方面均差异无统计学意义(P>0.05)。ERAS组术后进食时间、进饮时间、首次排气时间、术后24 h补液量、首次下床活动时间、首次提肛训练时间、总住院时间、术前住院时间、术后住院时间、拔除尿管时间、住院费用显著低于对照组(P<0.05)。ERAS组拔除尿管后第1天尿失禁发生率显著高于对照组(P<0.05)。ERAS组术后1周、2周、1个月、2个月尿失禁的发生率和对照组差异无统计学意义(P>0.05);随访至术后3个月,所有患者尿失禁症状消失。两组患者均无其余并发症发生。结论:将ERAS理念引入PKEP的围手术期管理中,具有术后恢复快、住院时间短、住院费用低等优点,值得临床推广应用。

Objective:To summarize the experience of enhanced recovery after surgery(ERAS)in transurethral bipolar plasmakinetic enucleation of the prostate(PKEP).Methods:The clinical data of 125 cases of BPH treated in our hospital from January 2017 to January 2018 were analyzed retrospectively.According to whether to take ERAS intervention,125 cases of BPH were divided into ERAS group(72 cases)and control group(53 cases),and all cases were treated with PKEP.The operative time,intraoperative bleeding volume,resected tissue weight,postoperative bladder irrigation,first postoperative anal exhaust time,postoperative intake time,postoperative feeding time,first time out of bed after surgery,time for the first rectal training after operation,indwelling catheter time,hospital stay,hospital costs,complications,urinary incontinence 3 months after surgery were all reported and compared between the two groups.Results:All patients finished surgery smoothly by PKEP.There was no bladder irrigation in both groups.There were no significant differences in the operative time,resected tissue weight,intraoperative bleeding volume between ERAS group and control group.Postoperative intake time,postoperative feeding time,fluid infusion 24 h after operation,first postoperative anal exhaust time,first time out of bed after surgery,time for the first rectal training after operation,indwelling catheter time,hospital stay,preoperative hospital stay,postoperative hospital stay,and hospital costs in ERAS group were significantly reduced as compared with those in control group(all P<0.05).The incidence of urinary incontinence in ERAS group was significantly higher than that in control group(P<0.05)at the first day of indwelling catheter removal.There were no significant differences in the incidence of urinary incontinence at first week,second week,first month and second month postoperation(P>0.05),and no urinary incontinence occurred in ERAS group and control group at 3 rd month after surgery.Conclusion:To introduce ERAS concept into the perioperative management of PKEP has many advantages,such as quick recovery after operation,short hospital stay and low hospitalization cost.It is worthy of clinical application.