加速康复在甲状腺日间手术中的应用:附1023例报告

Implementation of enhanced recovery after surgery program in ambulatory thyroid surgery:a report of 1023 cases

目的:探讨在加速康复外科(ERAS)理念下日间甲状腺手术的可行性及安全性。方法:回顾性分析2015年1月—2018年8月在中南大学湘雅医院日间病房经过严格筛选后接受手术治疗的1 023例患者的临床资料,所有患者术前、术中、术后管理均贯彻ERAS理念。结果:1 023例患者中,女806例(78.8%),男217例(21.2%),平均年龄(40±10)岁;腔镜手术275例(26.9%),开放手术748例(73.1%)。平均住院时间(20.6±6.9)h,平均手术时间(114.32±38.41)min,术中平均失血量(26.62±31.31)mL。1例经全乳晕腔镜甲状腺术后4 h由于胸部隧道出血出现伤口肿胀和颈部压迫症状,经穿刺引流和局部压迫后好转。术后发生暂时性低钙血症335例(32.7%),症状性低钙血症123例(12.0%),腔镜与开放手术后低钙血症和症状性低钙血症的发生率均分别为29.45%、8.73%与33.96%、13.23%;28例(2.7%)患者出现暂时性喉返神经损伤(包括腔镜手术7例,开放手术21例),术后无永久性低钙血症和永久性喉返神经损伤患者;术后伤口出现局部感染在腔镜与开放手术分别为2例(0.73%)、1例(0.13%);术后无食管漏、气管漏、乳糜漏、呼吸困难及窒息患者。结论:术前严格筛选患者,治疗全程在ERAS理念指导下,日间甲状腺手术是一种安全可行、方便高效的手术方式。

Objective:To explore the feasibility and safety of ambulatory thyroid surgery under the protocol of enhanced recovery after surgery(ERAS). Methods:The clinical data of1023patients who underwent thyroid surgery under strict selection criteria in the ambulatory ward of Xiangya Hospital of Central South University between January2015and August2018were retrospectively analyzed,The ERAS protocol was implemented in all patients before,during and after surgery.Results:Of the1023patients,806cases(78.8%)were females and217cases(21.2%)were males,with a mean age of(40±10)years;275cases(26.9%)underwent endoscopic surgery and748cases(73.1%)had open surgery. The average operative time was(114.32±38.41)min,the average hospitalization time was(20.6±6.9)h,and the average intraoperative blood loss was(26.62±31.31)mL.Wound swelling and neck compression symptoms occurred in one patient undergoing bilateral areolar endoscopy4h after operation due to bleeding from the chest subcutaneous tunnel,which were improved by aspiration drainage and local compression.Transient hypocalcemia and symptomatic hypocalcemia occurred in335cases(32.7%)and123(12.0%)after operation,and the incidence of hypocalcemia and symptomatic hypocalcemia for endoscopic surgery was29.45%and8.73%,and for open surgery was33.96%and13.23%,respectively.Temporary recurrent laryngeal nerve injury was found in28cases(2.7%)(including7cases undergoing endoscopic surgery and21cases undergoing open surgery). No permanent hypocalcemia or recurrent laryngeal nerve injury was noted in any of the patients after operation. Postoperative wound infection occurred in2patients(0.73%)undergoing endoscopic surgery and one patient (0.13%)undergoing open surgery,respectively.No cases of postoperative esophageal leakage,trachea leakage, chylous leakage, dyspnea and asphyxia were observed in these patients.Conclusion:Under strict selection criteria,and ERAS concept guidance for whole treatment process,ambulatory thyroid surgery is a safe and feasible,as well as convenient and efficient surgical approach.