加速康复外科在后腹腔镜肾上腺切除术中的应用

Application of fast track surgery strategy in retroperitoneal laparoscopic adrenalectomy

目的加速康复外科(fast track surgery,FTS)在泌尿外科的应用研究相对较少。文中探讨FTS对行后腹腔镜肾上腺切除术患者术后康复的影响。方法将2012年1-11月南京军区南京总医院泌尿外科80例行后腹腔镜肾上腺切除术的患者按分层抽样法分成FTS组和对照组,每组40例。分别运用加速康复和常规围手术期处理方案,比较2组患者术后肛门通气时间、开始进食时间、胃肠道并发症发生率、术后首次下床活动时间、导尿管和引流管留置时间、术后住院时间、住院费用,疼痛评分采用直观模拟量表(visual analogue scale,VAS),总体状态评分采用李克量表形式,并在术后第7天、第30天对患者进行电话随访。结果 FTS组较对照组在首次肛门通气时间缩短[(20.6±8.3)h vs(39.8±18.3)h,P<0.05]、开始进食时间缩短[(21.1±9.9)h vs(51.8±16.9)h,P<0.05]、首次下床活动时间缩短[(23.6±9.0)h vs(55.6±18.5)h,P<0.05],导尿管留置时间缩短[(20.2±8.3)h vs(62.5±27.1)h,P<0.05],引流管留置时间缩短[(20.9±7.9)h vs(70.6±18.9)h,P<0.05]、术后住院时间缩短[(2.43±0.94)d vs(5.46±1.60)d,P<0.05]、住院费用减少[(2.17±0.32)万元vs(2.86±0.65)万元,P<0.05],FTS组术后24h静息状态及12、24h咳嗽状态VAS疼痛评分较对照组降低[(0.70±0.61)vs(1.40±0.84),(0.93±0.89)vs(1.80±1.38),(1.27±0.99)vs(4.65±1.33),P<0.01];FTS组患者术后第1天、第2天总体状态评分明显优于对照组[(6.85±1.00)vs(4.28±1.11)、(8.30±0.94)vs(5.53±1.24),P<0.01]。2组均无伤口感染、迟发出血等并发症发生。结论 FTS运用于后腹腔镜肾上腺切除术能提高患者整体状态,加速患者康复。

Objective Studies on the application of fast track surgery （ FTS） are comparatively limited in urologic proce-dures.This randomized controlled study was to evaluate the impact of FTS on recovery after retroperitoneal laparoscopic adrenalectomy . Methods Eighty patients undergoing retroperitoneal laparoscopic adrenalectomy were randomly assigned to an FTS and a control group of equal number to receive an FTS recovery program and conventional perioperative care , respectively .Comparisons were made between the two groups in the time of the first flatus , first oral nutrition , and first mobilization , the incidence of gastrointestinal tract complica-tions, the time of drainage and transurethral catheterization , the length of postoperative hospital stay , hospitalization expenses , visual analogue scale （VAS） pain scores, and general state of the patients . Results The FTS group, in comparison with the control, showed significantly earlier time of first flatus （[20.6 ±8.3] vs [39.8 ±18.3]h, P〈0.05）, first oral nutrition （[21.1 ±9.9] vs [51.8 ±16.9]h, P〈0.05）, and first mobilization （[23.6 ±9.0] vs [55.6 ±18.5]h, P〈0.05）, markedly shorter time of drain-age （[20.9 ±7.9] vs [70.6 ±18.9]h, P〈0.05）, transurethral catheterization （[20.2 ±8.3] vs[62.5 ±27.1]h, P〈0.05）, and postoperative hospital stay （[2.43 ±0.94] vs [5.46 ±1.60] d, P〈0.05）, remarkably less expenses of hospitalization （[21.7 ± 3.2] vs [28.6 ±6.5] ￥1000, P〈0.05）, and lower postoperative pain scores at 12 h （0.93 ±0.89 vs 1.80 ±1.38）, at 24 h while coughing （1.27 ±0.99 vs 4.65 ±1.33）, and at 24 h at rest （0.70 ±0.61 vs 1.40 ±0.84） （P〈0.05）.The general state score was dramatically higher in the FTS patients than in the control on postoperative day （POD） 1 （6.85 ±1.00 vs 4.28 ±1.11） and POD 2 （8.30 ±0.94 vs 5.53 ±1.24） （P〈0.01）.No significant differ-ences were observed in the general state of the patients between POD 2 and the baseline （P〉0.05）, nor in the incidence of gastrointesti-nal tract complications between the FTS and control groups （ P 〉0.05）. Conclusion By improving the general state and accelera-ting the recovery of the patients , FTS can be applied safely and effectively in retroperitoneal laparoscopic adrenalectomy .