加速康复外科理念在微创食管癌根治术围手术期的应用价值

Value of enhanced recovery after surgery in perioperative period of minimally invasive esophagectomy for esophageal carcinoma

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在微创食管癌(esophageal carcinoma,EC)根治术围手术期的应用价值.方法将2015-08/2017-02在南昌大学第二附属医院胸外科收治的100例接受全胸腹腔镜微创EC根治术的患者按随机数字表法分成ERAS组(n=50)和对照组(n=50),ERAS组采用ERAS理念进行围手术期处理,对照组采用传统的围手术期处理,比较2组患者的临床指标.结果2组患者术前一般资料无明显差异(均P>0.05).2组患者的手术时间(312.8 min±34.9 min vs310.1 min±28.4 min)、术中出血量(175.3 mL±30.4 mL vs 170.5 mL±29.8 mL)、术后并发症发生率均无明显差异(均P>0.05).但ERAS组术后首次排气时间(35.2 h±7.0 h vs 45.2 h±9.1 h)、早期NRS疼痛评分、术后营养指标(血清总蛋白、白蛋白)、术后住院时间(8.2 d±2.1 d vs 11.1 d±4.6 d)均明显优于对照组(均P<0.05).所有患者无出院30 d再次入院或手术病例.结论ERAS理念应用于微创EC患者围手术期的管理安全有效,能加快患者术后恢复.

AIM To evaluate the application of enhanced recovery after surgery（ERAS） in perioperative period of minimally invasive esophagectomy for esophageal carcinoma（EC）.METHODS One hundred patients who would undergo minimally invasive esophagectomy for EC at the Second Affiliated Hospital of Nanchang University from August 2015 to February 2017 were randomly divided into an ERAS group（n=50） and a control group（n = 50）.The ERAS group was perioperatively managed using the ERAS concept,while the control group was routinely managed.Clinical indexes of the two groups were compared.RESULTS There were no significant difference in demographic data between the two groups before surgery（P〈0.05）.Operative time（312.8 min ± 34.9 min vs 310.1 min ± 28.4 min）,intraoperative blood loss（175.3 mL±30.4 mL vs 170.5 mL±29.8 mL）,and postoperative complication rates did not differ between the two groups（P〈0.05）.Time to first postoperative exhaust（35.2 h ± 7.0 h vs 45.2 h± 9.1 h）,NRS pain score,early postoperative nutritional index（serum total protein and albumin）,and postoperative hospital stay（8.2 d ±2.1 d vs 11.1 d ± 4.6 d） were significantly better in the ERAS group than in the control group（P〈0.05）.There were no hospital readmission or resurgery cases in either group within 30 d after surgery.CONCLUSION ERAS concept applied in the perioperative period of minimally invasive esophagectomy for EC is safe and effective and can accelerate the postoperative recovery of patients.