加速康复外科在腹腔镜根治性前列腺切除术中的应用

The application of enhanced recovery after surgery in laparoscopic radical prostatectomy

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)治疗方案在腹腔镜根治性前列腺切除术患者围术期中应用的安全性和优越性。方法收集2016年1月至2017年2月本院88例行腹腔镜根治性前列腺切除术患者的临床资料。ERAS组患者(34例)围术期采用ERAS处理方案,对照组患者(54例)围术期采用传统处理方案。比较两组患者术后首次饮水时间、首次下床活动时间、首次肛门排气时间、首次排便时间、导尿管拔除时间、引流管拔除时间、住院天数、无并发症患者住院天数、住院费用、术后并发症发生率、死亡情况、再手术及30天内再入院情况的差异。结果两组患者均顺利完成手术。ERAS组患者术后首次饮水时间、首次下床活动时间、首次肛门排气时间、首次排便时间、导尿管和引流管拔除时间均提前于对照组患者(P<0.001),住院天数和无并发症患者住院天数均短于对照组(P<0.001),住院费用低于对照组(P<0.001),术后并发症总发生率低于对照组(P<0.05),且ERAS组无死亡、再手术及30天内再入院患者。结论 ERAS模式的开展能够促进腹腔镜根治性前列腺切除术患者早日康复,同时缩短住院天数,减少住院费用,降低术后并发症发生率。

Objective To discuss the safety and superiority of the enhanced recovery after surgery （ERAS） in patients with laparoscopic radical prostatectomy.Method A retrospective analysis of 88 patients from January 2016 to February 2017 in our hospital who underwent laparoscopic radical prostatectomy, 34 patients were treated with ERAS as ERAS group, 54 patients were treated with traditional treatment as control group. The time of first drinking, first ambulation time, first anal exhaust time, the first defecation time, the time of pulling out the urethral tube, the time of pulling out the pelvic drainage tube, the time of hospitalization, the time of hospitalization in patients with no complications, the hospitalization expenses, incidence of postoperative complications, the mortality rate, incidence of re-operation, incidence of readmission in 30 days between the two groups were compared.Result The time of first drinking, first ambulation time, first anal exhaust time, the first defecation time, the time of pulling out the urethral tube, the time of pulling out the pelvic drainage tube, the time of hospitalization and the time of hospitalization in patients with no complications in ERAS group were significantly shorter than control group （P〈0.001）. The hospitalization expenses in ERAS group were lower than those in control group （P〈0.001）. The incidence of postoperative complications in ERAS group were significantly lower than that in control group （P〈0.05）. No one died, had reoperation or readmission in 30 days in ERAS group.Conclusion The application of ERAS in perioperative management can enhance the patient＇s recovery after laparoscopic radical prostatectomy, relieve postoperative pain and reduce hospitalization time and costs, decrease the overall incidence of postoperative complications.