基于加速康复外科理念的输尿管软镜钬激光碎石术

Clinical Study of Flexible Ureteroscopic Holmium Laser Lithotripsy Based on the Concept of Enhanced Recovery After Surgery

目的探讨基于加速康复外科(enhanced recovery after surgery,ERAS)理念的输尿管软镜钬激光碎石术的临床疗效。方法回顾性分析2015年1月~2017年5月255例上尿路结石行输尿管软镜钬激光碎石术的资料。按经治医师不同分成2组,其中传统处理方法 134例(对照组),采用ERAS措施121例(ERAS组)。比较2组手术时间、术后下床活动时间、术后发热、术后住院时间、住院总费用、清石率等。结果 251例软镜碎石手术获得成功,对照组3例、ERAS组1例软镜手术失败。ERAS组和对照组的手术时间[(80.7±32.3)min vs.(86.3±33.6)min,t=-1.342,P=0.181]和清石率[86.7%(104/120)vs.85.5%(112/131),χ~2=0.072,P=0.789]无明显差异。ERAS组术后下床活动时间明显早于对照组[(11.3±5.2)h vs.(21.5±4.4)h,t=-16.940,P=0.000],术后住院时间明显短于对照组[(2.2±0.9)d vs.(3.4±1.9)d,t=-6.341,P=0.000],住院总费用明显低于对照组[(19.4±3.8)千元vs.(21.0±4.7)千元,t=-2.980,P=0.003],术后发热率低于对照组[25.0%(30/120)vs.37.4%(49/131),χ~2=4.468,P=0.035]。结论基于ERAS理念的输尿管软镜钬激光碎石术安全可靠,术后恢复快,住院费用低。

Objective To study the clinical efficacy of flexible ureteroscopic holmium laser lithotripsy based on the concept of enhanced recovery after surgery（ ERAS）. Methods A retrospective analysis on clinical data of 255 patients with upper urinary calculi from January 2015 to May 2017 in our hospital. According to the different responsible doctors,those cases were divided into two groups： 134 cases received flexible ureteroscopic holmium laser lithotripsy combined with traditional perioperative treatment regimen（ the control group） and 121 cases received flexible ureteroscopic holmium laser lithotripsy combined with ERAS concept（ the ERAS group）. The operative time,the postoperative ambulation time,the postoperative fever rate,the length of hospitalization,the total cost of hospitalization,and the removal rate of stones were compared between the two groups. Results A total of 251 of the 255 cases successfully underwent transurethral flexible ureteroscopic holmium laser lithotripsy. In the control group,there were 3 cases of failure to the operation,and 1 case in the ERAS group. There was no significant difference in the operative time [（ 80. 7 ± 32. 3） min vs.（ 86. 3 ± 33. 6） min,t =-1. 342,P = 0. 181] and the stone clearance rate [86. 7%（ 104/120） vs. 85. 5%（ 112/131）,χ^2=0. 072,P = 0. 789]between the two groups. The patients in the ERAS group had shorter postoperative ambulation time [（ 11. 3 ± 5. 2）h vs.（ 21. 5 ± 4. 4） h,t =-16. 940,P = 0. 000 ],shorter postoperative hospital stay [（ 2. 3 ± 0. 9） d vs.（ 3. 4 ± 1. 9） d,t =-6. 341,P = 0. 000],lower total cost of hospitalization [（ 19. 4 ± 3. 8） × 10-3 RMB vs.（ 21. 0 ± 4. 7） × 10-3 RMB,t =-2. 980,P =0. 003],and lower postoperative fever rate [25. 0%（ 30/120） vs. 37. 4%（ 49/131）,χ^2= 4. 468,P = 0. 035] than those in the control group. Conclusion Flexible ureteroscopic holmium laser lithotripsy based on the concept of ERAS for the treatment of upper urinary tract calculus is safe and reliable,with rapid postoperative recovery,low cost of hospitalization and worthy of clinical promotion.