术后加速康复在妇科腹腔镜手术具有盆腹腔粘连患者中的应用分析

Analysis of the application of enhanced recovery after surgery in gynecological laparoscopic surgery with pelvic and abdominal adhesion

目的探讨术后加速康复外科（ERAS）在妇科良性病变伴盆腹腔粘连腹腔镜手术中应用的安全性与有效性。方法选取2017年7月至2018年6月北京大学人民医院妇科病房进行腹腔镜下良性病变手术患者92例,根据术中有无盆腹腔粘连分为两组,围手术期全部实施相同ERAS方案。比较两组患者术中出血量、手术时间、术后活动、饮水时间、术后疼痛、术后住院时间时间和住院总费用等客观指标,以及患者术后疼痛、术后活动及肠道感觉情况等指标。结果单因素分析显示,无粘连组与有粘连组术中出血量（10 ml,30 ml;P=0.001）、手术时间（60 min,82.5 min;P 〈0.05）,术后住院时间（2.00 d,3.00 d;P=0.007）,总住院时间（5.00 d,6.00 d;P=0.008）和住院费用（11 260元,15 071元）中位数比较,差异均有统计学意义（P 〈0.05）;而在术后首次下床活动时间、术后首次饮水时间、术后首次进食时间、术后疼痛评分、术后恢复满意度比较,差异均无统计学意义（P〉0.05）。多因素分析发现,术中出血增多（P=0.085）和住院时间增加（P=0.000）与手术方式有关,与实施ERAS无关,而粘连患者中手术时间延长（t=7.157,P 〈0.05）,住院费用增加（t=6.190,P 〈0.05）与实施ERAS管理可能有一定关系。两组均未发生并发症。结论妇科良性病变盆腹腔粘连患者围手术期应用ERAS措施客观手术指标,患者主观满意与无粘连手术满意度基本相当。

Objective To investigate the safety and efficacy of enhanced recovery after surgery（ERAS） in patients with adhesions of pelvic and abdominal organs during gynecologic laparoscopic surgery. Methods A total of 92 patients who underwent laparoscopic benign surgery in Peking University People＇s Hospital from July 2017 to June 2018 were enrolled. According to the intraoperative pelvic and abdominal adhesions conditions, the patients were divided into two groups. The same ERAS perioperative procedures were performed between two groups. Univariate and multivariate analysis were used to compare the two groups, including intraoperative blood loss, operation time, postoperative activity, drinking time, postoperative pain, postoperative hospital stay, total hospitalization cost, and postoperative pain, postoperative activity, and intestinal sensation. Results Univariate analysis showed that there was significantly difference between the non-adhesive group and the adhesive group in intraoperative blood loss（10 ml, 30 ml; P=0.001）, and the operation time（60 min, 82.5 min; P〈0.05）. The days after hospitalization（2.00 d, 3.00 d; P=0.007）, the total hospital stays（5.00 d, 6.00 d; P=0.008）, the total cost of hospitalization（ $11 260, $15 071; P〈0.05）. There was no significant difference in the time of first time to get out of bed after surgery, the time of first drinking after surgery, the time of first feeding after surgery, and the postoperative pain score. There was no significant difference in postoperative recovery of subjective satisfaction between the two groups（P〈0.05）. Further multivariate analysis found that the main influencing factors of intraoperative bleeding（P=0.085） and hospitalization time（P=0.000） related to surgical methods, which were not related to the implementation of ERAS, but the operation time was extended（P〈0.05） and the costs increased（t=6.190, P〈0.05） which may be related to the implementation of ERAS management. Conclusions Perioperative ERAS in patients with pelvic and abdominal adhesions are safe and effective and the patient＇s subjective satisfaction is comparable to that of non-adhesive patients.