加速康复外科策略与常规策略在腹腔镜前列腺癌根治术中的效价比较

Comparison between enhanced recovery after surgery(ERAS) strategy and conventional strategy in laparoscopic radical prostatectomy

目的探讨基于多模式镇痛的加速康复外科(ERAS)理念应用于腹腔镜前列腺癌根治术中的优势。方法回顾性分析2017年1月至12月我院同一组手术医师行腹腔镜下前列腺癌根治术患者围术期的相关资料,ERAS组患者11例,常规策略组患者24例。结果两组患者年龄,ASA分级及心功能分级差异无统计学意义。ERAS组患者较常规治疗组术中补液量降低[(7.2±2.2)mlvs(10.7±3.8)ml/kg/h,P=0.009],术后住院时间明显减少[(7.5±2.8)dvs(10.3±2.8)d,P=0.008],术后首次排气时间缩短[(1.4±0.9)dvs(2.4±0.9)d,P=0.018]。ERAS组住院总费用及麻醉费用均较对照组增加[(75129±21217)元vs(55201±19109)元,P=0.009;(5537±4430)元vs(3121±726)元,P=0.01],而在总住院时间、麻醉费用所占住院总费用比例方面,两组差异无统计学意义。结论在腹腔镜前列腺癌根治术中应用ERAS理念下多模式镇痛,可以加速患者胃肠道功能恢复,缩短术后住院时间,不增加围术期并发症的发生率。

Objective To explore the value of the enhanced recovery after surgery (ERAS) concept that based on multimodal analgesia in laparoscopic radical prostatectomy. Methods Perioperative clinical data of patients underwent laparoscopic radical prostatectomy in our hospital from January 2017 to December 2017 were analyzed retrospectively. According to whether the patients received ERAS treatment, they were divided into ERAS group and control group. There were 11 patients in ERAS group received ERAS perioperative treatment. There were 24 patients in control group received traditional perioperative treatment. Results There was no difference in age, ASA classification and cardiac function classification between the two groups. Compared with the control group, the ERAS group was significantly reduced in intraoperative infusion volume [(7.2±2.2) ml vs (10.7±3.8) ml/kg/h, P=0.009]. The postoperative hospitalization time was significantly shortened [(7.5±2.8) d vs (10.3±2.8) d, P=0.008]. The first time of anal exhaust after operation was shortened [(1.4±0.9) d vs (2.4±0.9) d, P=0.018]. Compared with the control group, the total cost of hospitalization and the anesthesia cost were both increased in ERAS group [(75 129±21 217) vs (55 201± 19 109) yuan, P=0.009;(5 538±4 431) vs (3 122±726) yuan, P=0.01]. Besides, there was no difference in the length of total hospitalization time, the proportion of the anesthesia cost in total cost between the two groups. Conclusion The application of ERAS concept that based on multimodal analgesia in laparoscopic radical prostatectomy enable to accelerate the recovery of gastrointestinal function of patients, shorten the postoperative hospitalization time, as well as, not to increase the occurrence of perioperative complications.