加速康复外科在胸腔镜胸交感神经切断术治疗手汗症中的应用

Application of enhanced recovery after surgery in thoracoscopic thoracic sympathectomy for palmar hyperhidrosis

目的探讨加速康复外科(ERAS)在胸腔镜胸交感神经切断术治疗手汗症的临床应用价值。方法回顾性研究我科2010年1月~2017年6月行胸腔镜胸交感神经切断术的78例手汗症患者的临床资料,根据是否采用ERAS理念,分为ERAS组38例,对照组40例。比较两组的手术时间、视觉疼痛评分、血清CRP上升水平、住院时间、住院费用、疗效满意率和并发症等资料。结果两组均在胸腔镜下顺利完成手术,无中转开胸,症状缓解率100%。两组术后满意率、气胸及胸腔积液发生率比较,差异无统计学意义(P>0.05)。ERAS组手术时间、VAS评分、血清CRP上升水平、住院时间、住院费用、代偿性多汗等均低于对照组,差异有统计学意义(P<0.05)。所有患者均完成1年随访,无复发病例。结论加速康复外科在胸腔镜胸交感神经切断术中的应用是安全、有效的,有利于患者的快速康复,缩短住院时间,降低医疗费用,具有一定优势。

Objective To investigate the clinical application value of enhanced recovery after surgery(ERAS)in thoracoscopic thoracic sympathectomy for palmar hyperhidrosis.Methods The clinical data of 78 patients with palmar hyperhidrosis who underwent thoracoscopic thoracic sympathectomy from January 2010 to June 2017 were retrospectively reviewed.According to the ERAS concept,the patients were divided into ERAS group(n=38)and control group(n=40).The operation time,visual pain score,serum CRP rise level,hospitalization time,hospitalization cost,satisfaction rate and complications were compared between the two groups.Results Both groups underwent successful thoracoscopic surgery without transposition to open chest surgery.The symptom relief rate was 100%.There was no significant difference in the postoperative satisfaction rate,the incidence of pneumothorax and pleural effusion between the two groups(P>0.05).The ERAS group was lower than the control group in terms of operation time,visual pain score,serum CRP rise level,hospitalization time,hospitalization cost,and compensatory hyperhidrosis,and the difference was statistically significant(P<0.05).All patients completed 1-year follow-up and had no recurrence.Conclusion Enhanced recovery after surgery is safe and effective in thoracoscopic thoracic sympathectomy,which is beneficial to patients'rapid recovery,and can shorten hospital stay and reduce medical expenses.It has certain advantages.