加速康复外科理念在输尿管软镜下钬激光碎石术日间手术模式中的应用效果

Effect of concept of enhanced recovery after surgery applied to holmium laser lithotripsy with flexible ureteroscope in ambulatory surgery mode

目的观察加速康复外科(ERAS)理念在输尿管软镜下钬激光碎石术(HLL-FU)日间手术模式中的应用效果。方法将80例肾结石患者随机分为观察组和对照组,每组40例。对照组按常规方法行HLL-FU日间手术模式治疗,观察组采用ERAS理念行HLL-FU日间手术模式治疗。观察两组围术期指标、疼痛视觉模拟量表(VAS)评分、焦虑自评量表(SAS)评分、血常规指标、术后并发症发生率及患者满意度。结果观察组手术时间、肠鸣音恢复时间、术后肛门排气时间、导尿管留置时间、输液时间及术后首次进食时间均短于对照组,术中出血量、住院费用均少于对照组,清石率高于对照组(均P<0.05)。术后24 h,观察组VAS、SAS评分及血肌酐、尿素氮水平、白细胞计数均低于对照组,血红蛋白水平高于对照组(均P<0.05);观察组术后并发症发生率低于对照组,满意度高于对照组(均P<0.05)。结论采用ERAS理念行HLL-FU日间手术模式治疗肾结石清石率高,手术创伤小,手术时间短,胃肠功能恢复快,治疗费用少,术后并发症发生率低,患者满意度高。

Objective To observe the effect of the concept of enhanced recovery after surgery(ERAS) applied to holmium laser lithotripsy with flexible ureteroscope(HLL-FU) in ambulatory surgery mode. Methods Eighty patients with renal calculus were randomly divided into observation group and control group, with 40 cases in each group. The control group underwent HLL-FU in ambulatory surgery mode, whereas the observation group employed the concept of ERAS to perform HLL-FU in ambulatory surgery mode. The two groups were compared in terms of perioperative indices, the Visual Analogue Scale(VAS) pain scores, the Self-Rating Anxiety Scale(SAS) scores, blood routine test indicators, incidence rate of postoperative complications, and patients′ satisfaction degree. Results The observation group had shorter operation duration, time to bowel sound normalization, postoperative anal exhaust time, duration of urethral catheter indwelling, infusion time, and time for first meal after operation, as well as less intraoperative blood loss and hospitalization costs and a higher stone clearance rate, as compared with the control group(all P<0.05). Twenty-four hours after operation, the observation exhibited lower VAS and SAS scores, lower levels of serum creatinine and blood urea nitrogen, lower WBC count, and higher hemoglobin level than the control group(all P<0.05);the incidence rate of postoperative complications was lower and the satisfaction degree was higher in the observation group than in the control group(all P<0.05). Conclusion For patients with renal calculus, employing ERAS concept to perform HLL-FU in ambulatory surgery mode achieves higher stone clearance rate, minor surgical trauma, shorter operation duration, rapid gastrointestinal function recovery, decreased treatment costs, low incidence rate of postoperative complications and high patients′ satisfaction.