加速康复外科在单孔腹腔镜全子宫切除术围手术期的应用

Application of enhanced recovery after surgery in laparoendoscopic single site surgery-total hysterectomy perioperative period

目的:分析加速康复外科(enhanced recovery after surgery,ERAS)在单孔腹腔镜全子宫切除术(laparoendoscopic single site surgery-total hysterectomy,LESS-TH)围手术期的应用效果。方法:选取在2017年2月至2018年9月于上海市第一人民医院宝山分院行LESS-TH的患者86例,随机分为对照组和观察组。对照组患者采用常规康复方案处理,观察组患者采用ERAS处理,分析两组患者处理后的临床疗效。结果:观察组患者排气、排便、留置尿管及住院时间短于对照组,手术日补液量少于对照组,差异有统计学意义(均P<0.05)。术后2,8,12,24 h时,观察组患者VAS评分低于对照组,差异有统计学意义(均P<0.05)。术前,两组患者炎症因子、营养指标水平比较,差异无统计学意义(均P>0.05)。术后,观察组患者血红蛋白(HGB)、白蛋白(ALB)水平高于对照组,C反应蛋白(CRP)、白介素-6(IL-6)水平低于对照组,差异有统计学意义(均P<0.05)。观察组患者恶心、呕吐发生程度优于对照组,并发症率低于对照组,差异有统计学意义(均P<0.05)。结论:ERAS应用于单孔腹腔镜下子宫切除术可加快患者恢复,抑制炎症反应,减轻术后疼痛,减少术后并发症。

Objective:To analyze the effect of enhanced recovery after surgery(ERAS)in laparoendoscopic single site surgery-total hysterectomy(LESS-TH)perioperative period.Methods:Eighty-six patients who underwent singleport laparoscopic hysterectomy in our hospital(February 2017 to September 2018)were randomly divided into control group and observation group.The patients in the control group were treated with routine rehabilitation regimen,and the patients in the observation group were treated with ERAS.Results:The patients in the observation group were shorter in exhaust,defecation,indwelling urethral catheter and hospital stay than in the control group,and the amount of fluid rehydration on the day of operation was less than that in the control group,the difference was statistically significant(all P<0.05).The VAS score in the observation group was significantly lower than that in the control group at 2 h,8 h,12 h and 24 h after operation(all P<0.05).There was no significant difference in the levels of inflammatory factors and nutritional indexes between the 2 groups before operation(all P>0.05).After operation,the level of HGB,ALB in the observation group was higher than that in the control group.The level of RP,IL-6 was lower than that of control group(all P<0.05).The incidence of nausea and vomiting in the observation group was better than that in the control group,and the complication rate was lower than that in the control group(all P<0.05).Conclusion:The application of ERAS in LESS-TH perioperative period can accelerate recovery,inhibit inflammatory reaction,relieve postoperative pain,and reduce postoperative complications.