加速康复外科在妇科良性肿瘤腹腔镜手术中应用的可行性和安全性分析

The feasibility and safety of enhanced recovery after surgery combined with laparoscopic in benign gynecologic tumor

目的探讨加速康复外科(ERAS)在妇科良性肿瘤腹腔镜手术中应用的可行性和安全性。方法选择2017年1月至2018年5月在安徽省宿州市立医院行手术治疗的妇科良性肿瘤患者160例,其中采用ERAS模式手术患者80例为ERAS组;采用传统模式手术患者80例为对照组。比较两组患者手术时间、术后出血量、术后首次排气时间、术后并发症发生率以及术后3、6、12、24 h疼痛视觉模拟评分(VAS评分),同时比较两组术后平均住院时间、平均住院费用。结果两组手术时间和术中出血量比较差异无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。ERAS组较对照组术后首次排气时间显著缩短[(9.8 ± 2.7)h比(19.1 ± 4.0)h](P<0.05)。ERAS组术后12、24 h VAS评分显著低于对照组[(1.9 ± 0.7)分比(4.2 ± 0.8)分、(1.3 ± 0.4)分比(3.5 ± 0.9)分],ERAS组无使用哌替啶患者,对照组4例术后使用哌替啶,两组哌替啶使用率比较差异有统计学意义[0比5.0%(4/80)](P<0.05)。ERAS组较对照组术后住院时间缩短[(3.9 ± 0.7)d比(5.2 ± 0.9)d],住院费用降低[(1.1 ± 0.1)万元比(1.3 ± 0.1)万元],差异均有统计学意义(P<0.01)。结论加速康复技术用于腹腔镜妇科良性肿瘤围手术期安全有效,值得深入推广。

Objective To explore the feasibility and safety of enhanced recovery after surgery(ERAS)combined with laparoscopic in benign gynecologic tumor.Methods The clinical data of 160 patients with benign gynecologic tumor underwent gynecological laparoscopic surgery in Suzhou Municipal Hospital from January 2017 to May 2018 were selected and analyzed.In these patients,80 patients who underwent ERAS combined with laparoscopic was enrolled in ERAS group,and 80 patients who underwent laparoscopic surgery in traditional model was enrolled in control group.The operation time,intraoperative blood loss,postoperative exhaust time,rate of postoperative complications,the scores of visual analogue scale(VAS)at postoperative 3,6,12,24 h,average hospital stay,and average hospitalization expenses were compared between two groups.Results The operation time,intraoperative blood loss in two groups had no significant differences(P>0.05).The rate of postoperative complications in two groups had no significant difference(P>0.05).The postoperative exhaust time in ERAS group was shorter than that in control group[(9.8±2.7)h vs.(19.1±4.0)h](P<0.05).The scores of VAS at postoperative 12,24 h were lower than those in control group[(1.9±0.7)scores vs.(4.2±0.8)scores,(1.3±0.4)scores vs.(3.5±0.9)scores](P<0.05).Four patients in control group were injected with pethidine and no patients in ERAS group used pethidine,and the rate of using pethidine in two groups had significant difference[0 vs.5.0%(4/80)](P<0.05).The average hospital stay,average hospitalization expenses in ERAS group were lower than those in control group[(3.9±0.7)d vs.(5.2±0.9)d,(1.1±0.1)ten thousand Yuan vs.(1.3±0.1)ten thousand Yuan](P<0.01).Conclusions The ERAS combined with laparoscopic in benign gynecologic tumor is safe and effective during perioperative period,and is worth of expanding.