加速康复外科理念在经尿道选择性绿激光前列腺汽化术围手术期的应用研究

Application of Enhanced Recovery after Surgery in the Perioperative Period of Greenlight Photoselective Vaporization of Prostate

目的:探讨加速康复外科(ERAS)理念对经尿道选择性绿激光前列腺汽化术(PVP)患者术后康复的安全性和有效性。方法:回顾2018年6月至2019年10月在河南科技大学第一附属医院行经尿道选择性绿激光PVP治疗的61例前列腺增生患者,其中采用加速康复理念进行围手术期管理30例(ERAS组),按照传统围手术期管理31例(对照组)。比较两组手术时间、术后6 h视觉模拟评分(VAS)、术后第1 d血白细胞计数、术后首次排气时间、国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率(Qmax)、术后尿管留置时间、住院时间以及出院3个月内并发症发生情况等。结果:两组术后6小时VAS评分、术后排气时间、留置尿管时间、平均住院时间比较差异有统计学意义(P<0.05)。两组术后3个月IPSS评分、术后3个月QOL评分、术后3个月Qmax比较差异均无统计学意义(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)。结论:ERAS应用于经尿道选择性绿激光PVP围手术期的管理满足安全性、有效性的要求,有助于缓解术后早期疼痛感,缩短肠道恢复、住院的时间,使患者能够更快地出院和康复。

Objective:To explore the safety and effectiveness of the enhanced recovery after surgery(ERAS)in the postoperative rehabilitation of patients undergoing transurethral selective greenlight photoselective vaporization of prostate(PVP).Methods:From June 2018 to October 2019,61 patients with prostatic hyperplasia were treated by transurethral selective greenlight photoselective vaporization of prostate PVP in the First Affiliated Hospital of Henan University of Science and Technology.Among them,30 patients(ERAS group)were managed in perioperative period with ERAS of accelerated rehabilitation,and 31 patients(control group)were managed in traditional perioperative period.The time of operation,visual analogue score(VAS)at 6 h after operation,WBC count at the 1 d after operation,time of first exhaust after operation,international prostate symptom score(IPSS),quality of life(QOL)score,maximum urine flow rate(Qmax),time of indwelling catheter after operation,length of stay in hospital and complications within 3 months after discharge were compared between the two groups.Results:There were significant differences in VAS score,postoperative exhaust time,indwelling catheter time and average hospital stay time between the two groups(P<0.05).There was no significant difference in IPSS,QOL and Qmax between the two groups(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:The application of ERAS in the perioperative management of transurethral selective greenlight photoselective vaporization of prostate PVP can meet the requirements of safety and effectiveness,help to relieve the early postoperative pain,shorten the time of intestinal recovery and hospitalization,and enable patients to discharge and recover faster.