加速康复外科在达芬奇机器人辅助腹腔镜下肾肿瘤剜除术中的应用研究

Application of enhanced recovery after surgery strategy in da Vinci robot assisted laparoscopic renal tumor enucleation

目的:探讨加速康复外科(ERAS)应用于机器人辅助腹腔镜下肾肿瘤剜除术的可行性。方法:将2016年8月至2019年6月收治的120例行机器人辅助腹腔镜下肾肿瘤剜除术的患者随机分为ERAS组与对照组,每组60例,两组围手术期分别采用不同的处理方式,对比分析两组术后恢复指标、疼痛指数、总体康复状态、住院时间、住院费用等相关指标。结果:ERAS组首次肛门通气时间[(23.6±11.3)h vs.(45.6±20.5)h]、开始进食时间[(24.8±12.3)h vs.(55.7±17.1)h]、首次下床活动时间[(45.0±11.3)h vs.(124.6±25.9)h]、导尿管留置时间[(82.4±11.5)h vs.(132.6±32.6)h]、引流管留置时间[(80.4±14.3)h vs.(140.6±31.2)h]优于对照组。两组手术时间、出血量差异无统计学意义(P>0.05),术中均无周围器官损伤。结论:ERAS措施应用于机器人辅助腹腔镜肾肿瘤剜除术可明显加速患者康复。

Objective:To evaluate the feasibility of ERAS in Da Vinci robot assisted laparoscopic renal tumor enucleation.Methods:From Aug.2016 to Jun.2019,120 patients who underwent Da Vinci robot assisted laparoscopic renal tumor enucleation were randomly assigned to an ERAS and a control group to receive an ERAS recovery program(n=60)or conventional perioperative care(n=60)respectively.Comparisons were made between the two groups including the patients’recovery index,pain scores,the general rehabilitation status,the hospital stay,and the hospitalization expenses.Results:The ERAS group,in comparison with the control,showed significantly earlier time of first flatus[(23.6±11.3)h vs.(45.6±20.5)h],first oral nutrition[(24.8±12.3)h vs.(55.7±17.1)h],and first mobilization[(45.0±11.3)h vs.(124.6±25.9)h],markedly shorter time of urethral catheter[(82.4±11.5)h vs.(132.6±32.6)h],drainage tube[(80.4±14.3)h vs.(140.6±31.2)h]and postoperative hospital stay,remarkably less expenses of hospitalization,and lower postoperative pain scores.There were no significantly statistical differences in operative time or blood loss(P>0.05),and no peripheral organ injury.Conclusions:ERAS can accelerate the patients recovery obviously and could be applied safely and effectively in Da Vinci robot assisted laparoscopic renal tumor enucleation.