加速康复外科在腹腔镜肾上腺切除围手术期中的临床应用经验

Application strategy and clinical experience of ERAS practice in perioperative period of laparoscopic adrenalectomy

目的探讨加速康复外科(ERAS)在腹腔镜肾上腺切除围手术期中的临床应用经验。方法2016年1月-2020年12月该院腹腔镜肾上腺切除术患者46例围手术期接受ERAS管理和57例接受传统管理,比较两组患者术后胃肠排气恢复时间、术后2 h疼痛评分、术后住院时间、尿路感染、尿潴留发生率、呼吸道感染发生率、深静脉血栓形成和切口感染的发生情况。结果两组患者性别、年龄、肾上腺左右侧、肾上腺肿瘤病理分类、肿瘤大小、是否伴有高血压、手术方式(经腹腔或腹膜后)、手术时间和术中出血情况比较,差异均无统计学意义(P>0.05)。ERAS组胃肠排气恢复时间及术后住院日均较传统组时间缩短,呼吸道感染发生率较传统组低,术后2 h疼痛评分较传统组低(P<0.05)。两组患者尿路感染、深静脉血栓形成、切口感染、拔除导尿管后尿潴留发生率比较,差异均无统计学意义(P>0.05)。结论将ERAS围手术期管理理念运用于临床,能促进腹腔镜肾上腺切除术后康复,值得临床推广。

Objective To explore the application strategy and clinical experience of enhanced recovery after surgery(ERAS)in perioperative period of laparoscopic adrenalectomy.Methods From January 2016 to December 2020,46 patients underwent laparoscopic adrenalectomy received ERAS management during the perioperative period,compared with 57 patients underwent laparoscopic adrenalectomy with traditional management.The postoperative recovery time of gastrointestinal exhaust,postoperative 2 h pain score,postoperative hospital stay,urinary tract infection,urinary retention,incidence of respiratory tract infection,deep venous thrombosis,and wound infection were compared between the two groups.Results There was no significant difference in sex ratio,age,left and right sides of adrenal gland,pathological classification of adrenal tumor,size of adrenal tumor,hypertension,operation method(transabdominal or retroperitoneal),operation time and intraoperative bleeding between the traditional group and ERAS group(P>0.05).The gastrointestinal exhaust time and postoperative hospital stay of ERAS group were shorter than those of the traditional group,the incidence of respiratory tract infection were lower than those of the traditional group,and the postoperative 2 h pain score was lower than that of the traditional group(P<0.05).There was no significant difference in the urinary tract infection,deep vein thrombosis,incision infection and urinary retention between the two group(P>0.05).Conclusion The application of ERAS perioperative management concept in clinical practice can promote the rehabilitation after laparoscopic adrenalectomy,which is worthy of clinical promotion.