加速康复外科理念在神经内镜经单鼻孔蝶窦入路垂体腺瘤切除术中的应用

Application of enhanced recovery after surgery concept in neuroendoscopy transsphenoidal pituitary adenoma resection

目的探讨加速康复外科(ERAS)理念在神经内镜下经单鼻孔蝶窦入路垂体腺瘤切除术中的应用效果。方法2020年2月~2020年9月住院治疗的垂体腺瘤病人60例,随机分为两组,对照组30例,按常规准备及常规操作进行手术;ERAS组30例,围手术期采用ERAS理念治疗。比较两组病人术后平均住院时间,术后症状及并发症发生率,手术后鼻腔胀痛VAS评分比较,住院期间病人满意度。结果ERAS组术后平均住院时间为(46±2.2)小时,对照组为(135±10.4)小时,两组比较差异有统计学意义(P<0.05);两组术后呼吸困难、头痛、鼻腔胀痛、鼻腔出血等发生率比较,ERAS组优于对照组,差异有统计学意义(P<0.05);ERAS组因鼻腔出血导致的非计划二次手术发生率为0,对照组为13%,两组比较差异有统计学意义(P<0.05);ERAS组术后鼻腔胀痛VAS评分为1.12±0.45,对照组为6.61±0.92,两组比较差异有统计学意义(P<0.05);ERAS组住院期间病人满意度为(97.63±2.37)%,对照组为(80.20±3.42)%,两组比较差异有统计学意义(P<0.05)。结论神经内镜下经单鼻孔蝶窦入路切除垂体腺瘤术中应用ERAS理念,可减少病人术后全身或局部并发症,缩短术后平均住院时间,提高手术疗效和满意度。

Objective To investigate the effect of accelerated rehabilitation surgery(ERAS)in neuroendoscopic transsphenoidal approach for pituitary adenoma resection.Methods From February 2020 to September 2020,the data of 60 cases of pituitary adenoma were retrospectively analyzed.30 cases underwent surgery according to routine preparation and routine operation as control group.ERAS group was 30 patients who received ERAS concept during perioperative period.The average length of postoperative hospital stay,incidence of postoperative symptoms and complications,VAS score of nasal distension after surgery,and investigation rate of patient satisfaction during hospitalization were compared between the two groups.Results The mean postoperative hospital stay in ERAS group[(46±2.2)h]was significantly better than that in control group[(135±10.4)h](P<0.05).The incidence of clinical symptoms and complications,such as dyspnea,headache,nasal distension and nasal bleeding,was higher in ERAS group than in control group(P<0.05).The incidence of unplanned secondary surgery due to nasal bleeding was significantly higher in ERAS group(0)than in control group(13%)(P<0.05).VAS score of nasal swelling pain in ERAS group(1.12±0.45)was significantly higher than that in control group(6.61±0.92)(P<0.05).Patients’satisfaction during hospitalization in ERAS group[(97.63±2.37)%]was better than that in control group[(80.20±3.42)%](P<0.05).Conclusion The application of ERAS concept in neuroendoscopic transsphenoidal approach for pituitary adenoma resection can reduce postoperative systemic or local complications and shorten the average postoperative hospital stay,improved the surgical efficacy and satisfaction of patients.