加速康复外科在后腹腔镜活体取肾中的应用

Application of enhanced recovery after surgery in retroperitoneal laparoscopic living donor nephrectomy

目的探讨加速康复外科(ERAS)在后腹腔镜活体取肾术(RLDN)围手术期应用的安全性及临床价值。方法回顾性分析2015年1月-2021年10月在烟台毓璜顶医院进行后腹腔镜活体取肾的供者55例,根据围手术期采用的处理方案分为ERAS组(28例)及传统处理组(27例)。对供者的手术时间、热缺血时间、术后视觉模拟疼痛评分(VAS)、术后住院时间、总住院费用、术后3个月取肾切口的并发症发生情况及切口的温哥华瘢痕量表评分(VSS)等进行比较分析。结果所有供者均顺利完成手术,其中ERAS组在手术时间[(140.54±28.23)min vs.(160.37±34.89)min]、热缺血时间[105.0(95.0~109.0)s vs.189.0(179.0~196.0)s]、术后疼痛程度等指标均优于传统处理组(P<0.05);术后住院时间[4.5(4.0~5.0)d vs.5.0(5.0~6.0)d]、总住院费用[(20401.50±6447.10)元vs.(25414.48±6594.80)元]、术后3个月取肾切口并发症[3例(10.7%)vs.24例(88.89%)]及切口VSS评分[4.0(3.0~5.0)分vs.9.0(8.0~10.0)分]ERAS组供者均小于传统处理组(P<0.05)。结论同围术期采用传统方案相比,RLDN围术期采用ERAS处理方案,可减轻供者的痛苦、降低住院时间和住院费用、提高切口满意度、加快康复的进程,且未增加术后并发症发生的风险。

Objective To investigate the safety and clinical significance of enhanced recovery after surgery(ERAS)program in the perioperative period of retroperitoneal laparoscopic living donor nephrectomy(RLDN).Methods A retrospective analysis was conducted on 55 donors who underwent RLDN in Yantai Yuhuangding Hospital during Jan.2015 and Oct.2021(28 cases in ERAS group,27 cases in traditional group).The operation time,warm ischemia time,visual analogue scale(VAS)score,post-operative hospital stay,total hospitalization costs,general complications 3 months after surgery,and Vancouver Scar Scale(VSS)score were compared between the 2 groups.Results All donors successfully completed the operation.The ERAS group was better than the traditional group in terms of operation time[(140.54±28.23)min vs.(160.37±34.89)min],warm ischemia time[105.0(95.0-109.0)s vs.189.0(179.0-196.0)s],VAS score(P<0.05),post-operative hospital stay[4.5(4.0-5.0)d vs.5.0(5.0-6.0)d],total hospitalization costs[(20401.50±6447.10)yuan vs.(25414.48±6594.80)yuan],complications[3 cases(10.71%)vs.24 cases(88.89%)],and VSS score[4.0(3.0-5.0)vs.9.0(8.0-10.0)](all P<0.05).Conclusion Compared with traditional protocols,the ERAS protocol in the perioperative period of RLDN can reduce the pain of donors,shorten hospital stay,reduce costs,improve patients’satisfaction on incision,and accelerate the recovery process without increasing postoperative complications.