加速康复外科在儿童尿道下裂围术期的应用效果分析

Analysis of the effectiveness of enhanced recovery after surgery in the perioperative period of children with hypospadias

目的回顾性分析加速康复外科(ERAS)管理在儿童尿道下裂患者围手术期中的应用效果。方法回顾性收集2018年7月至2022年8月中山大学附属第六医院收治的213例小儿尿道下裂患者的临床资料,排除未行手术治疗及行Ⅰ期预置尿道板者,共纳入尿道下裂患者112例,其中行横裁包皮岛状皮瓣管状尿道成形术(Duckett术)29例,改良加盖岛状皮瓣术(Onlay术)17例,Ⅱ期尿道板纵切卷管术(TIP术)41例,因尿瘘行手术修补者25例。所有患儿围术期采用ERAS流程管理,回顾性分析患儿年龄、身高、体质量指数、合并疾病、手术方式、手术时间、麻醉方式、镇痛方式、术中出血量等资料,同时收集患儿术后住院时间,术后恢复饮食及下床活动时间和术后并发症等临床资料。结果患者总住院时间为(5.8±2.6)d,总术后住院时间为(3.9±2.2)d,手术时间为(139±47)min,术中出血量为[10(5,20)]ml,术后3 h恢复饮食者占87.5%(98/112),术后当天下床活动者为83.9%(94/112),术后随访2~53个月,中位时间27个月。术后总体并发症发生率为19.6%(22/112),其中感染2例,予抗炎引流后好转;尿瘘9例,尿道狭窄4例,尿瘘伴尿道狭窄4例,尿道憩室1例,阴茎头裂开1例,尿道肿物1例,予再次手术后均好转。结论ERAS在小儿尿道下裂围术期应用具有一定的安全性及可行性,可促进术后康复,且未增加并发症。

Objective To retrospectively analyze the effectiveness of enhanced recovery after surgery(ERAS)management on children with hypospadias during the perioperative period.Methods The clinical data of 213 children with hypospadias admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from July 2018 to August 2022 were collected,and 112 patients with hypospadias were included,including 29 patients treated with Duckett surgery,17 patients treated with modified Onlay surgery,41 cases with TIP surgery and 25 cases underwent surgical repair due to urinary fistula.All children were managed by ERAS process in the perioperative period,and the baseline data of children's age,height,BMI,comorbidity,operation mode,operation time,anesthesia mode,analgesia mode,intraoperative blood loss were analyzed retrospectively.At the same time,the clinical data of children's postoperative hospitalization time,postoperative recovery time of diet and activity,postoperative complications were collected.Results The overall hospitalization time was(5.8±2.6)d,the overall postoperative hospitalization time was(3.9±2.2)d,the operation time was(139±47)min,and the intraoperative blood loss was[10(5,20)]ml.87.5%(98/112)of the patients returned to diet 3 hours after the operations,and 83.9%(94/112)of the patients had out-of-bed activity in the day after the operations.The median follow-up time was 27 months,ranging from 2 to 53 months.The overall postoperative complication rate was 19.6%(22/112),of which 2 cases were infected and improved after anti inflammation and drainage,9 cases of urinary fistula,4 cases of urethral stricture,4 cases of urinary fistula with urethral stricture,1 case of urethral diverticulum,1 case of penis head rupture,and 1 case of urethral lump.All of them improved after reoperation.Conclusions ERAS is safe and effective in children with hypospadias during perioperative period,which can promote postoperative rehabilitation without increasing complications.