加速康复外科理念在根治性膀胱切除术和尿流改道围手术期的应用

Application of enhanced recovery after surgery in perioperative period of radical cystectomy and urinary diversion

目的探讨加速康复外科(ERAS)理念在根治性膀胱切除术和尿流改道围手术期中的应用价值。方法选取2015年6月至2020年6月于该中心接受“腹腔镜下根治性膀胱切除术+盆腔淋巴结清扫+回肠代膀胱腹壁造口术”治疗的膀胱癌患者58例,其中27例予以传统康复治疗(传统组),31例予以ERAS治疗(ERAS组)。比较两组术前基本资料及病理分期,以及术后首次进水时间、首次排便时间、住院时间、肠外营养和抗生素使用时间、引流管留置时间及并发症发生情况等。结果与传统组比较,ERAS组术后首次进水时间[(0.71±0.24)d vs.(3.28±0.73)d]、首次排便时间[(2.72±0.69)d vs.(4.55±1.07)d]、术后住院时间[(9.0±3.1)d vs.(18.0±6.8)d]、肠外营养使用时间[(4.4±2.6)d vs.(7.9±4.4)d]、抗生素使用时间[(3.2±2.6)d vs.(13.4±5.6)d]、引流管留置时间[(5.4±2.4)d vs.(11.6±5.6)d]均缩短,差异有统计学意义(P<0.05)。两组术后感染、术后出血、肠梗阻及尿瘘等并发症发生率均无明显差异(P>0.05)。结论ERAS应用于膀胱癌根治术可有效缩短患者住院时间和肠外营养使用时间,促进患者术后恢复,在膀胱癌治疗中有一定的应用价值。

Objective To explore the application value of enhanced recovery after surgery(ERAS)in perioperative period of radical cystectomy and urinary diversion.Methods From June 2015 to June 2020,a total of 58 patients with bladder cancer who underwent"laparoscopic radical cystectomy for bladder cancer+pelvic lymphadenectomy+ileal generation of bladder abdominal wall stoma surgery"in this center were selected,of which 27 patients were treated with traditional rehabilitation(the traditional group),and 31 patients were treated with ERAS(the ERAS group).The preoperative basic data and pathological staging,as well as the time of first intake water and defecation,hospitalization time,parenteral nutrition and antibiotic use time,indwelling drainage tube time and complications were compared between the two groups.Results The time of first intake water[(0.71±0.24)d vs.(3.28±0.73)d],the time of first defecation[(2.72±0.69)d vs.(4.55±1.07)d],hospitalization time[(9.0±3.1)d vs.(18.0±6.8)d],parenteral nutrition time[(4.4±2.6)d vs.(7.9±4.4)d],antibiotic used time[(3.2±2.6)d vs.(13.4±5.6)d],drainage tube indwelling time[(5.4±2.4)d vs.(11.6±5.6)d]in the ERAS group were shorter than those in the traditional group,and all the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications such as postoperative infection,postoperative bleeding,bowel obstruction and urinary fistula between the two groups(P>0.05).Conclusion The application of ERAS in radical resection of bladder cancer can effectively shorten the hospitalization time and parenteral nutrition use time,promote the postoperative recovery of patients,which has certain application value in the treatment of bladder cancer.