快速康复在根治性膀胱切除术围手术期的应用及效果评价

Application of enhanced recovery after surgery in perioperative period of radical cystectomy and evaluation on its effect

目的:探讨快速康复在根治性膀胱切除术围手术期的应用效果。方法:将腹腔镜根治性膀胱切除术的膀胱癌患者115例,随机分为加速康复外科(enhanced recovery after surgery,ERAS)组和常规处理组,ERAS组采用快速康复方案,常规处理组采用传统方案,观察首次排气、首次排便、肠梗阻并发症、住院时间等一系列指标。结果:ERAS组首次排气时间及排便时间分别为(34.67±3.13)h、(55.10±5.73)h,均较常规处理组缩短[(43.03±4.42)h;(63.64±4.82)h],差异具有统计学意义(P<0.05)。首次下床活动时间,ERAS组为(24.89±5.74)h,也较常规处理组的(39.58±7.85)h短,差异具有统计学意义(P<0.05)。ERAS组的住院时间为(7.81±2.03)d,短于常规处理组的(13.56±1.99)d,差异具有统计学意义(P<0.05)。结论:膀胱癌根治性膀胱切除术后采取快速康复理念安全可靠,而且可以在不增加并发症的前提下,缩短平均住院日,加速患者的康复。

Objective:To discuss the application of enhanced recovery after surgery(ERAS)in the perioperative among the patients with radical cystectomy. Methods:Under the peritoneoscope,115 patients with bladder cancer accepting laparoscopic radical cystectomy were divided into the ERAS group and conventionaltreatment group at random. The ERAS scheme was applied in ERAS,while the conventional scheme was applied in the conventional treatment group to observe a series of indexes which include first exhaust,first defecation,intestinal obstruction,hospital stay,etc. Results:The first time of anal exsufflation and the first defecation time in ERAS group were(34.67±3.13)h and(55.10±5.73)h,while the first time of anal exsufflationand the first defecation time in the conventional treatment group were(43.03±4.42)h and(63.64±4.82)h,respectively. The intestinal function recovery of patients in ERAS group was obviously reduced by comparing with the conventional treatment group. First bed-off time in ERAS group was(24.89±5.74)h,which was also less than the conventional treatment group(39.58±7.85)h. The difference had the statistical significance(P<0.05). The length of stay in ERAS group was(7.81 ±2.03) d,which was less than the conventional treatment group(13.56±1.99)d. The difference had the statistical significance(P<0.05). Conclusions:After radical cystectomy,enhanced recovery aftersurgery is safe and reliable. Moreover,under the precondition of not increasing complications,it can shorten average length of stay and speed up patients' recovery.