加速康复外科在肾上腺和肾脏肿瘤手术中的应用

Application of enhanced recovery after surgery in adrenal and renal tumor operation

目的:评估加速康复外科(enhanced recovery after surgery,ERAS)在肾上腺和肾脏肿瘤手术中应用的效果。方法:将2017年3月至2018年2月我院收治的拟行手术治疗的肾上腺肿瘤、肾脏肿瘤按随机数字表法随机分为ERAS组和常规组,按照预设的纳入排除标准,最终ERAS组纳入89例,其中肾上腺肿瘤38例、肾癌15例、肾囊肿36例。常规处理组纳入100例,其中肾上腺肿瘤49例、肾癌16例、肾囊肿35例。ERAS组按照预设的加速康复外科措施进行围手术期处理,比较2组围手术期相关指标。结果:与传统组相比,ERAS组的术后首次饮水时间[(3.1±1.7)h vs.(7.8±3.5)h,t′=-11.419,P=0.000]、术后首次进食时间[(7.6±3.7)h vs.(13.0±6.9)h,t′=-6.611,P=0.000]和术后首次下床时间[(9.1±4.9)h vs.(26.9±16.3)h,t′=-10.449,P=0.000]明显提前;术后留置尿管时间[(10.1±4.5)h vs.(23.2±15.4)h,t=-8.165,P=0.000]、术后肛门排气时间[(10.0±7.6)h vs.(15.0±9.0)h,t′=-4.157,P=0.000]和术后住院天数[(2.7±1.8)d vs.(3.6±2.1)d,t′=-3.128,P=0.002]明显缩短;术后2 h VAS疼痛评分[(3.3±0.8)vs.(4.3±0.8),t=-8.925,P=0.000]和术后首次下床时VAS评分[(2.5±0.6)vs.(3.4±0.7),t=-8.662,P=0.000]降低;手术时间[(55.8±32.5)min vs.(58.5±31.8)min,t′=-0.557,P=0.578]、术中出血量[(48.2±39.2)m L vs.(48.3±34.6)m L,t′=-0.008,P=0.994]、术后并发症(3/89 vs.6/100,χ2=0.712,P=0.398)、引流管留置时间[(24.4±16.2)h vs.(27.0±15.3)h,t′=-1.143,P=0.255]两组对比差异无统计学意义。结论:ERAS理念运用于肾上腺和肾脏肿瘤手术的围手术期是安全有效的,能够明显加速患者术后康复,提高患者舒适感,缩短住院时间。

Objective:To evaluate the effect of enhanced recovery after surgery(ERAS)on adrenal and renal tumor operation. Methods:The patients with adrenal tumor or renal tumor treated by the proposed surgery in our hospital from March 2017 to February 2018 were randomly divided into ERAS group and routine group by random number table method. According to preset inclusion and exclusion criteria,89 cases were in ERAS group,including 38 cases of adrenal tumor,15 cases of kidney cancer and 36 cases of renal cyst,100 cases were in the routine group,including 49 cases of adrenal tumor,16 cases of kidney cancer and 35 cases of renal cyst. The ERAS group was treated by preset ERAS measures and was compared with the routine group by perioperative indicators. Results:Compared with those of routine group,postoperation first drinking time [(3.1 ±1.7) h vs.(7.8 ±3.5) h,t′ =-11.419,P=0.000],postoperation first eating time[(7.6±3.7)h vs.(13.0±6.9)h,t′=-6.611,P=0.000] and postoperation first off-bed ambulation time [(9.1 ±4.9) h vs.(26.9 ±16.3) h,t′ =-10.449,P =0.000) in ERAS group were earlier;postopertion placing urinary catheter time[(10.1±4.5)h vs.(23.2±15.4)h,t=-8.165,P=0.000],postoperative anal exhaust time[(10.0±7.6)h vs.(15.0±9.0)h,t′ =-4.157,P =0.000] and postoperative hospitalization days [(2.7 ±1.8) d vs.(3.6 ±2.1) d,t′ =-3.128,P =0.002] were significantly shorter in ERAS group;postoperative 2 h VAS pain score[(3.3±0.8)vs.(4.3±0.8),t=-8.925,P=0.000] and postoperation first offbed ambulation VAS pain score[(2.5±0.6)vs.(3.4±0.7),t=-8.662,P=0.000] were lower in ERAS group. There was no significantly statistical difference in operation time[(55.8±32.5)min vs.(58.5±31.8)min,t′=-0.557,P=0.578],bleeding [(48.2 ±39.2) m L vs.(48.3±34.6)m L,t′=-0.008,P=0.994],postoperative complications(3/89 vs. 6/100,χ2=0.712,P=0.398)and drainage tube retention time between two groups[(24.4±16.2)h vs.(27.0±15.3)h,t′=-1.143,P=0.255]. Conclusion:The application of the ERAS concept is safe and effective in perioperative period of adrenal and kidney turnor surgery,which can significantly accelerate postoperative rehabilitation,improve patient's comfort and shorten hospital stay.