基于ERAS理念在输尿管软镜日间手术治疗直径<2 cm肾结石优化管理中的应用体会  

Application of ERAS theory in<2 cm nephrolithiasis patients underwent RIRS in day surgery

作　　者：李天宇[1] 陈阳[1] 姚建妮 莫林键[1] 邓裕辉 周善昌 刘德云[1] 程继文 Li Tianyu;Chen Yang;Yao Jianni;Mo Linjian;Deng Yuhui;Zhou Shanchang;Liu Deyun;Cheng Jiwen(Department of Urology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Guangxi Medical University,Nanning 530021,China;Department of Urology,Guangxi Pingnan People's Hospital,Pingnan 537000,China;Department of Urology,Guangxi Hechi People's Hospital of Traditional Chinese Medicine,Hechi 547000,China)

机构地区：[1]广西医科大学第一附属医院泌尿外科,南宁530021 [2]广西医科大学,南宁530021 [3]广西平南县人民医院泌尿外科,平南537000 [4]广西河池市中医院外三科,河池547000

出　　处：《广西医科大学学报》2018年第3期335-339,共5页Journal of Guangxi Medical University

基　　金：国家自然科学基金资助项目(No.81660424)

摘　　要：目的:评价基于加速康复外科(ERAS)理念的逆行输尿管软镜下钬激光碎石术(RIRS)日间手术治疗直径<2cm肾结石的效果及应用体会。方法:选择2017年1—8月在本院住院接受RIRS或经皮肾镜碎石术(PCNL)治疗的90例肾结石(直径<2cm)患者,其中基于ERAS理念的日间RIRS手术患者22例(日间RIRS组),传统RIRS手术患者44例(传统RIRS组),PCNL手术患者24例(PCNL组),比较3组住院时间、手术时间、治疗费用、术中出血量、术后抗生素及止痛药物使用率。结果:日间RIRS组和传统RIRS组的手术时间、住院时间均短于PCNL组,治疗费用、术中出血量、术后止痛药物使用率均少于PCNL组(均P<0.05)。尽管与传统RIRS相比,日间RIRS手术在手术时间、术中出血量、术后止痛药物应用方面无显著改善,但日间RIRS手术可明显缩短患者的住院时间,减少治疗费用(P<0.05)。结论:在处理直径<2cm的肾结石中,基于ERAS理念,优化管理后的日间RIRS手术可缩短住院时间,促进患者康复,利于医疗资源的有效循环利用。Objective:To evaluate the effect of enhanced recover after surgery(ERAS)theory in<2 cm nephrolithiasis patients who underwent retrograde intrarenal surgery(RIRS)in day surgery.Methods:Nine-ty patients with nephrolithiasis(<2 cm)undergoing RIRS or percutaneous nephrolithotomy(PCNL)in our hospital from January 2017 to August 2017 were selected,among which 22 patients received RIRS in day surgery bases on ERES theory,44 cases received conventional RIRS and 24 cases received PCNL.The hospital days,operation time,treatment expenses,intraoperative blood-loss,and use of antibiotic and anal-gesic drugs were recorded and compared.Results:The hospital days and operation time among patients un-dergoing RIRS in day surgery were significantly shorter than those who received PCNL,and the treatment expenses?intraoperative blood-loss volume and the rate of analgesic drug use were markedly lower(P<0.05).There were no significant differences in the operation time,intraoperative blood-loss volume and fre-quency of postoperative painkiller use between patients undergoing RIRS in day surgery and those undergo-ing conventional RIRS?but patients who received RIRS in day surgery had shorter duration of hospitaliza-tion and lower treatment costs(P<0.05).(Conclusion:RIRS in day surgery based on ERAS theory in the treatment of nephrolithiasis(<2 cm)could accelerate patients'rehabilitation?shorten hospital days?and promote the effective recycling of medical resources.

关 键 词：加速康复外科 输尿管软镜碎石术 肾结石 日间手术 

分 类 号：R699.2[医药卫生—泌尿科学]