模块化手术流程下加速康复外科在腹腔镜膀胱癌根治性精准切除并回肠膀胱术中的应用  

Application of enhanced recovery after surgery concept in laparoscopic radical cystectomy and ileal conduit diversion under modular operation

作　　者：曹智 王葵 胡汉洪 王尉 杨成林 胡正飞 张小明 肖远松 汪帮琦 张辉 聂海波 Cao Zhi;Wang Kui;Hu Hanhong;Wang Wei;Yang Chenglin;Hu Zhengfei;Zhang Xiaoming;Xiao Yuansong;Wang Bangqi;Zhang Hui;Nie Haibo(Department of Urology,General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]南部战区总医院泌尿外科,广州510010

出　　处：《国际外科学杂志》2021年第6期395-401,共7页International Journal of Surgery

基　　金：广州市科技计划项目(基础与应用基础研究项目)(202002030030);广东省基础与应用基础研究基金项目(2020A1515010044)。

摘　　要：目的探讨模块化手术流程下加速康复外科(ERAS)在腹腔镜膀胱癌根治性精准切除并回肠膀胱术中的应用价值。方法回顾性选取2017年1月—2019年12月南部战区总医院泌尿外科施行的腹腔镜膀胱癌根治性精准切除并回肠膀胱术42例,根据围手术期采用的管理方法不同将其分为两组:ERAS管理组和常规管理组,每组各21例。其中ERAS管理组患者围手术期采用ERAS管理,常规管理组患者围手术期采用常规管理。比较两组患者的术后住院时间、首次排气时间、首次排便时间、首次下床时间、首次流食时间、术后疼痛视觉模拟评分(VAS),以及转铁蛋白、上臂肌围、体重指数、血浆白蛋白、总蛋白及前白蛋白等相关营养指标。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;偏态分布的计量资料以中位数(四分位间距)[M(P_(25),P_(75))]表示,组间比较采用Mann-Whitney U检验;计数资料组间比较采用χ^(2)检验。结果ERAS组患者的术后住院时间为(8.9±1.8)d、首次排气时间为(33.4±3.2)h、首次排便时间为(60.3±7.8)h、首次下床活动时间为(23.1±6.7)h、首次流食时间为(82.7±18.5)h及术后VAS评分为(1.3±0.6)分,均较常规处理组明显减少[(12.3±2.3)d、(51.4±5.2)h、(73.0±8.1)h、(34.7±8.2)h、(109.7±21.6)h、(3.6±0.8)分],差异具有统计学意义(P<0.05)。ERAS组患者术后1周转铁蛋白下降值为[0.8(-0.4,2.2)g/L]、体重指数下降值为[(1.61±0.73)kg/m^(2)]、血浆白蛋白下降值为[(3.5±1.5)g/L]、总蛋白下降值为[(10.1±5.6)g/L]、前白蛋白下降值为[(90.5±11.3)mg/L],明显少于常规管理组[(1.9(0.9,3.6)g/L、(2.32±1.05)kg/m^(2)、(9.6±2.0)g/L、(16.3±4.9)g/L、(131.3±7.4)g/L],差异均具有统计学意义(P<0.05)。结论模块化腹腔镜膀胱癌根治性精准切除+回肠膀胱术后采取ERAS理念有利于缩短住院时间,减轻术后疼痛,对患者机体损耗及免疫功能的影Objective To explore the application value of enhanced recovery after surgery(ERAS)in laparoscopic radical resection of bladder cancer and ileal bladder surgery under modular operation procedures.Methods A retrospective selection of 42 cases of laparoscopic radical radical resection of bladder cancer and ileal bladder surgery performed by the Department of Urology,General Hospital of Southern Theater Command from January 2017 to December 2019 were divided into two groups according to the different management methods adopted during the perioperative period:ERAS management group and conventional management group,each with 21 cases.Among them,patients in the ERAS management group were managed by ERAS during the perioperative period,and patients in the conventional management group were managed by conventional management during the perioperative period.The postoperative hospital stay,first exhaust time,first defecation time,first time to get out of bed,first liquid food time,postoperative visual analogue scale(VAS)score,as well as transferrin,upper arm circumference,body mass index,plasma albumin,total protein,and total protein were compared between the two groups of patients after surgery.The measurement data conforming to the normal distribution were expressed as mean±standard deviation(Mean±SD),and the in dependent t-test was used for comparison between groups;the measurement data of non-normal distribution were expressed as the median(interquartile range)[M(P_(25),P_(75))],the independent sample Mann-Whitney U test was used for comparison between groups;the Chi-square test was used for comparison of enumeration data between groups.Results The postoperative hospital stay in the ERAS group was(8.9±1.8)d,the first exhaust time was(33.4±3.2)h,the first defecation time was(60.3±7.8)h,the first time to get out of bed was(23.1±6.7)h,the first liquid food time was(82.7±18.5)h and postoperative VAS was(1.3±0.6),that were significantly reduced compared with the conventional treatment group[(12.3±2.3)d,(51.4±5.2)h

关 键 词：膀胱肿瘤 根治性膀胱切除 围手术期医护 特殊医学用途配方食品 加速康复外科 

分 类 号：R737.14[医药卫生—肿瘤]