加速康复外科理念联合术中喷凝止血技术在后腹腔镜保留肾单位手术中的应用价值  

Application value of enhanced recovery after surgery concept combined with intraoperative spray coagulation hemostasis in retroperitoneal laparoscopic nephron sparing surgery

作　　者：孙圣阳 刘阳 杜元程 苑炜 李宝 卢洪凯[2] 乔梁[2] SUN Shengyang;LIU Yang;DU Yuancheng;YUAN Wei;LI Bao;LU Hongkai;QIAO Liang(School of Clinical Medicine,Weifang Medical University,Weifang,Shandong 261042,China;Department of Urology,Weifang People's Hospital,Weifang,Shandong 261000,China)

机构地区：[1]潍坊医学院临床医学院,山东潍坊261042 [2]潍坊市人民医院泌尿外科,山东潍坊261000

出　　处：《安徽医药》2023年第3期524-529,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 探讨加速康复外科(ERAS)理念联合术中喷凝止血技术在后腹腔镜保留肾单位手术病人围手术期中的应用。方法 选取2018年1月1日至2021年3月31日潍坊市人民医院泌尿外科收治的T1期肾癌病人120例,用抽签法随机分为观察组(n=60)和传统组(n=60)。观察组采取ERAS理念进行围手术期管理,并且术中应用喷凝止血的方式对肾实质进行止血;传统组采取传统方式进行围手术期管理。比较两组病人的手术时间、术中出血量、术中肾热缺血时间、术后首次肛门排气时间、术后疼痛水平、腹膜外引流管拔除时间、术后住院天数、术后第1天肌酐水平。结果 传统组和观察组手术时间、术后第1天肌酐水平差异无统计学意义(P>0.05)。观察组术中热缺血时间短[(23.3±4.1)min比(33.9±4.3)min],术中出血量少[(91.4±10.5)mL比(145.2±9.3)mL],术后首次肛门排气时间短[(22.9±4.8)h比(30.3±3.8)h],术后疼痛评分降低[(3.6±1.3)分比(5.6±1.2)分],腹膜外引流管拔除时间提前[(1.2±0.4)d比(2.2±0.4)d],术后住院天数少[(4.4±0.8)d比(6.2±0.9)d],且两组差异有统计学意义(P<0.05)。结论 ERAS理念联合术中喷凝止血技术在T1期肾癌病人行后腹腔镜保留肾单位手术的围手术期的应用安全,有效。可减轻围手术期应激反应,加速病人的术后康复,具有临床推广前景及价值。Objective To explore the perioperative application of the concept of enhanced recovery after surgery(ERAS) combined with intraoperative spray coagulation hemostasis in patients undergoing retroperitoneal laparoscopic nephron sparing surgery.Methods A total of 120 patients with stage T1 renal carcinoma treated in the Department of Urology of Weifang People’s Hospital from January 1, 2018 to March 31, 2021 were randomly assigned into observation group(n= 60) and conventional group(n=60). The observation group adopted ERAS concept for perioperative management. Meanwhile, the technique of spray coagulation hemostasis was used to stop bleeding in the renal parenchyma during operation. The conventional group took the traditional way for perioperative management. A comparison was made of the operation time, intraoperative blood loss, intraoperative renal warm ischemia time, first postoperative exhaust time, postoperative pain level, removal time of extraperitoneal drainage tube, postoperative hospital stay and creatinine level on the first day between the two groups.Results There was no significant difference in operation time and creatinine level on the first day after operation between conventional group and observation group(P> 0.05). In observation group, the warm ischemia time was shorter [(23.3 ± 4.1) min vs.(33.9 ± 4.3) min], the intraoperative blood loss was less [(91.4 ± 10.5) mL vs.(145.2 ± 9.3) mL], the first postoperative exhaust time was shorter [(22.9 ± 4.8) h vs.(30.3 ± 3.8) h], the postoperative pain score was reduced(3.6 ± 1.3 vs. 5.6 ± 1.2), the removal time of extraperitoneal drainage tube was earlier [(1.2 ± 0.4) d vs.(2.2 ± 0.4) d] and the postoperative hospital stay was shorter [(4.4 ± 0.8) d vs.(6.2 ± 0.9) d]. The difference between the two groups was statistically significant(P<0.05). Conclusion The concept of enhanced recovery after surgery combined with intraoperative spray coagulation hemostasis is safe and effective in the perioperative management of retroperitoneal laparoscopic

关 键 词：肾肿瘤 止血技术 加速康复外科 保留肾单位术 后腹腔镜肾切除术 喷凝 

分 类 号：R737.11[医药卫生—肿瘤]