加速康复外科方案在腹腔镜根治性膀胱切除+体腔内尿流改道术围手术期应用的效果分析  

The effect of enhanced recovery after surgery protocols combined with laparoscopic radical cystectomy with intracorporeal urinary diversion

作　　者：孙林[1] 宋黎明[1] 魏后忆 高建东[2] 张玉冬 王明帅[1] 瓦斯里江·瓦哈甫[1] 黄静[2] 邢念增[1] 吴安石[2] 牛亦农[1] Sun Lin;Song Liming;Wei Houyi;Gao Jiandong;Zhang Yudong;Wang Mingshuai;Wasilijiang Wahafu;Huang Jing;Xing Nianzeng;Wu Anshi;Niu Yinong(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Anaesthesiology,Beijingg Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020 [2]首都医科大学附属北京朝阳医院麻醉科,北京100020

出　　处：《中华泌尿外科杂志》2023年第5期363-368,共6页Chinese Journal of Urology

摘　　要：目的探讨加速康复外科(ERAS)方案在腹腔镜根治性膀胱切除(LRC)+体腔内尿流改道术(ICUD)围手术期应用的效果。方法回顾性分析2014年3月至2020年9月首都医科大学附属北京朝阳医院83例接受LRC+ICUD患者的临床资料,根据围手术期管理模式不同分为ERAS组和常规康复外科(CRAS)组。ERAS组29例,男26例,女3例;年龄(62.07±9.26)岁;ASA分级Ⅰ~Ⅱ级26例,Ⅲ级3例;行新辅助化疗4例;有腹部手术史7例。CRAS组54例,男44例,女10例;年龄(61.59±10.16)岁;ASA分级Ⅰ-Ⅱ级50例,Ⅲ级4例;行新辅助化疗9例;有腹部手术史10例。两组患者术前一般资料差异均无统计学意义(P>0.05)。两组患者均行LRC+ICUD。ERAS组较CRAS组对围手术期管理措施进行了优化,主要包括:术前针对手术方案的选择、术后护理及康复训练等方面进行宣教,优化术前肠道准备措施;术中保温及严格液体管理等;术后早期拔除胃管,早期进食及下床活动,优化术后镇痛方案。比较两组患者围手术期相关指标及并发症情况。结果ERAS组行Bricker回肠通道术20例,Studer原位回肠新膀胱9例;病理分期T_(a)、T_(is)、T_(1)、T_(2)、T_(3)、T_(4a)期分别有3、3、7、7、5、4例;N_(0)、N_(1)、N_(2)、N_(3),期分别有23、2、3、1例;病理诊断低级别尿路上皮癌3例,高级别尿路上皮癌24例,其他组织学亚型2例。CRAS组行Bricker回肠通道术31例,Studer原位回肠新膀胱23例;病理分期T_(a)、T_(is)、T_(1)、T_(2)、T_(3)、T_(4a)期分别有5、3、12、9、15、10例;N0、N1、N2、N3期分别有35、6、7、6例;病理诊断低级别尿路上皮癌6例,高级别尿路上皮癌45例,其他组织学亚型3例。两组手术方式、病理分期、病理类型差异均无统计学意义(P>0.05)。ERAS组较CRAS组围手术期最大白蛋白降低率[(25.73±8.63)%与(32.63±9.05)%,P=0.001]、住院时间[9(7,13)d与12(9,16)d,P=0.006]、术后30d内并发症发生率[55.2%(16/29)与83.3%(45/54),P=0.009]均降低�Objective To explore the effect of enhanced recovery after surgery(ERAS)protocols in patients undergoing laparoscopic radical cystectomy(LRC)and intracorporeal urinary diversion(ICUD).Methods A total of 83 patients who received LRC+ICUD in Beijing Chaoyang Hospital from March 2014 to September 2020,were divided into 2 groups based on different perioperative management,including 29 ERAS cases and 54 conventional recovery after surgery(CRAS)cases.The ERAS group included 26 males and 3 females,with an average age of(62.07±9.26)years.There were 26 patients with ASA class Ⅰ-Ⅱ,3 patients with ASA class 1,4 patients received neoadjuvant chemotherapy,and 7 patients had a history of abdominal surgery in ERAS group.The CRAS group included 44 males and 10 females,with an average age of(61.59±10.16)years.There were 50 patients with ASA class Ⅰ-Ⅱ,4 patients with ASA class II,9 patients received neoadjuvant chemotherapy,and 10 patients had a history of abdominal surgery in CRAS group.There were no statistically significant differences in the baseline characteristics between the two groups.The patients in both groups underwent LRC+ICUD procedures.The perioperative results and complications between the two groups were compared.Results In the ERAS group,there were 20 patients who underwent Bricker ileal conduit surgery and 9 patients who underwent Studer orthotopic ileal neobladder surgery.Pathological staging included 3,3,7,7,5 and 4 cases in stage T_(a),T_(is),T_(1),T_(2),T_(3),and T_(4a),respectively.There were 23,2,3 and 1 patient with pathological stage N_(0),N_(1),N_(2) and N_(3),respectively.Pathological diagnosis included 3 cases of low-grade urothelial carcinoma,24 cases of highgrade urothelial carcinoma,and 2 cases of other histological subtypes.In the CRAS group,there were 31 patients who underwent Bricker ileal conduit surgery and 23 patients who underwent Studer orthotopic ileal neobladder surgery.Pathological staging included 5,3,12,9,15 and 10 patients in stage T_(a),T_(is),T_(1),T_(2),T_(3),and T_(4a),re

关 键 词：膀胱切除术 根治性 体腔内尿流改道 加速康复外科 血清白蛋白 

分 类 号：R699.5[医药卫生—泌尿科学]