加速康复外科理念在达芬奇机器人食管癌McKeown手术中应用的回顾性队列研究  

Application of enhanced recovery after surgery in da Vinci robotic McKeown surgery for esophageal cancer:A retrospective cohort study

作　　者：韩志伟 蔺瑞江 马敏杰[1,2,3,4] 李琼[1] 王晨晗 韩彪[2,3,4] HAN Zhiwei;LIN Ruijiang;MA Minjie;LI Qiong;WANG Chenhan;HAN Biao(The First Clinical Medical College of Lanzhou University,Lanzhou,730000,P.R.China;Department of Thoracic Surgery,The First Hospital of Lanzhou University,Lanzhou,730000,P.R.China;Major in R&D and Application of Key Technologies in Thoracic Surgery,Gansu International Science and Technology Cooperation Base,Lanzhou,730000,P.R.China;Gansu Provincial Medical Quality Control Center of Thoracic Surgery,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院胸外科,兰州730000 [3]胸外科关键技术研发与应用专业甘肃省国际科技合作基地,兰州730000 [4]甘肃省胸外科医疗质量控制中心,兰州730000

出　　处：《中国胸心血管外科临床杂志》2023年第10期1415-1421,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省青年科技基金(21JR1RA107,21JR7RA382);甘肃省自然科学基金(21JR1RA118);兰州大学第一医院院内青年基金(ldyyyn2020-75)。

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在达芬奇机器人食管癌McKeown手术中的应用。方法回顾性分析2017—2021年于兰州大学第一医院行达芬奇机器人食管癌McKeown手术患者的临床资料。按治疗模式不同将患者分为两组:常规组应用胸外科常规围术期治疗模式,ERAS组应用ERAS治疗模式。比较两组患者的相关住院指标以及术后并发症发生率。结果共纳入128例患者,其中男106例、女22例,平均年龄61.91岁。常规组71例、ERAS组57例。ERAS组术后疼痛指数显著低于常规组(P<0.05),且ERAS组术后使用镇痛泵时间短于常规组[(2.39±0.49)d vs.(3.13±0.63)d,P<0.001]。两组术后相关并发症(胃食管反流、吻合口狭窄、吻合口瘘、心律失常、喉返神经损伤、乳糜胸、吻合口炎、切口感染)发生率差异无统计学意义(P>0.05),但ERAS组术后肺部感染发生率低于常规组,差异有统计学意义(12.28%vs.26.76%,P=0.043),且术后胸腔积液量低于常规组,差异有统计学意义(P<0.05)。ERAS组手术时间[(294.35±15.19)min vs.(322.79±59.09)min,P<0.001]、术后肛门排气时间[(1.44±0.39)d vs.(1.94±0.43)d,P<0.001]、术后拔除鼻空肠营养管时间[(6.79±0.73)d vs.(8.21±0.86)d,P<0.001]、住院时间[(19.88±3.36)d vs.(21.34±3.59)d,P=0.020]、住院费用[(105575.28±8960.75)元vs.(137894.64±19518.60)元,P<0.001]均低于或短于常规组。ERAS组术后下床活动时间长于常规组(P<0.05),但两组术前麻醉时间差异无统计意义(P=0.841)。结论在达芬奇机器人食管癌McKeown手术中应用ERAS理念可有效缓解患者生理与心理负担,降低术后相关并发症发生率,有效缩短总住院时间,节省住院费用,减轻患者与社会的经济负担。因此,可在达芬奇机器人食管癌McKeown手术中推广应用。Objective To investigate the application of enhanced recovery after surgery(ERAS)in da Vinci robotic McKeown surgery for esophageal cancer.Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed.According to the treatment,they were divided into two groups,a conventional group and an ERAS group.Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery,and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode.Relevant hospitalization indicators and postoperative complication rates were compared between the two groups.Results Finally 128 patients were collected,including 106 males and 22 females,with an average age of 61.91 years.There were 71 patients in the conventional group and 57 patients in the ERAS group.The postoperative pain index in the ERAS group was significantly lower than that in the conventional group(P<0.05),and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group(2.39±0.49 d vs.3.13±0.63 d,P<0.001).There was no statistical difference in the incidence of postoperative related complications(gastroesophageal reflux,anastomotic stenosis,anastomotic fistula,arrhythmia,recurrent laryngeal nerve injury,chylothorax,anastomosis stomatitis or incisional infection)between the two groups(P>0.05),but the incidence of postoperative lung infection in the ERAS group was statistically lower(12.28%vs.26.76%,P=0.043),and the volume of postoperative pleural effusion was statistically less compared with the conventional group(P<0.05).In the ERAS group,the surgery time(294.35±15.19 min vs.322.79±59.09 min,P<0.001),postoperative exhaust time(1.44±0.39 d vs.1.94±0.43 d,P<0.001),postoperative removal time of nasolasal tube(6.79±0.73 d vs.8.21±0.86 d,P<0.001),hospital stay(19.88±3.36 d vs.21.34±3.59 d,P=0.

关 键 词：加速康复外科 达芬奇机器人 食管癌 McKeown手术 回顾性队列研究 

分 类 号：R735.1[医药卫生—肿瘤]