ERAS理念下早期拔除尿管在腹腔镜子宫根治术后的应用
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摘要
腹腔镜手术是利用电子、光学、摄像等高科技技术在密闭的腹腔内进行手术,具有创伤小、恢复快、并发症少的特点,本文旨在探讨加速康复外科(Enhanced Recovery After Surgery,ERAS)理念下早期拔除尿管在腹腔镜子宫根治术(Laparoscopic Radical Hysterectomy,LRH)后膀胱功能管理中的应用价值。回顾性分析我院2018年1月至6月行腹腔镜子宫根治术及盆腔淋巴结清扫术的74例患者资料,该74例患者在围手术期均实施加速康复外科护理。其中33例患者于术后6～9日拔除尿管为实验组,41例留置尿管时间≥10天者为对照组。比较两组的尿管重置率、术后住院日、焦虑抑郁情况、术后生命质量以及膀胱功能等预后指标,评价ERAS理念下早期拔除尿管在膀胱功能管理中的临床应用价值。结果实验组患者的留置尿管时间、术后HADS评分、EORTC QLQ-C30评分及术后住院日均小于对照组,差异有统计学意义(P<0. 05),两组的尿管重置率以及残余尿没有显著差异(P> 0. 05)。ERAS理念下对腹腔镜子宫根治术患者早期拔除尿管对于患者的膀胱功恢复虽无统计学意义,但可减轻患者术后的焦虑抑郁情绪,提高生命质量,缩短术后住院日,建议子宫根治术后6-9天可遵医嘱拔除尿管。
Objective Laparoscopic surgery is the use of high technology such as electronics,optics,and photography to perform surgery in a closed abdominal cavity.It has the characteristics of small trauma,rapid recovery and fewer complications.This article is to explore the application value of enhanced recovery after surgery(ERAS) for bladder function in patients after laparoscopic radical hysterectomy(LRH).Methods The data of 74 patients who had undergone LRH and ERAS during perioperative period in our hospital from January 2018 to June 2018. 33 patients treated with extraction of urethral catheterization after 6 ～ 9 days of operation was experimental group. 41 patients with long-term indwelling urethral catheter were taken as the control group.The prognostic indicators such as ureteral replacement rate,postoperative hospitalization time,anxiety and depression,postoperative quality of life and bladder function were compared between the two groups. Results The time of retained ureter,the days of hospitalization after operation and the scores of HADSand EORTC QLQ-C30 were significantly lower in the experimental group than those in the control group(P<0. 05).There was no statistical difference in ureteral replacement rate and bladder function(P>0. 05).Conclusion Early extraction of urethral catheterization for patients who had undergone LRH and ERAS is feasible,which can reduce anxiety and depression and postoperative hospitalization time after surgery and improve the quality of life of patients.Removal the urethral tube 6 to 9 days after LRH is worth to recommend.
Objective Laparoscopic surgery is the use of high technology such as electronics,optics,and photography to perform surgery in a closed abdominal cavity.It has the characteristics of small trauma,rapid recovery and fewer complications.This article is to explore the application value of enhanced recovery after surgery(ERAS) for bladder function in patients after laparoscopic radical hysterectomy(LRH).Methods The data of 74 patients who had undergone LRH and ERAS during perioperative period in our hospital from January 2018 to June 2018. 33 patients treated with extraction of urethral catheterization after 6 ～ 9 days of operation was experimental group. 41 patients with long-term indwelling urethral catheter were taken as the control group.The prognostic indicators such as ureteral replacement rate,postoperative hospitalization time,anxiety and depression,postoperative quality of life and bladder function were compared between the two groups. Results The time of retained ureter,the days of hospitalization after operation and the scores of HADSand EORTC QLQ-C30 were significantly lower in the experimental group than those in the control group(P<0. 05).There was no statistical difference in ureteral replacement rate and bladder function(P>0. 05).Conclusion Early extraction of urethral catheterization for patients who had undergone LRH and ERAS is feasible,which can reduce anxiety and depression and postoperative hospitalization time after surgery and improve the quality of life of patients.Removal the urethral tube 6 to 9 days after LRH is worth to recommend.
引文
[1]周琦,吴小华,刘继红等.宫颈癌诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(06):613-622.
[2]周琦,吴小华,刘继红等.子宫内膜癌诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(08):880-886.
[3]刘大纯,王晓霜.腹腔镜手术治疗宫颈癌的临床效果及对生存质量的影响[J].基因组学与应用生物学,2018,37(02):596-603.
[4]ZHAO Y,HANG B,XIONG G W,et al.Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer:A Systematic Review and Meta-analysis[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2017,27(11):1132-1144.
[5]LATERZA R M,SIEVERT K D,DE RIDDER D,et al.Bladder function after radical hysterectomy for cervical cancer[J].Neurourology and Urodynamics,2015,34(4):309-315.
[6]SELCUK S,CAM C,ASOGLU M R,et al.Effect of simple and radical hysterectomy on quality of life-Analysis of all aspects of pelvic floor dysfunction[J].European Journal of Obstetrics Gynecology&Reproductive Biology,2016,198(3):84-88.
[7]GALICZEWSKI JM.Interventions for the prevention of catheter associated urinary tract infections in intensive care units:an integrative review[J].Intensive and Critcal Care Nursing,2016,32(2):1-11.
[8]KREIN SL,FOWLER KE,RATZ D,et al.Preventing device associated infections in US hospitals:national surveys from 2005to 2013[J].BMJ Quality&Safety,2015,24(6):385-392.
[9]NELSON G,ALTMAN A D,NICK A,et al.Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations-PartI[J].Gynecologic Oncology,2015,140(2):313-322.
[10]ROH J W,LEE D O,SUH D H,et al.Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer:a randomized controlled trial[J].Journal of Gynecologic Oncology,2015,26(2):90-99.
[11]KRUPPA J,KAVVADIAS T,AMANN S,et al.Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy:a prospective pilot study[J].European Journal of Obstetrics&Gynecology and Reproductive Biology,2016,201(6):131-134.
[12]邹冰玉,刘思伟,雷华江等.早期拔除尿管与清洁间歇性导尿术相结合在腹腔镜下广泛性子宫切除术后的应用[J].实用医院临床杂志,2018,15(4):109-111.
[13]OH J K,NOH-Hyun Park,Seung-June Oh.Effect of the systematised critical pathway protocol on emptying failure as a secondary complication of radical hysterectomy due to uterine cervix cancer[J].Journal of Clinical Nursing,2014,23(6):1702-1707.
[14]李婵,万晓霞,谢伟,李天庭,梁金星.照明光源对多光谱图像采集精度影响的研究[J].激光杂志,2016,37(12):44-47.
[15]贺红英,李力,陈国伟,林佳静,陈艳丽.腹腔镜和开腹手术治疗早期宫颈癌疗效对比的系统评价[J].肿瘤防治研究,2017,44(03):214-220.
[16]陈春林.宫颈癌手术保留盆腔神经相关问题[J].中国实用妇科与产科杂志,2015,31(06):507-511.
[17]王静,张璐,毛文娟等.加速康复外科在妇科腹腔镜手术中应用的可行性和安全性分析[J].中国妇产科临床杂志,2018,19(06):485-488.
[18]曾朝阳,刘娟,周妍,曾春燕,吴俊微.宫颈癌术后对患者盆底功能影响的研究[J].中国现代医学杂志,2018,28(03):59-63.
[19]何梅,周满丽,王雯,张丹,唐盈,于梦帆,周丹丹.出院准备度护理评估工具研究进展[J].中国护理管理,2018,18(09):1252-1256.
[2]周琦,吴小华,刘继红等.子宫内膜癌诊断与治疗指南(第四版)[J].中国实用妇科与产科杂志,2018,34(08):880-886.
[3]刘大纯,王晓霜.腹腔镜手术治疗宫颈癌的临床效果及对生存质量的影响[J].基因组学与应用生物学,2018,37(02):596-603.
[4]ZHAO Y,HANG B,XIONG G W,et al.Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer:A Systematic Review and Meta-analysis[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2017,27(11):1132-1144.
[5]LATERZA R M,SIEVERT K D,DE RIDDER D,et al.Bladder function after radical hysterectomy for cervical cancer[J].Neurourology and Urodynamics,2015,34(4):309-315.
[6]SELCUK S,CAM C,ASOGLU M R,et al.Effect of simple and radical hysterectomy on quality of life-Analysis of all aspects of pelvic floor dysfunction[J].European Journal of Obstetrics Gynecology&Reproductive Biology,2016,198(3):84-88.
[7]GALICZEWSKI JM.Interventions for the prevention of catheter associated urinary tract infections in intensive care units:an integrative review[J].Intensive and Critcal Care Nursing,2016,32(2):1-11.
[8]KREIN SL,FOWLER KE,RATZ D,et al.Preventing device associated infections in US hospitals:national surveys from 2005to 2013[J].BMJ Quality&Safety,2015,24(6):385-392.
[9]NELSON G,ALTMAN A D,NICK A,et al.Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations-PartI[J].Gynecologic Oncology,2015,140(2):313-322.
[10]ROH J W,LEE D O,SUH D H,et al.Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer:a randomized controlled trial[J].Journal of Gynecologic Oncology,2015,26(2):90-99.
[11]KRUPPA J,KAVVADIAS T,AMANN S,et al.Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy:a prospective pilot study[J].European Journal of Obstetrics&Gynecology and Reproductive Biology,2016,201(6):131-134.
[12]邹冰玉,刘思伟,雷华江等.早期拔除尿管与清洁间歇性导尿术相结合在腹腔镜下广泛性子宫切除术后的应用[J].实用医院临床杂志,2018,15(4):109-111.
[13]OH J K,NOH-Hyun Park,Seung-June Oh.Effect of the systematised critical pathway protocol on emptying failure as a secondary complication of radical hysterectomy due to uterine cervix cancer[J].Journal of Clinical Nursing,2014,23(6):1702-1707.
[14]李婵,万晓霞,谢伟,李天庭,梁金星.照明光源对多光谱图像采集精度影响的研究[J].激光杂志,2016,37(12):44-47.
[15]贺红英,李力,陈国伟,林佳静,陈艳丽.腹腔镜和开腹手术治疗早期宫颈癌疗效对比的系统评价[J].肿瘤防治研究,2017,44(03):214-220.
[16]陈春林.宫颈癌手术保留盆腔神经相关问题[J].中国实用妇科与产科杂志,2015,31(06):507-511.
[17]王静,张璐,毛文娟等.加速康复外科在妇科腹腔镜手术中应用的可行性和安全性分析[J].中国妇产科临床杂志,2018,19(06):485-488.
[18]曾朝阳,刘娟,周妍,曾春燕,吴俊微.宫颈癌术后对患者盆底功能影响的研究[J].中国现代医学杂志,2018,28(03):59-63.
[19]何梅,周满丽,王雯,张丹,唐盈,于梦帆,周丹丹.出院准备度护理评估工具研究进展[J].中国护理管理,2018,18(09):1252-1256.