加速康复外科理念在卵巢子宫内膜异位囊肿围术期管理中的应用
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摘要
目的探究加速康复外科(ERAS)理念应用于卵巢子宫内膜异位囊肿围术期管理的安全性、有效性以及可行性。方法采用回顾性队列研究方法。连续收集2017年8月1日至2017年12月31日中国医科大学附属盛京医院诊断为卵巢子宫内膜异位囊肿的患者94例,其中干预组64例,传统组30例(为同期对照)。主要观察疼痛视觉模拟评分(VAS)、术后首次下床活动时间、术后首次肛门排气时间、术后住院时长和术后留置腹腔引流时长等指标。结果 2组术后即刻的VAS疼痛评分无统计学意义(P>0.05),但在术后4 h、术后第1日以及术后第2日干预组的VAS疼痛评分都明显低于对照组(P <0.05),干预组术后留置腹腔引流时长、术后首次下地活动时间、术后首次肛门排气时间和术后住院时长显著小于对照组(P <0.05)。结论 ERAS理念应用于妇科卵巢子宫内膜异位囊肿围术期管理是安全、有效、可行的,值得进一步推广。
Objective To elucidate the safety,efficacy,and feasibility of enhanced recovery after surgery(ERAS) in the perioperative management of ovarian endometriosis. Methods A retrospective cohort study design was used. We collected the clinical data of 94 patients who had been diagnosed as having ovarian endometriosis in Shengjing Hospital of China Medical University between August 1,2017,to December 31,2017. The patients were divided into two groups,one consisting of 64 patients who received ERAS and the other consisting of 30 patients who received traditional management as controls. The main observation indexes were as follows:visual analog scale(VAS) score for pain,time of first postoperative activity,time to first exhaustion after surgery,postoperative hospitalization duration,duration of peritoneal drainage tube retention after surgery. Results No statistically significant difference was found between the two groups in terms of the immediate postoperative VAS pain scores(P > 0.05). However,4 hours,1 day,and 2 days after surgery,the VAS pain scores were significantly lower in the intervention group than in the control group(P < 0.05). Furthermore,the other indexes,including time of first postoperative activity,duration of peritoneal drainage tube retention after surgery,time to first exhaustion after surgery,and postoperative hospitalization duration,were significantly lower in the ERAS group than in the control group. Conclusion ERAS is safe,effective,and feasible for application in the perioperative management of ovarian endometriosis.
Objective To elucidate the safety,efficacy,and feasibility of enhanced recovery after surgery(ERAS) in the perioperative management of ovarian endometriosis. Methods A retrospective cohort study design was used. We collected the clinical data of 94 patients who had been diagnosed as having ovarian endometriosis in Shengjing Hospital of China Medical University between August 1,2017,to December 31,2017. The patients were divided into two groups,one consisting of 64 patients who received ERAS and the other consisting of 30 patients who received traditional management as controls. The main observation indexes were as follows:visual analog scale(VAS) score for pain,time of first postoperative activity,time to first exhaustion after surgery,postoperative hospitalization duration,duration of peritoneal drainage tube retention after surgery. Results No statistically significant difference was found between the two groups in terms of the immediate postoperative VAS pain scores(P > 0.05). However,4 hours,1 day,and 2 days after surgery,the VAS pain scores were significantly lower in the intervention group than in the control group(P < 0.05). Furthermore,the other indexes,including time of first postoperative activity,duration of peritoneal drainage tube retention after surgery,time to first exhaustion after surgery,and postoperative hospitalization duration,were significantly lower in the ERAS group than in the control group. Conclusion ERAS is safe,effective,and feasible for application in the perioperative management of ovarian endometriosis.
引文
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[14]SMITH MD,MCCALL J,PLANK L,et al.Preoperative carbohydrate treatment for enhancing recovery after elective surgery[J].Cochrane Database Syst Rev,2014,14(8):CD009161.DOI:10.1002/14651858.CD009161.
[15]WIJK L,FRANZEN K,LJUNGQVIST O,et al.Implementing a structured Enhanced Recovery After Surgery(ERAS)protocol reduces length of stay after abdominal hysterectomy[J].Acta Obstet Gynecol Scand,2014,93(8):749-756.DOI:10.1111/aogs.12423.
[16]WAU Y,RELPH S,BELL A,et al.Can enhanced recovery pathways improve outcomes of vaginal hysterectomy?Cohort control study[J].J Minim Invasive Gynecol,2014,21(1):83-89.DOI:10.1016/j.jmig.2013.06.007.
[2]郎景和.子宫内膜异位症发病的“在位内膜决定论”:第八次全国妇产科学学术会议论文汇编[C].南京,2004.
[3]KEHLET H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[4]NELSON G,ALTMAN AD,NICK A,et al.Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery after Surgery(ERAS?)society recommendations[J].Gynecol Oncol,2016,140(2):313-322.DOI:10.1016/j.ygyno.2015.11.015.
[5]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断和治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[6]ASTANEHE A,TEMPLE-OBERKE C,NIELSEN M,et al.An enhanced recovery after surgery pathway for microvascular breast reconstruction is safe and effective[J].Plast Reconstr Surg Glob Open,2018,6(1):e1634.DOI:10.1097/GOX.0000000000001634.
[7]PANG KH,GROVES R,VENUGOPAL S,et al.Prospective implementation of enhanced recovery after surgery protocols to radical cystectomy[J].Eur Urol,2017,8(17):30660-30667.DOI:10.1016/j.eururo.2017.07.031.
[8]TROWBRIDGE ER,DREISBACH CN,SAROSIEK BM,et al.Review of enhanced recovery programs in benign gynecologic surgery[J].Int Urogynecol J,2018,29(1):3-11.DOI:10.1007/s00192-017-3442-0.
[9]NICHOLSON A,LOWE MC,PARKER J,et al.Systematic review and meta-analysis of enhanced recovery programmes in surgical patients[J].Br J Surg,2014,101(3):172-188.DOI:10.1002/bjs.9394
[10]LJUNGQVIST O,JONATHAN E.Rhoads lecture 2011:insulin resistance and enhanced recovery after surgery[J].J Parenter Enteral Nutr,2012,36(4):389-398.DOI:10.1177/0148607112445580
[11]MOLLER A,VILLEBRO N,PEDERSEN T,et al.Interventions for preoperative smoking cessation[J].Cochrane Database Syst Rev,2005,20(3):CD002294.
[12]OPPDEAL K,MOLLER AM,PEDERSEN B,et al.Preoperative alcohol cessation prior to elective surgery[J].Cochrane Database Syst Rev,2012,11(7):CD008343.DOI:10.1002/14651858.CD008343.
[13]GUSTAFSSON UO,SCOTT MJ,SCHWENK W,et al.Guidelines for perioperative care in elective colonic surgery:Enhanced Recovery After Surgery(ERAS)society recommendations[J].World J Surg,2012,37(2):259-284.DOI:10.1016/j.clnu.2012.08.013.
[14]SMITH MD,MCCALL J,PLANK L,et al.Preoperative carbohydrate treatment for enhancing recovery after elective surgery[J].Cochrane Database Syst Rev,2014,14(8):CD009161.DOI:10.1002/14651858.CD009161.
[15]WIJK L,FRANZEN K,LJUNGQVIST O,et al.Implementing a structured Enhanced Recovery After Surgery(ERAS)protocol reduces length of stay after abdominal hysterectomy[J].Acta Obstet Gynecol Scand,2014,93(8):749-756.DOI:10.1111/aogs.12423.
[16]WAU Y,RELPH S,BELL A,et al.Can enhanced recovery pathways improve outcomes of vaginal hysterectomy?Cohort control study[J].J Minim Invasive Gynecol,2014,21(1):83-89.DOI:10.1016/j.jmig.2013.06.007.