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加速康复外科在妇科恶性肿瘤腹腔镜手术中的临床应用 被引量:29

Clinical application of enhanced recovery after surgery in laparoscopic surgery for gynecologic malignancies
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摘要 目的探讨加速康复外科(ERAS)理念对于妇科恶性肿瘤腹腔镜术后加速康复的临床意义。方法选取自2014年4月至2018年4月本院收治的37例确诊为妇科恶性肿瘤并选择腹腔镜手术的患者,依照围手术期管理方案分为ERAS组16例和对照组21例。回顾性分析两组患者的临床资料,比较两组患者的术后肛门排气时间、住院时间及应激反应、术后并发症发生率。结果 ERAS组术后肛门排气时间[(27.25±2.71)h],与对照组[(30.37±1.59)h]比较ERAS组明显缩短,差异有统计学意义(P 〈0.05);ERAS组术后住院时间为(4.50±0.32)d,对照组为(4.87±0.26)d,两组比较,差异有统计学意义(P 〈0.05);ERAS组术后24 h血清TNF-α、IL-6值分别为(59.750±7.978)ng/ml和(13.125±4.189)ng/ml,对照组分别为(80.22±7.84)ng/ml和(16.80±2.85)ng/ml,两组比较,差异均有统计学意义(P 〈0.05)。ERAS组并发症6例,其中腹胀2例、下肢静脉血栓(VTE)1例、淋巴囊肿2例、尿潴留1例;对照组并发症11例,其中切口愈合不良1例、腹胀4例、VTE 2例、淋巴囊肿3例、尿潴留1例,两组比较,差异均无统计学意义(P〉0.05)。结论腹腔镜技术结合ERAS理念对妇科恶性肿瘤患者的临床治疗是安全有效的,可减少手术应激,加速患者康复。 Objective To explore the clinical significance of enhanced recovery after surgery(ERAS) in the accelerated rehabilitation of gynecologic malignancies after laparoscopic surgery. Methods 37 cases of gynecologic malignant tumors after laparoscopic surgery were selected from April 2014 to April 2018 in our hospital. According to the perioperative management scheme, they were divided into 16 cases of ERAS group and 21 cases of control group. The clinical data of the two groups were retrospectively analyzed, and the postoperative anal exhaust time, hospitalization time, stress response and postoperative complications of the two groups were compared. Results Postoperative anal exhaust time of the ERAS group [(27.25+2.71) h] was significantly shorter than that of the control group [(30.37+1.59) h].(P〈0.05). The postoperative hospitalization stay of ERAS group was4.50±0.32 d, and that of control group was4.87±0.26 d, the difference between the two groups was statistically significant(P〈0.05). The serum levels of TNF-a and IL-6 of 24 h after operation were 59.750±7.978 ng/ml and 13.125±4.189 ng/ml in ERAS group, 80.222±7.839 ng/ml and 16.800±2.85 ng/ml in control group, respectively, the difference between the two groups was statistically significant(P〈0.05). There were 6 cases of complication in ERAS group, 1 case of abdominal distention, 1 case of venous thrombosis(VTE), 2 cases of lymphatic cyst, 1 case of urinary retention. 11 cases in observation group, 1 case of poor wound healing, 4 cases of abdominal distention, 2 cases of VTE, 3 cases of lymphatic cyst, 1 case of urinary retention, which had no significant difference(P〈0.05). Conclusion Laparoscopy combined with ERAS is safe and effective for the clinical treatment of gynecological malignant tumors, which can reduce the surgical stress and accelerate the recovery of patients.
作者 许洁 崇庆国 韩洪超 孟祥楠 XU Jie;CHONG Qingguo;HAN Hongchao;MENG Xiangnan(Department of Obstetrics and Gynecology,Yancheng Third People's Hospital,Jiangsu 224000,China)
出处 《中国妇产科临床杂志》 CSCD 北大核心 2018年第6期489-492,共4页 Chinese Journal of Clinical Obstetrics and Gynecology
关键词 妇科恶性肿瘤 加速康复外科 腹腔镜 临床研究 Gynecologic malignant tumor enhanced recovery after surgery Laparoscope Clinical research
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