加速康复外科在肾上腺肿瘤微创手术中的应用研究

doi:10.11958/20240073

天津医药 ›› 2024, Vol. 52 ›› Issue (10): 1038-1040.doi: 10.11958/20240073

加速康复外科在肾上腺肿瘤微创手术中的应用研究

杨先瑞¹(), 康绍叁², 郭琪³, 赵妍⁴, 李刚¹, 韩瑞发¹, 蔡启亮¹^,^△()

1 天津医科大学第二医院泌尿外科（邮编300211）
2 华北理工大学附属医院泌尿外科
3 天津医科大学第二医院影像科
4 天津医科大学第二医院影像科内分泌科

收稿日期:2024-01-22 修回日期:2024-04-07 出版日期:2024-10-15 发布日期:2024-10-14
通讯作者: △ E-mail：caiqiliang@tmu.edu.cn
作者简介:杨先瑞（1999），男，硕士在读，主要从事泌尿系肿瘤的基础与临床研究。E-mail：yangxr495@tmu.edu.cn
基金资助:
国家自然科学基金资助项目(72174144);天津市自然科学基金项目(2021JCYBJC01470);天津市教委基金项目(2022ZD068);天津市科技计划项目(23JCJQJC00080);天津市卫生健康高层次人才培养工程(TJSQNYXXR-D2-158)

Application of enhanced recovery after surgery in minimally invasive surgery for adrenal tumors

YANG Xianrui¹(), KANG Shaosan², GUO Qi³, ZHAO Yan⁴, LI Gang¹, HAN Ruifa¹, CAI Qiliang¹^,^△()

1 Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
2 Department of Urology, North China University of Science and Technology Affiliated Hospital
3 Department of Imaging, the Second Hospital of Tianjin Medical University
4 Department of Endocrinology, the Second Hospital of Tianjin Medical University

Received:2024-01-22 Revised:2024-04-07 Published:2024-10-15 Online:2024-10-14
Contact: △ E-mail：caiqiliang@tmu.edu.cn

杨先瑞, 康绍叁, 郭琪, 赵妍, 李刚, 韩瑞发, 蔡启亮. 加速康复外科在肾上腺肿瘤微创手术中的应用研究[J]. 天津医药, 2024, 52(10): 1038-1040.

YANG Xianrui, KANG Shaosan, GUO Qi, ZHAO Yan, LI Gang, HAN Ruifa, CAI Qiliang. Application of enhanced recovery after surgery in minimally invasive surgery for adrenal tumors[J]. Tianjin Medical Journal, 2024, 52(10): 1038-1040.

摘要/Abstract

摘要：

目的探讨加速康复外科（ERAS）应用于肾上腺肿瘤微创手术中的可行性和有效性。方法选择接受后腹腔镜肾上腺肿瘤切除术的患者139例，肿瘤最大径≤6.0 cm。根据围手术期方案分为ERAS组65例和常规组74例。比较2组患者一般资料（年龄、性别、肿瘤位置、肿瘤直径），手术指标（手术时间、手术出血量），术后康复指标（首次下床时间、首次排气时间、术后导尿管留置时间、术后引流管留置时间、术后住院时间）以及并发症的发生情况。结果 2组患者性别、年龄、肿瘤位置、肿瘤直径、手术时间和手术出血量比较差异均无统计学意义（P>0.05）。ERAS组患者首次下床时间、首次排气时间、导尿管留置时间、引流管留置时间和住院时间均短于常规组，且术后并发症总发生率低于常规组（P<0.05）。结论 ERAS方案应用于肿瘤最大径≤6.0 cm的肾上腺肿瘤患者微创手术中是安全可行的。

关键词: 术后加速康复, 腹腔镜检查, 肾上腺肿瘤, 围手术期, 后腹腔镜

Abstract:

Objective To evaluate the feasibility and effectiveness of enhanced recovery after surgery (ERAS) in minimally invasive surgery for adrenal tumors. Methods A total of 139 patients underwent retroperitoneal laparoscopic adrenalectomy were selected in this study. The maximum tumor diameter was ≤ 6.0 cm. According to the perioperative plan, patients were divided into the ERAS group (n=65) and the conventional group (n=74). The general information (age, gender, tumor location and tumor diameter), surgical indicators (surgical time and surgical blood loss), postoperative rehabilitation indicators (first off-bed ambulation time, first exhaust time, postoperative catheterization time, postoperative drainage tube retention time and postoperative hospitalization time) and incidence of complications were compared between two groups of patients. Results There were no significant differences in gender, age, tumor location, tumor diameter, surgical time and surgical blood loss between the two groups of patients (P>0.05). In the ERAS group, first off-bed ambulation time, first exhaust time, the indwelling duration of catheters and drainage tubes were shorter than those in the conventional group, and the overall incidence of postoperative complications was lower in the ERAS group than that in the conventional group (P<0.05). Conclusion The ERAS protocol is safe and feasible for minimally invasive surgery in patients with adrenal tumors with a maximum tumor diameter of ≤ 6.0 cm.

Key words: enhanced recovery after surgery, laparoscopy, adrenal gland neoplasms, perioperative period, retroperitoneal laparoscopy

中图分类号:

R699.3

图/表 3

参考文献 15

[1]	NELSON G, BAKKUM-GAMEZ J, KALOGERA E, et al. Guidelines for perioperative care in gynecologic/oncology:Enhanced Recovery After Surgery (ERAS) society recommendations-2019 update[J]. Int J Gynecol Cancer, 2019, 29(4):651-668. doi:10.1136/ijgc-2019-000356.
[2]	SANDRUCCI S, BEETS G, BRAGA M, et al. Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition)[J]. Eur J Surg Oncol, 2018, 44(4):509-514. doi:10.1016/j.ejso.2017.12.010.
[3]	ALI Z S, MA T S, OZTURK A K, et al. Pre-optimization of spinal surgery patients:Development of a neurosurgical enhanced recovery after surgery (ERAS) protocol[J]. Clin Neurol Neurosurg, 2018, 164:142-153. doi:10.1016/j.clineuro.2017.12.003.
[4]	DE GROOT J J, VAN ES L E, MAESSEN J M, et al. Diffusion of enhanced recovery principles in gynecologic oncology surgery:is active implementation still necessary?[J]. Gynecol Oncol, 2014, 134(3):570-575. doi:10.1016/j.ygyno.2014.06.019.
[5]	AARTS M A, ROTSTEIN O D, PEARSALL E A, et al. Postoperative ERAS interventions have the greatest impact on optimal recovery:experience with implementation of ERAS across multiple hospitals[J]. Ann Surg, 2018, 267(6):992-997. doi:10.1097/SLA.0000000000002632.
[6]	AZHAR R A, BOCHNER B, CATTO J, et al. Enhanced recovery after urological surgery:a contemporary systematic review of outcomes,key elements,and research needs[J]. Eur Urol, 2016, 70(1):176-187. doi:10.1016/j.eururo.2016.02.051.
[7]	FU B, ZHANG X, WANG G X, et al. Long-term results of a prospective,randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J]. J Urol, 2011, 185(5):1578-1582. doi:10.1016/j.juro.2010.12.051.
[8]	GAVRIILIDIS P, CAMENZULI C, PASPALA A, et al. Posterior retroperitoneoscopic versus laparoscopic transperitoneal adrenalectomy:a systematic review by an updated meta-analysis[J]. World J Surg, 2021, 45(1):168-179. doi:10.1007/s00268-020-05759-w.
[9]	HE L, LI Y, LIAO X, et al. Effects of evidence-based nursing combined with enhanced recovery after surgery on shoulder joint function and neurological function after arthroscopic rotator cuff injury repair[J]. Medicine (Baltimore), 2021, 100(47):e27951. doi:10.1097/MD.0000000000027951.
[10]	DERESSA D, GEBREYOHANNIS T, BOKA A, et al. Satisfaction with preoperative education and surgical services among adults elective surgical patients at selected public hospitals in Addis Ababa,Ethiopia[J]. SAGE Open Med, 2022, 10:20503121221143219. doi:10.1177/20503121221143219.
[11]	ANGIOLI R, PLOTTI F, CAPRIGLIONE S, et al. The effects of giving patients verbal or written pre-operative information in gynecologic oncology surgery:a randomized study and the medical-legal point of view[J]. Eur J Obstet Gynecol Reprod Biol, 2014, 177:67-71. doi:10.1016/j.ejogrb.2014.03.041.
[12]	TAN J, RYAN E J, DAVEY M G, et al. Mechanical bowel preparation and antibiotics in elective colorectal surgery:network meta-analysis[J]. BJS Open, 2023, 7(3):zrad040. doi:10.1093/bjsopen/zrad040.
[13]	GILLIS C, LJUNGQVIST O, CARLI F. Prehabilitation,enhanced recovery after surgery,or both? A narrative review[J]. Br J Anaesth, 2022, 128(3):434-448. doi:10.1016/j.bja.2021.12.007.
[14]	XU Q, ZHU M, LI Z, et al. Enhanced recovery after surgery protocols in patients undergoing liver transplantation:A retrospective comparative cohort study[J]. Int J Surg, 2020, 78:108-112. doi:10.1016/j.ijsu.2020.03.081.
[15]	PISARSKA-ADAMCZYK M, TORBICZ G, GAJEWSKA N, et al. The impact of perioperative fluid therapy on the short-term outcomes after laparoscopic colorectal cancer surgery with ERAS protocol:a prospective observational study[J]. Sci Rep, 2023, 13(1):22282. doi:10.1038/s41598-023-49704-y.

组别	n		性别（男/女）		年龄/岁	肿瘤位置（左/右）
常规组	74		32/42		56.20±10.51	37/37
ERAS组	65		29/36		54.35±11.46	37/28
χ²或t			0.026		0.992	0.666
组别		肿瘤直径/cm		手术时间/min			手术出血量/mL
常规组		2.99±1.02		110.41±43.27			67.16±42.38
ERAS组		2.75±1.01		99.63±41.54			56.00±39.10
t		1.380		1.492			1.606

组别	n		性别（男/女）		年龄/岁	肿瘤位置（左/右）
常规组	74		32/42		56.20±10.51	37/37
ERAS组	65		29/36		54.35±11.46	37/28
χ²或t			0.026		0.992	0.666
组别		肿瘤直径/cm		手术时间/min			手术出血量/mL
常规组		2.99±1.02		110.41±43.27			67.16±42.38
ERAS组		2.75±1.01		99.63±41.54			56.00±39.10
t		1.380		1.492			1.606

组别	n	首次下床时间/d	首次排气时间/h	导尿管留置时间/h	引流管留置时间/h	住院时间/d
常规组	74	2.1±0.9	48.4±25.7	44.7±18.1	112.3±30.2	5.8±1.5
ERAS组	65	1.7±0.8	36.8±21.2	27.7±12.7	76.1±19.7	3.6±0.8
t		2.957^＊	2.883^＊	6.316^＊	8.217^＊	10.568^＊

组别	n	首次下床时间/d	首次排气时间/h	导尿管留置时间/h	引流管留置时间/h	住院时间/d
常规组	74	2.1±0.9	48.4±25.7	44.7±18.1	112.3±30.2	5.8±1.5
ERAS组	65	1.7±0.8	36.8±21.2	27.7±12.7	76.1±19.7	3.6±0.8
t		2.957^＊	2.883^＊	6.316^＊	8.217^＊	10.568^＊

组别	n	恶心呕吐	腹胀	发热	泌尿系感染	切口感染	皮疹	总发生率
常规组	74	8（10.8）	6（8.1）	4（6.2）	2（5.4）	1（1.4）	1（1.4）	22（29.7）
ERAS组	65	3（4.6）	3（4.6）	2（3.1）	0（0）	0（0）	0（0）	8（12.3）

加速康复外科在肾上腺肿瘤微创手术中的应用研究

Application of enhanced recovery after surgery in minimally invasive surgery for adrenal tumors

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