加速康复外科与传统围手术期管理模式在机器人辅助腹腔镜前列腺癌根治术的临床疗效对比分析
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摘要
目的将加速康复外科(ERAS)围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术(RARP),并对比传统围手术期管理模式与ERAS的临床实践效果差异。方法回顾性分析2018年5月至2018年8月南京大学医学院附属鼓楼医院泌尿外科共110例行机器人辅助腹腔镜根治性前列腺切除术患者的临床资料,并按照筛选条件最终纳入共70例患者,采用RARP术,且均采用ERAS围手术期管理模式,为ERAS组。并按照纳入标准纳入既往于南京大学医学院附属鼓楼医院泌尿外科2017年5月至2018年4月行RARP但未行加速康复外科围手术期管理模式的70例患者为对照组。ERAS组与对照组患者在年龄、体质量指数、术前实验室检查如血清白蛋白及血红蛋白、前列腺体积、术前PSA、术前ECOG评分、EPIC评分、临床分期和Gleason评分的差异均无统计学意义(P>0.05)。结果两组手术均顺利完成,围手术期未出现病死或严重并发症,患者均顺利出院。术中情况:ERAS组与对照组在手术时间、术中出血量、术中直肠损伤、闭孔神经损伤、大血管损伤、淋巴结清扫比率差异均无统计学意义(P>0.05)。术后情况:ERAS组与传统围手术管理组在回病房后至首次进食时间、首次活动时间、首次排气时间、术后6 h疼痛评分、住院天数差异均有统计学意义(P<0.05),术后Clavien-Dindo并发症分级、切缘阳性情况、术后实验室指标差异及术后1周及术后1个月早期尿控恢复差异无统计学意义(P>0.05)。结论将加速康复外科围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术,较传统围手术期管理模式更能促进患者康复,缓解术后疼痛,缩短住院天数。
Objective To evaluate the clinical benefits of ERAS for prostate cancer patients undergoing robot-assisted laparoscopic prostatectomy compared to traditional perioperative management mode. Methods The clinical data of 110 patients undergoing RARP in the Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical College from May 2018 to August 2018 were analyzed retrospectively A total of 70 patients according to the screening conditions using the transperitoneal approach and the ERAS enrolled into ERAS group. According to the inclusion criteria, 70 patients who underwent RARP without ERAS were included in the control group.There were no significant differences in age, body mass index, preoperative laboratory tests such as Alb and Hb, prostate volume, preoperative PSA, preoperative ECOG score, EPIC score, clinical stage, and Gleason score between the patients of two groups(P>0.05). Results The operation was successfully completed in both groups. There were no deaths or serious complications during the perioperative period, and the patients were discharged smoothly. There was no significant difference in the ratio of operation time, intraoperative blood loss, intraoperative rectal injury, obturator nerve injury, large vessel injury, and lymph node dissection between the two groups(P>0.05).There were statistically significant difference between the ERAS group and the traditional perioperative management group in the time of returning to the first feeding time, the first activity time, the first exhaust time, the 6 h postoperative pain score, and the length of hospital stay(P<0.05). There was no significant difference in postoperative grading of Gravien-Dindo, positive margins, postoperative laboratory indexes, and urinary recovery at 1 week and 1 month after surgery(P>0.05). Conclusions RARP is a safe and effective surgical procedure for the treatment of localized prostate cancer. ERAS protocols may effectively accelerate patient rehabilitation, shorten the length of hospital stay and relieve postoperative pain.
Objective To evaluate the clinical benefits of ERAS for prostate cancer patients undergoing robot-assisted laparoscopic prostatectomy compared to traditional perioperative management mode. Methods The clinical data of 110 patients undergoing RARP in the Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical College from May 2018 to August 2018 were analyzed retrospectively A total of 70 patients according to the screening conditions using the transperitoneal approach and the ERAS enrolled into ERAS group. According to the inclusion criteria, 70 patients who underwent RARP without ERAS were included in the control group.There were no significant differences in age, body mass index, preoperative laboratory tests such as Alb and Hb, prostate volume, preoperative PSA, preoperative ECOG score, EPIC score, clinical stage, and Gleason score between the patients of two groups(P>0.05). Results The operation was successfully completed in both groups. There were no deaths or serious complications during the perioperative period, and the patients were discharged smoothly. There was no significant difference in the ratio of operation time, intraoperative blood loss, intraoperative rectal injury, obturator nerve injury, large vessel injury, and lymph node dissection between the two groups(P>0.05).There were statistically significant difference between the ERAS group and the traditional perioperative management group in the time of returning to the first feeding time, the first activity time, the first exhaust time, the 6 h postoperative pain score, and the length of hospital stay(P<0.05). There was no significant difference in postoperative grading of Gravien-Dindo, positive margins, postoperative laboratory indexes, and urinary recovery at 1 week and 1 month after surgery(P>0.05). Conclusions RARP is a safe and effective surgical procedure for the treatment of localized prostate cancer. ERAS protocols may effectively accelerate patient rehabilitation, shorten the length of hospital stay and relieve postoperative pain.
引文
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[6] 鲁全芝,乔祖俊,王刚,等.快速康复外科理念在腹腔镜结直肠癌围手术期中的临床应用研究[J].中国肿瘤外科杂志,2018,10(1):44-47.
[7] 何龙光,车斯尧,陈钦寿.快速康复外科理念在肝癌切除围手术期的应用[J].中国肿瘤外科杂志,2018,10(2):117-119.
[8] Cerantola Y,Valerio M,Persson B,et al.Guidelines for perioperative care after radical cystectomy for bladder cancer:Enhanced Recovery After Surgery (ERAS(?)) society recommendations[J].Clin Nutr,2013,32(6):879-887.
[9] Lin C,Wan F,Lu Y,et al.Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy[J].J Int Med Res,2019,47(1):114-121.
[10] Magheli A,Knoll N,Lein M,et al.Impact of fast-track postoperative care on intestinal function,pain,and length of hospital stay after laparoscopic radical prostatectomy[J].J Endourol,2011,25(7):1143-1147.
[11] Sugihara T,Yasunaga H,Horiguchi H,et al.Is mechanical bowel preparation in laparoscopic radical prostatectomy beneficial?An analysis of a Japanese national database[J].BJU Int,2013,112(2):E76-81.
[12] Bragg D,El-Sharkawy AM,Psaltis E,et al.Postoperative ileus:Recent developments in pathophysiology and management[J].Clin Nutr,2015,34(3):367-376.
[13] Liu Q,Jiang H,Xu D,et al.Effect of gum chewing on ameliorating ileus following colorectal surgery:A meta-analysis of 18 randomized controlled trials[J].Int J Surg,2017,47:107-115.
[14] Andrews JI,Fleener DK,Messer SA,et al.The yeast connection:is Candida linked to breastfeeding associated pain?[J].Am J Obstet Gynecol,2007,197(4):424.e1-4.
[2] 朱耀.腹腔镜下保留性神经的前列腺癌根治术[J].中国肿瘤外科杂志,2016,8(2):96-98.
[3] Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[4] 沃奇军,张大宏,祁小龙,等.应用加速康复外科理念的机器人辅助腹腔镜前列腺癌根治术[J].中国内镜杂志,:1-13.
[5] 李宁,江志伟.重视快速康复外科新理念在胃肠癌患者中应用研究[J].中国肿瘤外科杂志,2009,1(1):15-16.
[6] 鲁全芝,乔祖俊,王刚,等.快速康复外科理念在腹腔镜结直肠癌围手术期中的临床应用研究[J].中国肿瘤外科杂志,2018,10(1):44-47.
[7] 何龙光,车斯尧,陈钦寿.快速康复外科理念在肝癌切除围手术期的应用[J].中国肿瘤外科杂志,2018,10(2):117-119.
[8] Cerantola Y,Valerio M,Persson B,et al.Guidelines for perioperative care after radical cystectomy for bladder cancer:Enhanced Recovery After Surgery (ERAS(?)) society recommendations[J].Clin Nutr,2013,32(6):879-887.
[9] Lin C,Wan F,Lu Y,et al.Enhanced recovery after surgery protocol for prostate cancer patients undergoing laparoscopic radical prostatectomy[J].J Int Med Res,2019,47(1):114-121.
[10] Magheli A,Knoll N,Lein M,et al.Impact of fast-track postoperative care on intestinal function,pain,and length of hospital stay after laparoscopic radical prostatectomy[J].J Endourol,2011,25(7):1143-1147.
[11] Sugihara T,Yasunaga H,Horiguchi H,et al.Is mechanical bowel preparation in laparoscopic radical prostatectomy beneficial?An analysis of a Japanese national database[J].BJU Int,2013,112(2):E76-81.
[12] Bragg D,El-Sharkawy AM,Psaltis E,et al.Postoperative ileus:Recent developments in pathophysiology and management[J].Clin Nutr,2015,34(3):367-376.
[13] Liu Q,Jiang H,Xu D,et al.Effect of gum chewing on ameliorating ileus following colorectal surgery:A meta-analysis of 18 randomized controlled trials[J].Int J Surg,2017,47:107-115.
[14] Andrews JI,Fleener DK,Messer SA,et al.The yeast connection:is Candida linked to breastfeeding associated pain?[J].Am J Obstet Gynecol,2007,197(4):424.e1-4.