加速康复外科理念辅助治疗小婴儿先天性巨结肠的有效性和安全性研究
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摘要
目的:探讨加速康复外科(Enhanced recovery after surgery,ERAS)理念用于治疗小婴儿先天性巨结肠(Hirschsprung's,HSCR)的临床疗效和安全性。方法:选择2016年01月至2017年12月在我院新生儿外科接受手术治疗并临床病理确诊的79例HSCR患儿并将其分为对照组和ERAS组。对照组26例给予经腹巨结肠根治术,ERAS组44例入院后据患儿病情进行宣教ERAS,再采用腹腔镜巨结肠根治术。比较两组手术时间、术后肠功能恢复时间、留置管道情况、平均住院日、住院费用、血清C反应蛋白(C-reactive protein,CRP)、降钙素原、白介素-6(Interleukin,IL-6)、皮质醇水平的变化及围手术期并发症的发生情况。结果:ERAS组手术时间、术中出血量、肠功能恢复时间、术前平均住院天数、术后平均住院天数、平均住院天数、平均费用、留置胃管时间、留置尿管时间均显著短于对照组。术后,ERAS组血清CRP、降钙素原、IL-6、皮质醇水平均明显低于对照组。ERAS组术中并发症发生率显著低于对照组(2.27%vs. 23.08,P<0.05)。结论:加速康复外科理念辅助治疗小婴儿先天性巨结肠可促进患者术后病情恢复,减少患者医疗费用并提高治疗安全性。
Objective: To investigate the clinical efficacy and safety of concept of accelerated recovery after surgery(ERAS) in the treatment of Hirschsprung's(HSCR) infants. Methods: From January 2016 to December 2017, 79 cases of infants with HSCR who underwent surgical treatment and diagnosed by the clinical pathology in our hospital were selected and divided into the control group and the ERAS group. In the control group, 26 patients underwent radical operation of abdominal megacolon, 44 patients in the ERAS group were enrolled in the hospital under the condition of ERAS, and then treated by laparoscopic megacolon radical surgery. The operation time,postoperative intestinal function recovery time, indwelling catheter status, average hospitalization stay, hospitalization cost, the changes of serum C-reactive protein(CRP), procalcitonin, interleukin(IL-6) and cortisol levels as well as the incidence of perioperative complications were compared between the two groups. Results: The operation time, intraoperative blood loss, intestinal function recovery time,average hospital stay, average postoperative hospital stay, average cost, indwelling gastric tube time, and indwelling catheter time were significantly lower or shorter in the ERAS group than those in the control group(P<0.05). After operation, the levels of serum CRP, procalcitonin, IL-6 and cortisol in the ERAS group were significantly lower than those in the control group(P<0.05). The incidence of intraoperative complications in the ERAS group was significantly lower than that in the control group(2.27% vs. 23.08, P<0.05). Conclusion:Accelerated rehabilitation surgery concept can promote the recovery of congenital megacolon in THE infants after surgery, reduce the medical expenses and improve the safety of treatment.
Objective: To investigate the clinical efficacy and safety of concept of accelerated recovery after surgery(ERAS) in the treatment of Hirschsprung's(HSCR) infants. Methods: From January 2016 to December 2017, 79 cases of infants with HSCR who underwent surgical treatment and diagnosed by the clinical pathology in our hospital were selected and divided into the control group and the ERAS group. In the control group, 26 patients underwent radical operation of abdominal megacolon, 44 patients in the ERAS group were enrolled in the hospital under the condition of ERAS, and then treated by laparoscopic megacolon radical surgery. The operation time,postoperative intestinal function recovery time, indwelling catheter status, average hospitalization stay, hospitalization cost, the changes of serum C-reactive protein(CRP), procalcitonin, interleukin(IL-6) and cortisol levels as well as the incidence of perioperative complications were compared between the two groups. Results: The operation time, intraoperative blood loss, intestinal function recovery time,average hospital stay, average postoperative hospital stay, average cost, indwelling gastric tube time, and indwelling catheter time were significantly lower or shorter in the ERAS group than those in the control group(P<0.05). After operation, the levels of serum CRP, procalcitonin, IL-6 and cortisol in the ERAS group were significantly lower than those in the control group(P<0.05). The incidence of intraoperative complications in the ERAS group was significantly lower than that in the control group(2.27% vs. 23.08, P<0.05). Conclusion:Accelerated rehabilitation surgery concept can promote the recovery of congenital megacolon in THE infants after surgery, reduce the medical expenses and improve the safety of treatment.
引文
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[13]Itou K,Fukuyama T,Sasabuchi Y,et al.Safety and efficacy of oral rehydration therapy until 2 h before surgery:a multicenter randomized controlled trial[J].J Anesth,2012,26:20-27
[14]Ni CY,Yang Y,Chang YQ,et al.Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer:A prospective randomized controlled trial[J].Eur JSurg Oncol,2013,39(6):542-547
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[16]Feroci F,Lenzi E,Baraghini M,et al.Fast-track colorectal surgery:protocol adherence influences postoperative outcomes[J].Int J Colorectal Dis,2013,28(1):103-109
[17]Kim JW,Kim WS,Cheong JH,et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial[J].World J Surg,2012,36(12):2879-2887
[18]Rao JH,Zhang F,Lu H,et al.Effects of multimodal fast-track surgery on liver transplantation outcomes[J].Hepatobiliary Pancreat Dis Int,2017,16(4):364-369
[19]Wilmore DW,Kehlet H.Management of patients in fast track surgery[J].BMJ,2001,322:473-476
[20]Vesterby MS,Pedersen PU,Laursen M,et al.Telemedicine support shortens length of stay after fast-track hip replacement[J].Acta Orthop,2017,88(1):41-47
[21]Dong Q,Zhang K,Cao S,et al.Fast-track surgery versus conventional perioperative management of lung cancer-associated pneumonectomy:a randomized controlled clinical trial[J].World J Surg Oncol,2017,15(1):20
[22]Chong W,Che XY,Wan W,et al.Application of fast-track surgery concept in the perioperative nursing care of andrological patients:Arandomized controlled studyl[J].Asian J Androl,2016,22(11):1001-1004
[23]Wei YN,Li NF,Cai XY,et al.Clinical application of fast-track surgery with Chinese medicine treatment in the devascularization operation for cirrhotic portal hypertension[J].Chin J Integr Med,2015,21(10):784-790
[24]Williamsson C,Karlsson N,Sturesson C,et al.Impact of a fast-track surgery programme for pancreaticoduodenectomy[J].West Engl Med J,2015,102(9):1133-1141
[25]Ansari D,Gianotti L,Schr觟der J,et al.Fast-track surgery:procedure-specific aspects and future direction.Langenbecks[J].Arch Surg,2013,398:29-37
[26]Basse L,Jakobsen DH,Bardram L,et al.Functional recovery after open versus laparoscopic colonic resection:a randomized,blinded study[J].Ann Surg,2005,241:416-423
[27]King PM,Blazeby JM,Ewings P,et al.Detailed evaluation of functional recovery following laparoscopic or open surgery for colorectal cancer within an enhanced recovery programme[J].Int J Colorectal Dis,2008,23:795-800
[28]Oliver J.Harrison,Neil J.Smart,Paul White,Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery[J].JSLS,2014,18(2):265-272
[29]Frontera D,Arena L,Corsale I,et al.Fast track in colo-rectal surgery.Preliminary experience in a rural hospital[J].G Chir,2014,35(11-12):293-301
[30]Gonenc M,Dural AC,Celik F,et al.Enhanced postoperative recovery pathways in emergency surgery:a randomised controlled clinical trial[J].Am J Surg,2014,207(6):807-814
[2]Ahmed Nasr,Katrina J Sullivan,Emily W Chan,et al.Validation of algorithms to determine incidence of Hirschsprung disease in Ontario,Canada:a population-based study using health administrative data[J].Clin Epidemiol,2017,9:579-590
[3]Benjamin N.Rollo,Dongcheng Zhang,Lincon A.Enteric Neural Cells From Hirschsprung Disease Patients Form Ganglia in Autologous Aneuronal Colon[J].Cell Mol Gastroenterol Hepatol,2016,2(1):92-109
[4]Lucy C.Sorensen,Kenneth A.Dodge,How Does the Fast Track Intervention Prevent Adverse Outcomes in Young Adulthood?[J].Child Dev,2016,87(2):429-445
[5]Conduct Problems Prevention Research Group.The Implementation of the Fast Track Program:An Example of a Large-Scale Prevention Science Efficacy Trial[J].J Abnorm Child Psychol,2002,30(1):1-17
[6]Mihai Paduraru,Luca Ponchietti,Isidro Martinez Casas.Enhanced Recovery after Emergency Surgery:A Systematic Review[J].Bull Emerg Trauma,2017,5(2):70-78
[7]Robert H.Thiele,Karthik Raghunathan,C.S.Brudney,American Society for Enhanced Recovery(ASER)and Perioperative Quality Initiative(POQI)joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery[J].Perioper Med(Lond),2016,5:24
[8]A.Feldheiser,O.Aziz,G.Baldini,B.P.B.W.Cox,et al.Enhanced Recovery After Surgery(ERAS)for gastrointestinal surgery,part 2:consensus statement for anaesthesia practice[J].Acta Anaesthesiol Scand,2016,60(3):289-334
[9]Stefano Bona,Mattia Molteni,Riccardo Rosati.Introducing an enhanced recovery after surgery program in colorectal surgery:A single center experience[J].World J Gastroenterol,2014,20(46):17578-17587
[10]Kehlet H,Wilmore DW.Evidence-based surgical care and the evolution of fast-track surgery.[J].Ann Surg,2008,248:189-198
[11]Feng F,Ji G,Li JP,et al.Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients[J].World J Gastroenterol,2013,19(23):3642-3648
[12]Zhou T,Wu X T,Zhou Y J,et al.Early removing gastrointestinal decompression and early oral feeding improve patients'rehabilitation after colorectostomy[J].World J Gas troenterol,2006,12:2459-2463
[13]Itou K,Fukuyama T,Sasabuchi Y,et al.Safety and efficacy of oral rehydration therapy until 2 h before surgery:a multicenter randomized controlled trial[J].J Anesth,2012,26:20-27
[14]Ni CY,Yang Y,Chang YQ,et al.Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer:A prospective randomized controlled trial[J].Eur JSurg Oncol,2013,39(6):542-547
[15]Feroci F,Lenzi E,Baraghini M,et al.Fast-track surgery in real life:how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery[J].United European Gastroenterol J,2013,23(3):259-265
[16]Feroci F,Lenzi E,Baraghini M,et al.Fast-track colorectal surgery:protocol adherence influences postoperative outcomes[J].Int J Colorectal Dis,2013,28(1):103-109
[17]Kim JW,Kim WS,Cheong JH,et al.Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer:a randomized clinical trial[J].World J Surg,2012,36(12):2879-2887
[18]Rao JH,Zhang F,Lu H,et al.Effects of multimodal fast-track surgery on liver transplantation outcomes[J].Hepatobiliary Pancreat Dis Int,2017,16(4):364-369
[19]Wilmore DW,Kehlet H.Management of patients in fast track surgery[J].BMJ,2001,322:473-476
[20]Vesterby MS,Pedersen PU,Laursen M,et al.Telemedicine support shortens length of stay after fast-track hip replacement[J].Acta Orthop,2017,88(1):41-47
[21]Dong Q,Zhang K,Cao S,et al.Fast-track surgery versus conventional perioperative management of lung cancer-associated pneumonectomy:a randomized controlled clinical trial[J].World J Surg Oncol,2017,15(1):20
[22]Chong W,Che XY,Wan W,et al.Application of fast-track surgery concept in the perioperative nursing care of andrological patients:Arandomized controlled studyl[J].Asian J Androl,2016,22(11):1001-1004
[23]Wei YN,Li NF,Cai XY,et al.Clinical application of fast-track surgery with Chinese medicine treatment in the devascularization operation for cirrhotic portal hypertension[J].Chin J Integr Med,2015,21(10):784-790
[24]Williamsson C,Karlsson N,Sturesson C,et al.Impact of a fast-track surgery programme for pancreaticoduodenectomy[J].West Engl Med J,2015,102(9):1133-1141
[25]Ansari D,Gianotti L,Schr觟der J,et al.Fast-track surgery:procedure-specific aspects and future direction.Langenbecks[J].Arch Surg,2013,398:29-37
[26]Basse L,Jakobsen DH,Bardram L,et al.Functional recovery after open versus laparoscopic colonic resection:a randomized,blinded study[J].Ann Surg,2005,241:416-423
[27]King PM,Blazeby JM,Ewings P,et al.Detailed evaluation of functional recovery following laparoscopic or open surgery for colorectal cancer within an enhanced recovery programme[J].Int J Colorectal Dis,2008,23:795-800
[28]Oliver J.Harrison,Neil J.Smart,Paul White,Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery[J].JSLS,2014,18(2):265-272
[29]Frontera D,Arena L,Corsale I,et al.Fast track in colo-rectal surgery.Preliminary experience in a rural hospital[J].G Chir,2014,35(11-12):293-301
[30]Gonenc M,Dural AC,Celik F,et al.Enhanced postoperative recovery pathways in emergency surgery:a randomised controlled clinical trial[J].Am J Surg,2014,207(6):807-814