手术加速康复计划对根治性膀胱切除术的影响。一项队列比较研究。
Impact of an enhanced recovery after surgery programme in radical cystectomy. A cohort-comparative study.
作者信息
Casans-Francés R, Roberto-Alcácer A T, García-Lecina A C, Ferrer-Ferrer M L, Subirá-Ríos J, Guillén-Antón J
机构信息
Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Servicio de Urología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
出版信息
Rev Esp Anestesiol Reanim. 2017 Jun-Jul;64(6):313-322. doi: 10.1016/j.redar.2016.12.002. Epub 2017 Feb 14.
OBJECTIVE
To evaluate the results of the implementation of an enhanced recovery program (ERAS) for open approach radical cystectomy compared to the historical cohort of the same hospital.
MATERIAL AND METHODS
A retrospective analysis of 138 consecutive patients who underwent radical cystectomy with Bricker or Studer ileal derivation (97 historical vs. 41 ERAS). Overall complication rate, Clavien-Dindo stage>2 complications, mortality, hospital and critical care length of stay and readmission rates, as well as need for reoperation, nasogastric intubation, transfusion or parenteral nutrition were compared.
RESULTS
No statistically significant differences in overall complication rate were found (73.171 vs. 77.32%; OR 1.25, 95% CI 0.54-2.981; P=.601) nor in Clavien-Dindo>2 complications (41.463 vs. 42.268%; OR 1.033, 95% CI 0.492-2.167; P=.93), mortality, lengths of stays readmission and reoperation rates. The need for nasogastric tube insertion was lower in the ERAS group (43.902 vs. 78.351%; OR 4.624, 95% CI 2.112-10.123; P<.0001), as well as the need for total parenteral nutrition (26.829 vs. 34.021%; OR 12.234, 95% CI 5.165-28.92; P<.0001), and time under endotracheal intubation since anaesthesia induction (median [IRQ]=325 (285-355) vs. 540 (360-600) min; P<.0001).
CONCLUSION
Enhanced recovery programs in radical cystectomy decrease interventionism on the patient without increasing morbidity and mortality.
目的
评估开放性根治性膀胱切除术实施强化康复计划（ERAS）的效果，并与同一家医院的历史队列进行比较。
材料与方法
对138例连续接受Bricker或Studer回肠代膀胱术的根治性膀胱切除术患者进行回顾性分析（97例为历史队列，41例为ERAS组）。比较总体并发症发生率、Clavien-Dindo分级>2级的并发症、死亡率、住院时间、重症监护时间、再入院率，以及再次手术、鼻胃管插管、输血或肠外营养的需求。
结果
总体并发症发生率（73.171%对77.32%；OR 1.25，95%CI 0.54 - 2.981；P = 0.601）、Clavien-Dindo分级>2级的并发症（41.463%对42.268%；OR 1.033，95%CI 0.492 - 2.167；P = 0.93）、死亡率、住院时间、再入院率和再次手术率均无统计学显著差异。ERAS组鼻胃管插入需求较低（43.902%对78.351%；OR 4.624，95%CI 2.112 - 10.123；P < 0.0001），全肠外营养需求也较低（26.829%对34.021%；OR 1.234，95%CI 5.165 - 28.92；P < 0.0001），且麻醉诱导后气管插管时间较短（中位数[四分位间距]=325（285 - 355）分钟对540（360 - 600）分钟；P < 0.0001）。
结论
根治性膀胱切除术中的强化康复计划可减少对患者的干预，且不增加发病率和死亡率。
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