Brescia Antonio, Tomassini Federico, Berardi Giammauro, Sebastiani Carola, Pezzatini Massimo, Dall'Oglio Anna, Laracca Giovanni Guglielmo, Apponi Fabrizio, Gasparrini Marcello
Department of General Surgery, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
Department of Anaesthesiology, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
Updates Surg. 2017 Sep;69(3):359-365. doi: 10.1007/s13304-017-0432-1. Epub 2017 Mar 22.
The ERAS represents a dynamic culmination of upon perioperative care elements, successfully applied to different surgical specialties with shorter hospital stay and lower morbidity rates. The aim of this study is to describe the introduction of the ERAS protocol in colorectal surgery in our hospital analysing our first series. Between September 2014 and June 2016, 120 patients suffering from colorectal diseases were included in the study. Laparoscopic approach was used in all patients if not contraindicated. Patients were discharged when adequate mobilization, canalization, and pain control were obtained. Analysed outcomes were: length of hospital stay, readmission rate, perioperative morbidity, and mortality. Malignant lesions were the most common indication (84.2%; 101/120). Laparoscopic approach was performed in the 95.8% of cases (115/120) with a conversion rate of 4.4% (5/115). Surgical procedures performed were: 36 rectal resections (30%), 36 left colonic resections (30%), 42 right hemicolectomy (35%), and 6 Miles (5%). The median hospital stay was of 4 (3-34) days in the whole series with a morbidity rate of 10% (12/120); four patients experienced Clavien-Dindo ≥ IIIa complications; and only one anastomotic leak was observed. No 30-day readmission and no perioperative mortality were recorded. At the univariate analysis, the presence of complications was the only predictive factor for prolonged hospital stay (p < 0.001). In our experience, implementation of ERAS protocol for colorectal surgery allows a significant reduction of hospital stay improving perioperative management and postoperative outcomes.
加速康复外科（ERAS）代表了围手术期护理要素的动态融合，已成功应用于不同外科专科，可缩短住院时间并降低发病率。本研究的目的是通过分析我们的首个系列病例，描述我院在结直肠手术中引入ERAS方案的情况。2014年9月至2016年6月，120例结直肠疾病患者纳入本研究。所有患者若无不适合的情况均采用腹腔镜手术方式。当患者实现充分活动、肠道通畅及疼痛得到控制后即可出院。分析的结果指标包括：住院时间、再入院率、围手术期发病率和死亡率。恶性病变是最常见的手术指征（84.2%；101/120）。95.8%的病例（115/120）采用了腹腔镜手术方式，中转开腹率为4.4%（5/115）。实施的手术包括：36例直肠切除术（30%）、36例左半结肠切除术（30%）、42例右半结肠切除术（35%）和6例腹会阴联合直肠癌根治术（5%）。整个系列病例的中位住院时间为4（3 - 34）天，发病率为10%（12/120）；4例患者发生Clavien-Dindo≥Ⅲa级并发症；仅观察到1例吻合口漏。未记录到30天再入院情况及围手术期死亡病例。单因素分析显示，并发症的存在是住院时间延长的唯一预测因素（p < 0.001）。根据我们的经验，在结直肠手术中实施ERAS方案可显著缩短住院时间，改善围手术期管理及术后结局。
