Palumbo Vito, Giannarini Gianluca, Crestani Alessandro, Rossanese Marta, Calandriello Mattia, Ficarra Vincenzo
Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy.
Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy.
Urology. 2018 May;115:125-132. doi: 10.1016/j.urology.2018.01.043. Epub 2018 Feb 15.
To assess whether an Enhanced Recovery After Surgery pathway was associated with a faster bowel function recovery and no increase in morbidity compared with standard perioperative care in a contemporary series of patients undergoing radical cystectomy.
A prospective single-center single-surgeon cohort of 114 consecutive patients treated with open radical cystectomy between July 2013 and June 2016 was analyzed. A study group of 74 patients with Enhanced Recovery After Surgery pathway was compared with a control group of 40 patients with standard perioperative care. Primary outcome was recovery of bowel function, measured by resumption of bowel sounds, passage of flatus, and passage of stool. Secondary outcome was rate of overall and major 90-day postoperative complications.
Bowel function recovery was significantly faster in the study group. Resumption of bowel sounds on postoperative day 1 was recorded in 43 (58%) vs 4 (10%) patients, passage of flatus within postoperative day 2 in 41 (55%) vs 11 (28%) patients, and passage of stool within postoperative day 3 in 37 (50%) vs no patients in the study vs control group, respectively (P < .01 for all). Overall and major 90-day complications were observed in 35 (47.3%) and 13 (17.6%) patients in the study group, and in 25 (62.5%) and 9 (22.5%) patients in the control group (P = .14 and 0.38, respectively).
In patients undergoing open radical cystectomy, an Enhanced Recovery After Surgery pathway allowed a significantly faster bowel function recovery with no increase in 90-day postoperative complications compared with standard perioperative care.
在当代一系列接受根治性膀胱切除术的患者中，评估与标准围手术期护理相比，术后加速康复路径是否与更快的肠功能恢复相关且不增加发病率。
分析了2013年7月至2016年6月期间由同一外科医生进行的114例接受开放性根治性膀胱切除术的连续患者的前瞻性单中心队列。将74例采用术后加速康复路径的患者研究组与40例接受标准围手术期护理的患者对照组进行比较。主要结局是肠功能恢复，通过肠鸣音恢复、排气和排便来衡量。次要结局是术后90天总体和主要并发症的发生率。
研究组的肠功能恢复明显更快。术后第1天记录到肠鸣音恢复的患者，研究组为43例（58%），对照组为4例（10%）；术后第2天排气的患者，研究组为41例（55%），对照组为11例（28%）；术后第3天排便的患者，研究组为37例（50%），对照组无患者排便（所有比较P均<0.01）。研究组35例（47.3%）和13例（17.6%）患者发生了术后90天总体和主要并发症，对照组分别为25例（62.5%）和9例（22.5%）患者（P分别为0.14和0.38）。
在接受开放性根治性膀胱切除术的患者中，与标准围手术期护理相比，术后加速康复路径可使肠功能恢复明显更快，且术后90天并发症不增加。
