Department of Gynecology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, No.100 Minjiang Avenue, Kecheng District, Quzhou City, 324000, Zhejiang Province, China.
BMC Womens Health. 2023 Aug 1;23(1):401. doi: 10.1186/s12905-023-02550-6.
Advances in surgical techniques and perioperative management are the two major contributing factors to improved surgical outcomes. The purpose of the current study was to compare the efficacy of single-port surgery and perioperative enhanced recovery after surgery (ERAS) management in laparoscopic myomectomy.
The present study included 120 patients undergoing laparoscopic myomectomy in the Gynecological Ward of Quzhou Affiliated Hospital of Wenzhou Medical University. According to the traditional perioperative management mode and ERAS management, multi-port and single-port procedures, all patients were assigned to the Conventional-SPLS (Single-Port Laparoscopic Surgery with conventional perioperative care) group (n = 34), Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care) group (n = 47), and ERAS (multi-port laparoscopic surgery with ERAS perioperative care) group (n = 39). The surgical outcomes of the three groups were compared operation time, intraoperative blood loss, variations in postoperative hemoglobin, postoperative walking time, postoperative flatus expelling time, postoperative hospital stay, and visual analog scale (VAS) scores at 6 and 12 h following surgery.
The ERAS group recovered the quickest in terms of postoperative walking time and flatus expelling duration. The ERAS group also recovered the shortest postoperative hospital stay (3.85 ± 1.14 days), which differed significantly from that in the Conventional-Multi group, but not significantly from that in the Conventional-SPLS group. In terms of VAS scores at 6 and 12 h after surgery, the ERAS group had the lowest pain intensity, which differed significantly from that of the other two groups. The effect of surgical procedures or postoperative care on hospital stay was assessed using multiple regression analysis. The results demonstrated that ERAS was an important independent contributor to reducing postoperative hospital stay (β = 0.270, p = 0.002), while single-port surgery did not affect this index (β = 0.107, p = 0.278).
In laparoscopic myomectomy, perioperative ERAS management could control postoperative pain and shorten hospital stay. Single-port surgery could speed up the recovery of gastrointestinal function and postoperative walking time, but it did not affect postoperative pain management or the length of hospital stay. Thus, the most effective approach to improving postoperative outcomes in laparoscopic myomectomy was the application of perioperative ERAS management.
手术技术的进步和围手术期管理是改善手术结果的两个主要因素。本研究的目的是比较单孔手术和围手术期加速康复（ERAS）管理在腹腔镜子宫肌瘤剔除术中的疗效。
本研究纳入了在温州医科大学附属衢州医院妇科病房接受腹腔镜子宫肌瘤剔除术的 120 例患者。根据传统围手术期管理模式和 ERAS 管理、多孔和单孔手术，所有患者被分为常规 SPLS（常规围手术期护理下单孔腹腔镜手术）组（n=34）、常规多（常规围手术期护理多孔腹腔镜手术）组（n=47）和 ERAS（ERAS 围手术期护理多孔腹腔镜手术）组（n=39）。比较三组的手术结果，包括手术时间、术中出血量、术后血红蛋白变化、术后行走时间、术后排气时间、术后住院时间和术后 6、12 小时视觉模拟评分（VAS）。
ERAS 组术后行走时间和排气时间恢复最快。ERAS 组的术后住院时间最短（3.85±1.14 天），与常规多组相比差异显著，但与常规 SPLS 组相比差异不显著。术后 6、12 小时 VAS 评分，ERAS 组疼痛强度最低，与其他两组相比差异显著。多因素回归分析评估手术方式或术后护理对住院时间的影响。结果表明，ERAS 是缩短术后住院时间的重要独立因素（β=0.270，p=0.002），而单孔手术对该指标无影响（β=0.107，p=0.278）。
在腹腔镜子宫肌瘤剔除术中，围手术期 ERAS 管理可以控制术后疼痛并缩短住院时间。单孔手术可以加快胃肠功能恢复和术后行走时间，但对术后疼痛管理或住院时间无影响。因此，改善腹腔镜子宫肌瘤剔除术术后结局的最有效方法是应用围手术期 ERAS 管理。
