加速康复外科管理非选择性应用于泌尿外科手术患者的回顾性研究

目的探索加速康复外科（ERAS）方案非选择性应用于泌尿外科成年患者围术期管理的安全性及有效性。 方法我院泌尿外科2018年7月至12月，415例成年手术患者均采用围术期ERAS管理。病种涵盖结石、结核、肿瘤和先天畸形等。三、四级手术324例（78.1%）。其中腹腔镜手术120例，经泌尿腔道内镜手术281例，开放手术14例。所有患者中男288例、女127例，年龄18~88岁，体质量指数14.0~35.9 kg/m²。回顾性分析这些患者的术后恢复结局。 结果患者术后住院时间平均（3.87±3.65）d，首次大便时间平均（1.01±1.02）d。术后当天恢复饮食380例（91.6%）、当天下床活动358例（86.3%）。术后并发症Clavien-Dindo分Ⅰ级36例（8.7%）、Ⅱ级17例（4.1%）、Ⅲa级3例（0.7%）、Ⅲb级2例（0.5%），无Ⅳ、Ⅴ级并发症。非计划手术2例（0.5%），1例是晚期膀胱癌患者膀胱肿瘤诊断性电切术后膀胱出血，另1例是腹腔镜肾蒂淋巴结结扎术后输尿管不全性梗阻。30天再入院1例（0.2%），原因是腹腔膀胱癌根治回肠膀胱术后泌尿系统感染。 结论泌尿外科成年手术患者实行非选择性ERAS管理安全可行，有助于患者快速回归日常生活（饮食、活动和排便）。

Retrospective study of enhanced recovery after surgery for patients undergoing unselective urological operations

ObjectiveTo evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) for patients undergoing unselective urological surgeries. MethodsERAS was applied for all 415 adults accepted operations in the department of urology in our hospital from July to December 2018. The diseases included stone, tuberculosis, tumor, congenital malformation and so on. There were 324 grade Ⅲ and Ⅳ surgeries (78.1%). Of 415 patients, 288 were male, and 127 were female. Their ages ranged from 18 to 88 years old and body mass index was (14.0-35.9) kg/m². 120 cases were performed laparoscopy, 281 cases underwent urologic endoscopic surgical procedure and only 14 cases accepted open operations. Their postoperative recovery data were retrospectively analyzed. ResultsThe postoperative hospital stay was (3.87±3.65) d. The first passage of stool was (1.01±1.02) d. Resumption of oral nutrition and mobilization on postoperative day 0 were recorded in 380(91.6%) and 358(86.3%) patients respectively. Grade I, Ⅱ, Ⅲa, Ⅲb complications were observed in 36(8.7%), 17(4.1%), 3(0.7%) and 2(0.5%) cases respectively according to Clavien-Dindo classification. There were no grade Ⅳ or Ⅴ complications. Unplanned reoperation occurred in 2 cases (0.5%). One case was intractable hemorrhage of bladder resulting from transurethral resection for bladder cancer. The other case was the incomplete ureteral obstruction secondary to the laparoscopic renal pedicle lymphatic disconnection. The readmission within 30 days after discharge happened in 1 case (0.2%) due to urinary infection after laparoscopic radical cystectomy with ileal conduit. ConclusionsIt is safe and feasible to unselectively carry out ERAS program for adults underdoing urological surgeries. It helps patients returning to common life (oral nutrition, mobilization and defecation) rapidly after surgery.