加速康复外科理念在机器人辅助腹腔镜前列腺癌根治手术后护理中的应用

目的 观察加速康复外科理念(ERAS)在机器人辅助腹腔镜前列腺癌根治术患者术后护理中的应用效果。方法 选择行达芬奇机器人辅助腹腔镜前列腺癌根治术的患者80例为研究对象。根据术后护理方法不同分为对照组和观察组,每组40例。对照组给予常规护理,观察组基于ERAS给予护理。观察并比较2组患者疗效及并发症发生情况。结果 2组患者术中出血量、手术时间及术后并发症总发生率比较,差异无统计学意义(P>0.05)。观察组患者术后首次下床时间、首次进水时间、肛门排气时间、引流管拔除时间及住院时间短于对照组,差异有统计学意义(P<0.05)。结论 ERAS应用于机器人辅助腹腔镜前列腺癌根治术的术后护理高效且安全。     

达芬奇机器人辅助腹腔镜前列腺癌根治术与传统腹腔镜前列腺癌根治术的护理及疗效研究

目的探讨达芬奇机器人辅助腹腔镜前列腺癌根治术的临床效果。方法选取2014年9月至2015年6月采用RALP手术的70例患者作为观察组,同时选取2014年6月至2015年6月采用LRP手术的70例患者作为对照组。比较两组患者的手术时间、手术平均出血量、肠道功能恢复时间、下床活动时间、拔伤口引流管时间、平均住院日、并发症发生率、近期尿控率。结果 RALP手术时间与LRP比较差异无统计学意义(P0.05);RALP手术平均出血量、肠道功能恢复时间、下床活动时间、拔伤口引流管时间、平均住院日、近期尿控等方面均优于LRP(P0.05);RALP术后并发症明显少于LRP,差异有统计学意义(P0.05);RALP组术后1个月尿控率为75.71%优于LRP组的51.43%,差异有统计学意义(P0.05)。结论 PALP在手术平均出血量、肠道功能恢复时间、下床活动时间、拔伤口引流管时间、平均住院日、并发症发生率、近期尿控等方面较LRP更有优势,同时降低了临床护理的工作量,提高了工作效率。     

应用加速康复外科理念的机器人辅助腹腔镜前列腺癌根治术

目的探讨应用加速康复外科(ERAS)理念的机器人辅助腹腔镜前列腺癌根治术(RARP)的安全性和优越性。方法回顾性分析2014年9月-2018年3月该院施行的490例RARP患者的临床资料。ERAS组230例采用ERAS处理方案,对照组260例围术期采用传统处理方案。使用SPSS 20.0进行数据分析。结果两组术中失血量、输血率、再手术率、肠粘连、肠梗阻、肺炎、肺栓塞(PTE)、下肢深静脉血栓(DVT)和30 d再入院率等比较,差异均无统计学意义(P0.05)。ERAS组术后疼痛数字评分(NRS)低于对照组(P 0.05);首次肛门排气时间(P 0.05)、首次排便时间(P 0.05)早于对照组;住院天数(P 0.05)短于对照组。结论应用ERAS理念行RARP安全有效,降低了术后疼痛反应,肠道功能恢复更快,可促进患者早日康复,缩短了住院时间。     

机器人辅助腹腔镜前列腺癌根治术后并发症的观察与护理

总结130例前列腺癌患者行达芬奇机器人辅助腹腔镜前列腺癌根治术后并发症的观察与护理。护理重点为严密监测生命体征,注意观察留置导尿及盆腔引流液的颜色、性状及量,保持引流通畅,鼓励患者早期活动,加强营养支持,及早介入盆底肌训练,观察患者控尿情况,发现病情变化,积极处理及护理。术后发生出血3例(2.31%)、尿漏11例(8.46%)、淋巴漏5例(3.85%)、肠梗阻2例(1.54%),经治疗及护理后均获得治愈。     

机器人辅助腹腔镜前列腺癌根治术围手术期护理

目的 探讨机器人辅助腹腔镜前列腺癌根治术围手术期护理.方法 采取术前针对性的心理护理,充分做好肠道准备和详细术后的功能训练指导;术后严密观察生命体征和腹部情况的变化,做好引流管的观察和护理,指导制订合理的饮食.结果 14例患者术后1年随访恢复良好,无并发症发生.结论 围手术期有针对性的系统护理,对机器人辅助腹腔镜前列腺癌治术患者早日康复有重要作用.     

机器人辅助下腹腔镜前列腺癌根治术后麻醉恢复质量的临床分析

目的 评价机器人辅助下腹腔镜前列腺癌根治术后麻醉恢复质量的影响因素.方法 搜集前列腺癌根治术患者60例,将患者分为两组:手术时间≤2 h组(S)、手术时间>2 h组(L),术后送麻醉复苏室(PACU)拔管后进行镇静程度评分.统计清醒拔管时间及出PACU时间,VAS疼痛评分和出现恶心呕吐的次数.分析影响麻醉恢复质量的因素...     

探讨精细化护理在机器人辅助腹腔镜下前列腺癌根治术患者中的应用价值

目的 探讨精细化护理在机器人辅助腹腔镜下前列腺癌根治术患者中的应用价值。方法 选取2017年1~12月于该院行机器人辅助腹镜下根治性前列腺切除术患者120例为研究对象,随机分为对照组与观察组,各60例。对照组患者接受传统的护理模式,观察组在传统护理模式的基础上接受精细化护理。从手术及住院相关指标、术后恢复指标、疼痛评分等方面比较两种护理模式的差异。结果 ①与对照组相比,观察组患者的术中出血量显著减少、术后住院时间更短、满意度更高、但住院费用也显著更高,差异均有统计学意义(均P<0.05)。②与对照组相比,观察组患者的术后恢复状况明显更好,观察组的排尿功能改善率更高,引流管拔除时间、肛门排气时间、下床活动时间及尿管拔除时间明显较短,差异均有统计学意义(均P<0.05)。③观察组患者的术后疼痛开始时间晚于对照组,差异有统计学意义(P<0.05),在手术当日疼痛开始时、术日临睡前两个时间点,两组患者的疼痛评分比较差异均无统计学意义(均P>0.05),随着术后恢复时间的延长,在术后24 h、术后48 h两个时间段,观察组的疼痛评分均显著低于对照组,差异有统计学意义(均P<0.05)。结论 对行机器人辅助腹腔镜下前列腺癌根治术的患者而言,精细化护理比传统护理更有利于患者恢复,提高满意度。     

机器人辅助前列腺癌根治术后拔除导尿管时间研究进展

从我国机器人辅助前列腺癌根治术(RARP)开展现状、国外RARP术后临床实践、RARP早期拔除导尿管原因分析、国内早期拔除导尿管可行性分析4个方面对RARP术后拔除导尿管时间研究进行综述,为更新RARP术后导尿管护理常规提供依据。     

机器人辅助腹腔镜前列腺癌根治术的手术配合

目的探讨机器人辅助腹腔镜前列腺癌根治术的护理配合,提高护士的手术配合质量。方法对国内首次开展的16例机器人辅助腹腔镜前列腺癌根治手术配合进行总结分析。结果16例机器人辅助腹腔镜前列腺根治术顺利完成,无一例中转开腹。结论充分的术前准备和熟练的手术配合是机器人手术成功的重要因素。     

Comparison of functional outcomes after retropubic,laparoscopic and robot-assisted radical prostatectomy: A meta-analysis

AIM: To assess the 6-mo and 12-mo functional outcomes after retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy retropubic radical prostatectomy(RRP) laparoscopic radical prostatectomy(LRP); robot-assisted laparoscopic prostatectomy(RARP). METHODS: A literature search was conducted using the Pub Med, EMBASE, The Cochrane Library and the Web of Knowledge databases updated to March, 2014 for relevant published studies. After data extraction and quality assessment via the Newcastle-Ottawa Scale or the Cochrane collaboration's tool for assessing risk ofbias, meta-analysis was performed using Rev Man 5.1. Either a random-effects model or a fixed-effects model was used. Potential publication bias was assessed using visual inspection of the funnel plots, and verified by the Egger linear regression test. RESULTS: Thirty-seven studies were identified in total: 14 articles comparing LRP with RRP, 12 articles comparing RARP with RRP, and 11 articles comparing RARP with LRP. For urinary continence, a statistically significant advantage was observed in RARP compared with LRP or RRP both at 6 mo [odds ratio(OR) = 1.93; P 0.01, OR = 2.23; P 0.05, respectively] and 12 mo(OR = 1.47; P 0.01, OR = 2.93; P 0.01, respectively) postoperatively. The continence recovery rates after LRP and RRP, with obvious heterogeneity(6-mo: I2 = 74%; 12-mo: I2 = 75%), were equivalent(6-mo: P = 0.52; 12-mo: P = 0.75). In terms of potency recovery, for the first time, we ranked the three surgical approaches into a superiority level: RARP LRP RRP, with a statistically significant difference at 12 mo [RARP vs LRP(OR = 1.99; P 0.01); RARP vs RRP(OR = 2.66; P 0.01); LRP vs RRP(OR = 1.34; P 0.05)], respectively. Meta-regression and subgroup analyses according to adjustment of the age, body mass index, prostate volume, Gleason score or prostate-specific antigen did not vary significantly. CONCLUSION: Current evidence suggests that minimally invasive approaches(RARP or LRP) are effective procedures for functional recovery. However, more high-quality randomized control trials investigating the long-term functional outcomes are needed.     

Patient-controlled femoral nerve analgesia versus patient-controlled intravenous analgesia for postoperative analgesia after trochanteric fracture repair

We assessed the efficacy of intravenous patient-controlled analgesia (PCA) and femoral nerve PCA after trochanteric fracture repair. A total of 40 patients were randomised to receive either femoral nerve PCA (Group I) or intravenous (IV) PCA (Group II) in the postoperative period. Group I received a continuous infusion of 0.125 bupivacaine at rate of 4 ml h⁻¹ plus PCA boluses of 3 ml with lockout time of 20 min. Morphine by IV PCA was applied as 1 mg bolus dose and 7 min lockout time in Group II. Pain scores (active–passive movement and during the resting), side effects, and patient satisfaction were recorded. Pain scores at rest were similar in both groups. Significantly better pain control at movement was observed in the Group I. Side effects were observed significantly more frequently in the Group II. Patient satisfaction was greater in Group I. Of the two PCA techniques tested, femoral nerve PCA with continuous infusion provides greater patient comfort both at rest and with ambulation than does IV PCA.     

Transperitoneal laparoscopic radical prostatectomy

The diagnosis of prostate cancer for any male of any age can profoundly affect his life and that of his family. Improvements in laparoscopic devices, combined with associated surgical equipment and innovative urologic uses, have changed the treatment choices and outcomes for these types of patients. Transperitoneal laparoscopic radical prostatectomy (TLRP) offers improved postoperative outcomes for patients with localized prostatic cancer, decreasing the profound postoperative effects on functional return and potency. Quantitative advantages of TLRP include increased safety, lower hospital costs, and length of stay, while qualitative advantages include increased patient satisfaction, accelerated recovery, and qualitatively improved functional return.     

Robotic-assisted laparoscopic radical prostatectomy

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ROBOTIC-ASSISTED radical prostatectomy uses the newest technology for surgical treatment of men with prostate cancer. Cancer of the prostate is the most common cancer in men and the second leading cause of death in American men.

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THE BENEFITS of robotic-assisted prostate surgery over open radical prostatectomy include small portal incisions, decreased blood loss, and shorter hospital stays.

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MAGNIFICATION of the surgeon's field of vision and jointed laparoscopic instruments that mimic the human wrist allow precision of movement and the ability to spare nerves, which result in improved postoperative urinary continence and sexual function. AORN J 84 (November 2006) 760-770. © AORN, Inc, 2006.