加速康复外科在全达芬奇机器人手术系统根治性全胃切除术中的应用价值

目的:探讨加速康复外科(ERAS)在全达芬奇机器人手术系统根治性全胃切除术中的应用价值。方法:采用回顾性队列研究方法。收集2016年1月至2019年2月南昌大学第一附属医院收治的97例行全达芬奇机器人手术系统根治性全胃切除术胃癌患者的临床病理资料;男57例,女40例;年龄为(59±10)岁,年龄范围为35~60岁。97例患者中,52例围术期应用ERAS理念进行管理,设为ERAS组;45例围术期应用传统理念进行管理,设为传统组。观察指标:(1)术中情况。(2)术后情况。正态分布的计量资料以±s表示,组间比较采用t检验;计数资料以绝对数表示,组间比较采用χ^2检验;重复测量资料采用重复测量方差分析;等级资料比较采用Mann-Whitney U检验。结果:(1)术中情况:ERAS组与传统组患者均顺利完成全达芬奇机器人手术系统根治性全胃切除术。ERAS组患者消化道重建方式(Roux-en-Y吻合、Uncut Roux-en-Y吻合),手术时间,术中出血量分别为25例、27例,(205±28)min,(176±80)mL,传统组患者上述指标分别为21例、24例,(199±31)min、(182±81)mL,两组患者上述指标比较,差异均无统计学意义(χ^2=0.02,t=1.00,0.37,P>0.05)。(2)术后情况:ERAS组患者术后首次下床活动时间,术后首次肛门排气时间,术后首次进食流质食物时间,腹腔引流管拔除时间,术后并发症,淋巴结清扫数目,术后肿瘤分期(Ⅰ期、Ⅱ期、Ⅲ期),术后住院时间,住院费用分别为(1.85±0.29)d、(2.90±0.47)d、(2.53±0.28)d,(5.72±0.95)d,6例,(28±8)枚,4例、25例、23例,(6.43±0.52)d,(60222±3888)元;传统组患者上述指标分别为(3.04±0.39)d,(3.82±0.36)d,(4.24±0.30)d,(6.75±0.48)d,5例,(27±6)d,3例、20例、22例,(8.47±0.69)d,(64197±3369)元。两组患者术后首次下床活动时间、术后首次肛门排气时间、术后首次进食流质食物时间、腹腔引流管拔除时间、术后住院时间、住院费用比较,差异均有统计学意义(t=17.19,10.69,29.02,6.58,16.57,5.34,P<0.05);两组患者术后并发症、淋巴结清扫数目、术后肿瘤分期比较,差异均无统计学意义(χ^2=0.01,t=0.68,Z=-0.46,P>0.05)。ERAS组和传统组患者视觉模拟疼痛评分分别由麻醉清醒后2 h的(3.06±0.29)分和(4.11±0.74)分下降为术后48 h的(2.13±0.32)分和(3.26±0.42)分,两组患者疼痛评分变化趋势比较,差异有统计学意义(F组间=264.45,P<0.05)。两组均无术后30 d死亡及再次入院患者。结论:ERAS理念应用于全达芬奇机器人手术系统根治性全胃切除术安全、有效,能促进肠道功能恢复,缩短住院时间,减轻术后疼痛,加速患者康复。

Application value of enhanced recovery after surgery in totally Da Vinci robotic total gastrectomy

Objective:To investigate the application value of enhanced recovery after surgery(ERAS)in totally Da Vinci robotic total gastrectomy.Methods:The retrospective cohort study was conducted.The clinicopathological data of 97 patients with gastric cancer who underwent totally Da Vinci robotic total gastrectomy in the First Affiliated Hospital of Nanchang University between January 2016 and February 2019 were collected.There were 57 males and 40 females,aged(59±10)years,with a range from 35 to 60 years.Of the 97 patients,52 receiving perioperative management using ERAS were allocated into ERAS group,and 45 receiving traditional perioperative management were allocated into traditional group.Observation indicators:(1)intraoperative situations;(2)postoperative situations.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed using the t test.Count data were described as absolute numbers,and the chi-square test was used for comparison between groups.Repeated measurement data were analyzed by ANOVA.Comparison of ordinal datas was analyzed using the Mann-Whitney U test.Results:(1)Intraoperative situations:patients in the ERAS group and traditional group underwent totally Da Vinci robotic total gastrectomy for gastric cancer successfully.Cases with Roux-en-Y anastomosis or uncut Roux-en-Y anastomosis(methods of digestive reconstruction),operation time,volume of intraoperative blood loss for the ERAS group were 25,27,(205±28)minutes,(176±80)mL,respectively,versus 21,24,(199±31)minutes,(182±81)mL for the traditional group,showing no significant difference in the above indicators between the two groups(χ^2=0.02,t=1.00,0.37,P>0.05).(2)Postoperative situations:time to first out-of-bed activities,time to first anal flatus,time to initial liquid food intake,time to abdominal drainage tube removal,cases with postoperative complications,the number of lymph node dissected,cases in stageⅠ,Ⅱ,Ⅲof postoperative tumor staging,duration of postoperative hospital stay,hospitalization expenses were(1.85±0.29)days,(2.90±0.47)days,(2.53±0.28)days,(5.72±0.95)days,6,28±8,4,25,23,(6.43±0.52)days,(60222±3888)yuan in the ERAS group and(3.04±0.39)days,(3.82±0.36)days,(4.24±0.30)days,(6.75±0.48)days,5,(27±6)days,3,20,22,(8.47±0.69)days,(64197±3369)yuan in the traditional group,respectively.There were significant differences in the time to first out-of-bed activities,time to first anal flatus,time to initial liquid food intake,time to abdominal drainage tube removal,duration of postoperative hospital stay and hospitalization expenses between the two groups(t=17.19,10.69,29.02,6.58,16.57,5.34,P<0.05).There was no significant difference in the postoperative complications,the number of lymph node dissected,or postoperative tumor staging between the two groups(χ^2=0.01,t=0.68,Z=-0.46,P>0.05).From 2 hours after anesthesia awakening to 48 hours after surgery,the visual analog pain scores were changed from 3.06±0.29 to 2.13±0.32 in the ERAS group,and from 4.11±0.74 to 3.26±0.42 in the traditional group,respectively,showing a significant difference in the changing trend between the two groups(F=264.45,P<0.05).There was no death or readmission in the postoperative 30 days.Conclusions:ERAS applied in the totally Da Vinci robotic total gastrectomy is safe and effective,which is associated with faster gastrointestinal function recovery,shorter hospital stay,better pain control,and quicker recovery afer surgery.