Application of enhanced recovery after surgery in perioperative period of minimally invasive gynecological surgery

doi:10.3877/cma.j.issn.1673-5250.2020.06.017

Objective

To investigate application of enhanced recovery after surgery (ERAS) in perioperative period of minimally invasive gynecological surgery.

Methods

From February to May, 2019, a total of 151 patients who underwent minimally invasive gynecological surgery in Gynecology Center of a grade A hospital in Urumqi were selected as research subjects.They were randomly divided into study group (n=105, taking ERAS management measures in perioperative period) and control group (n=46, taking routine management measures in perioperative period) by simple randomization method.The general clinical data, disease classification and resection extent of operation, the first time to out-of-bed activity after operation, anal exhaust, drinking water and time to return to routine diet, visual analogue scale (VAS) scores on the day after surgery and in the state of rest and activity on the first day after surgery of two groups were collected. Independent-samples t test, Mann-Whitney U test or chi-square test were used for statistical comparisons. This study was approved by the Ethics Committee of the grade A hospital in Urumqi (Approval No.K202001-20). Each patient signed the informed consent for clinical research. There were no statistical significances in age, height, weight, body mass index (BMI) and other general clinical data between two groups (P>0.05).

Results

①The proportion of malignant disease and preoperative assessment of resection extent of operation ≥ laparoscopic hysterectomy in study group were 12.4% (13/105) and 30.5% (32/105) respectively, which were significantly higher than those 0 and 15.2% (7/46) in control group, and both differences were statistically significant (χ²=6.232, 3.888; P=0.013, 0.049). ②The first time to drink water after surgery and to return to routine diet in study group were 5.0 h (3.0-9.0 h) and 17.0 h (10.0-24.0 h), respectively, which were significantly shorter than those in control group 16.0 h (13.7-19.0 h) and 24.0 h (19.5-30.2 h), and both differences were statistically significant (Z=-7.255, -4.488; P<0.001). ③VAS scores on the day after surgery and in the state of activity on the first day after surgery in study group were 3.0 scores (3.0-4.0 scores) and 2.0 scores (1.0-3.0 scores), respectively, which were significantly higher than those in control group 2.0 scores (2.0-3.0 scores) and 1.0 score (0-2.0 scores), and both the differences were statistically significant (Z=-5.458, -4.207; P<0.001). ④There were no significant differences in the length of hospital stay after surgery and the total cost of hospital stay between two groups (P>0.05).

Conclusions

ERAS can significantly accelerate postoperative recovery in patients undergoing minimally invasive gynecological surgery in perioperative period. Due to the relatively small sample size included in this study, and the patients in study group have more severe disease and greater scope of surgery, the application effect of ERAS in perioperative period of minimally invasive gynecological surgery still needs more large samples, multi-center, randomized controls to further studied and confirmed.

Key words: Surgical procedures, minimally invasive, Gynecologic surgical procedures, Enhanced recovery after surgery, Perioperative care, Women

表1 2组妇科微创手术治疗患者一般临床资料比较(±s)

组别	例数	年龄(岁)	身高(cm)	体重(kg)	BMI(kg/m²)
研究组	105	40.9±11.4	161.1±5.1	60.4±11.6	23.5±3.9
对照组	46	39.7±11.2	161.7±5.5	62.8±9.6	23.9±3.6
t值		0.323	0.329	1.038	0.298
P值		0.529	0.524	0.189	0.546

表1 2组妇科微创手术治疗患者一般临床资料比较(±s)

组别	例数	年龄(岁)	身高(cm)	体重(kg)	BMI(kg/m²)
研究组	105	40.9±11.4	161.1±5.1	60.4±11.6	23.5±3.9
对照组	46	39.7±11.2	161.7±5.5	62.8±9.6	23.9±3.6
t值		0.323	0.329	1.038	0.298
P值		0.529	0.524	0.189	0.546

表2 2组妇科微创手术治疗患者疾病类型及手术范围比较[例数(%)]

组别	例数	疾病类型		术前评估手术范围是否≥腹腔镜下子宫切除术手术范围
组别	例数	良性	恶性	是	否
研究组	105	92(87.6)	13(12.4)	32(30.5)	73(69.5)
对照组	46	46(100.0)	0(0)	7(15.2)	39(84.8)
χ²值		6.232		3.888
P值		0.013		0.049

表2 2组妇科微创手术治疗患者疾病类型及手术范围比较[例数(%)]

组别	例数	疾病类型		术前评估手术范围是否≥腹腔镜下子宫切除术手术范围
组别	例数	良性	恶性	是	否
研究组	105	92(87.6)	13(12.4)	32(30.5)	73(69.5)
对照组	46	46(100.0)	0(0)	7(15.2)	39(84.8)
χ²值		6.232		3.888
P值		0.013		0.049

表3 2组妇科微创手术治疗患者术后首次肛门排气、下床活动、饮水及恢复常规饮食时间比较[h，M(P₂₅～P₇₅)]

组别	例数	术后首次肛门排气时间	术后首次下床活动时间	术后首次饮水时间	术后恢复常规饮食时间
研究组	105	15.0(10.0～22.0)	15.0(10.0～20.0)	5.0(3.0～9.0)	17.0(10.0～24.0)
对照组	46	17.5(12.0～24.0)	16.0(13.0～18.2)	16.0(13.7～19.0)	24.0(19.5～30.2)
Z值		-1.624	-1.023	-7.255	-4.488
P值		0.104	0.306	<0.001	<0.001

表3 2组妇科微创手术治疗患者术后首次肛门排气、下床活动、饮水及恢复常规饮食时间比较[h，M(P₂₅～P₇₅)]

组别	例数	术后首次肛门排气时间	术后首次下床活动时间	术后首次饮水时间	术后恢复常规饮食时间
研究组	105	15.0(10.0～22.0)	15.0(10.0～20.0)	5.0(3.0～9.0)	17.0(10.0～24.0)
对照组	46	17.5(12.0～24.0)	16.0(13.0～18.2)	16.0(13.7～19.0)	24.0(19.5～30.2)
Z值		-1.624	-1.023	-7.255	-4.488
P值		0.104	0.306	<0.001	<0.001

表4 2组患者术后当天及术后第1天活动与安静状态下VAS评分比较[分，M(P₂₅～P₇₅)]

组别	例数	术后当天	术后第1天活动状态下	术后第1天安静状态下
研究组	105	3.0(3.0～4.0)	2.0(1.0～3.0)	1.0(0～2.0)
对照组	46	2.0(2.0～3.0)	1.0(0～2.0)	1.0(0～1.2)
Z值		-5.458	-4.207	-1.285
P值		<0.001	<0.001	0.199

表4 2组患者术后当天及术后第1天活动与安静状态下VAS评分比较[分，M(P₂₅～P₇₅)]

组别	例数	术后当天	术后第1天活动状态下	术后第1天安静状态下
研究组	105	3.0(3.0～4.0)	2.0(1.0～3.0)	1.0(0～2.0)
对照组	46	2.0(2.0～3.0)	1.0(0～2.0)	1.0(0～1.2)
Z值		-5.458	-4.207	-1.285
P值		<0.001	<0.001	0.199

表5 2组妇科微创手术治疗患者术后住院时间与住院总费用比较[M(P₂₅～P₇₅)]

组别	例数	术后住院时间(d)	住院总费用(元)
研究组	105	5.0(3.5～6.0)	20 698.9(17 611.5～26 332.5)
对照组	46	4.0(3.0～5.0)	21 730.6(18 907.7～26 196.3)
Z值		-1.644	-0.780
P值		0.100	0.435

表5 2组妇科微创手术治疗患者术后住院时间与住院总费用比较[M(P₂₅～P₇₅)]

组别	例数	术后住院时间(d)	住院总费用(元)
研究组	105	5.0(3.5～6.0)	20 698.9(17 611.5～26 332.5)
对照组	46	4.0(3.0～5.0)	21 730.6(18 907.7～26 196.3)
Z值		-1.644	-0.780
P值		0.100	0.435

[1]	中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016)[J]．中华外科杂志，2016, 54(6): 413-418. DOI: 10.3760/cma.j.issn.0529-5815.2016.06.004.
[2]	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617. DOI: 10.1093/bja/78.5.606.
[3]	Miralpeix E, Nick AM, Meyer LA, et al. A call for new standard of care in perioperative gynecologic oncology practice: impact of enhanced recovery after surgery (ERAS) programs[J]. Gynecol Oncol, 2016, 141(2): 371-378.DOI：10.1016/j.ygyno.2016.02.019.
[4]	Song W, Wang K, Zhang RJ, et al. The enhanced recovery after surgery (ERAS) program in liver surgery: a Meta-analysis of randomized controlled trials[J]. Springerplus, 2016, 5: 207.DOI: 10.1186/s40064-016-1793-5.
[5]	Vlug MS, Wind J, Hollmann MW, et al. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)[J]. Ann Surg, 2011, 254(6): 868-875.DOI: 10.1097/SLA.0b013e31821fd1ce.
[6]	Coyle MJ, Main B, Hughes C, et al. Enhanced recovery after surgery (ERAS) for head and neck oncology patients[J]. Clin Otolaryngol, 2016, 41(2): 118-126.DOI: 10.1111/coa.12482.
[7]	Wainwright T, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery[J]. Best Pract Res Clin Anaesthesiol, 2016, 30(1): 91-102.DOI: 10.1016/j.bpa.2015.11.001.
[8]	Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations--Part Ⅰ[J]．Gynecol Oncol, 2016, 140(2):313-322.DOI: 10.1016/j.ygyno.2015.11.015.
[9]	Nelson G, Altman AD, Nick A，et al.Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations--Part Ⅱ[J]．Gynecol Oncol, 2016, 140(2): 323-332. DOI: 10.1016/j.ygyno.2015.12.019.
[10]	中华医学会妇产科学分会加速康复外科协作组．妇科手术加速康复的中国专家共识[J]．中华妇产科杂志，2019, 54(2): 73-79. DOI: 10.3760/cma.j.issn.0529-567x.2019.02.001.
[11]	徐丛剑，华克勤．实用妇产科学[M]. 4版. 北京：人民卫生出版社，2018: 997-1059.
[12]	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review[J]. JAMA Surg, 2017, 152(3): 292-298. DOI: 10.1001/jamasurg.2016.4952.
[13]	Muallem MZ, Dimitrova D, PietznerK, et al. Implementation of enhanced recovery after surgery (ERAS) pathways in gynecologic oncology. A NOGGO-AGO* survey of 144 Gynecological Departments in Germany[J]. Anticancer Res, 2016, 36(8): 4227-4232.
[14]	金颖，李幸霞，齐佳燕，等. 加速康复外科指南在我国25个省份三级甲等医院妇科的应用情况调查[J]．中华护理杂志，2018，53(9):1084-1088.DOI: 10.3761/j.issn.0254-1769.2018.09.013.
[15]	李秀梅，陈继惠，刘辰，等. 快速康复外科理念在妇科围手术期护理中的应用[J]．实用医药杂志，2010, 27(6): 542-544. DOI: 10.3969/j.issn.1671-4008.2010.06.042.
[16]	程传喜，郭玲，柳兆芳．加速康复外科在妇科腔镜手术中的应用体会[J]．腹腔镜外科杂志，2017, 22(9): 700-704.DOI：10.13499/j.cnki.fqjwkzz.2017.09.700.
[17]	Modesitt SC, Sarosiek BM, Trowbridge ER, et al.Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization[J]．Obstet Gynecol, 2016, 128(3): 457-466. DOI: 10.1097/AOG.0000000000001555.

[1]	Jingyu Qian, Mingming Zheng. Interpretation of the Italian guidelines on non-invasive and invasive prenatal diagnosis：executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology（SIGO）[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 486-492.
[2]	Xialin Li, Fang He. Risk assessment and early warning system for postpartum hemorrhage[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 498-503.
[3]	Ziyang Liu, Jianjian Cui, Yin Zhao. Current research status on obstetric disseminated intravascular coagulation and its scoring system[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 511-518.
[4]	Fanying Zeng, Jie Ruan, Xinghui Liu, Guolin He. Current status of perinatal medicine advances under the new reproductive situation and coping strategies in prenatal care[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 519-524.
[5]	Xiaofei Li, Hongli Liu, Qiuling Shi, Jing Tian, Li Li, Hongbo Qi, Xin Luo. A prospective randomized controlled study of low intensity focused ultrasound uterine involution treatment for prevention and treatment of postpartum hemorrhage in natural childbirth women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 534-539.
[6]	Rong Huang, Ziyu Liang, Wenjin Qi. Expression and significance of NLRP3 inflammasome in serum of pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 540-548.
[7]	Xia He, Rong Huang, Wenjin Qi. High-throughput sequencing study on the abundance of placenta and fetal membrane flora in pregnant women with premature rupture of membranes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 549-555.
[8]	Jiangyan Xie, Yafei Wang, Fang He. Pregnancy complicated with thrombotic thrombocytopenic purpura：two cases report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(05): 556-563.
[9]	Xiaoyan Han, Hua Yang. Relationship between low level of serum placental growth factor in the second trimester pregnancy women and adverse fetal prognosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 398-402.
[10]	Jiali Du, Rui Bao, Chunhong Qiao, Wei Han. Construction of a prediction model for adverse pregnancy outcomes after emergency cervical cerclage in pregnant women with cervical incompetence during the second trimester[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 403-409.
[11]	Jinhan Yao, Weina Wang, Yuquan Zhang. Current research status on prognosis of patients with pregnancy-related deep vein thrombosis[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 367-373.
[12]	Tingting Xu, Yongchi Zhan, Xiaodong Wang, Xiaodong Wang. Perinatal outcomes of fetomaternal hemorrhage syndrome pregnant women with sinusoidal fetal heart tracing[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(04): 382-389.
[13]	Kai Zhong, Tiemin Jiang, Ruiqing Zhang, Yingmei Shao, Qiang Guo. Application of enhanced recovery after surgery in hepatectomy for hepatic cystic echinococcosis[J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(06): 425-429.
[14]	Jianan Feng, Lei Cai, Guolin He, Shunjun Fu, Cheng Zhang, Zhoubin Feng, Yaohong Wen, Hongkun Tan, Mingxin Pan. Safety and efficacy of primary duct closure after laparoscopic common bile duct exploration: analysis of 128 cases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 543-550.
[15]	Yuling Cai, Gang Wang, Zhiwei Jiang. Research progress of acupuncture in the treatment of postoperative ileus[J]. Chinese Journal of Acupuncture and Moxibustion(Electronic Edition), 2024, 13(04): 164-168.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export