加速康复外科理念在经胸前入路腔镜甲状腺外科领域中的临床应用

Clinical application of the concept of enhanced recovery after surgery in transthoracic laparoscopic thyroid surgery

摘要:

目的 初步探讨加速康复外科（ERAS）理念在经胸前入路腔镜甲状腺外科手术应用中的可行性及有效性。方法 回顾性分析2018年6月－2020年6月该院139例符合入组标准的经胸前入路腔镜甲状腺手术患者的临床资料，按时间段分为传统经胸前入路腔镜手术组（TES组）及加速康复手术组（ERAS组），比较两组患者术后并发症（出血、恶心呕吐）发生情况及应激指标。结果 ERAS组术后恶心呕吐等并发症明显少于传统组，疼痛评分、白细胞计数和C反应蛋白等明显低于TES组，两组患者比较，差异均有统计学意义（P < 0.05）。结论 多模式镇痛及超前镇吐等ERAS理念应用于经胸前入路腔镜甲状腺外科领域中安全可行，能有效降低术后并发症发生率，缩短住院时间，提高患者术后舒适度，值得临床应用及推广，但具体实施方案还有待进一步优化。

Abstract:

Objective To explore the feasibility and effectiveness of the concept of enhanced recovery after surgery in application of transthoracic laparoscopic thyroid surgery.Methods Retrospective analysis of clinical data of all patients underwent transthoracic anterior thoracic endoscopic thyroid surgery from June 2018 to June 2020. 139 patients were divided into transthoracic endoscopic surgery group and accelerated rehabilitation surgery group (ERAS group) by time period. The occurrence of postoperative complications (hemorrhage, nausea and vomiting) and stress index were compared between the two groups.Results The complications such as postoperative nausea and vomiting in the ERAS group was less than that in the transthoracic endoscopic surgery group, the stress index such as pain score, leukocytes and C-reactive protein in the ERAS group were significantly lower than those in the transthoracic endoscopic surgery group (P < 0.05).Conclusion The application of multimodal analgesia and advanced antiemetics in the field of enhanced recovery after surgery in transthoracic laparoscopic thyroid surgery is safe and feasible. It can effectively reduce postoperative complications, shorten hospital stay and improve postoperative comfort. It is worthy of clinical application and promotion. But the specific implementation plan needs to be further optimized.