亢渐　牛吉瑞

【摘要】 目的 探讨加速康复外科在腹腔镜肾癌根治术中的临床应用效果。方法72例行腹腔镜肾癌根治术患者， 随机分为加速康复外科组和常规手术组， 各36例。加速康复外科组患者围手术期应用加速康复外科干预， 常规手术组患者围手术期应用常规处理。观察所有患者的治疗情况， 并比较两组患者术中出血量、手术切口长度、术后排气时间、术后下地时间及术后住院时间。結果 所有患者均成功完成手术， 术后无严重并发症和死亡情况。术后病理均为透明细胞癌， 随访期间无一例患者发生转移和复发。加速康复外科组患者术中出血量为（50.2±27.1）ml， 手术切口长度为（9.5±2.7）cm， 术后排气时间为（3.6±2.1）d， 术后下地时间为（3.3±1.1）d， 术后住院时间为（5.4±1.6）d;常规手术组患者术中出血量为（92.3±32.1）ml， 手术切口长度为（20.1±4.7）cm， 术后排气时间为（5.5±2.5）d， 术后下地时间为（6.3±2.2）d， 术后住院时间为（7.5±2.1）d。加速康复外科组患者术中出血量少于常规手术组， 手术切口长度、术后排气时间、术后下地时间及术后住院时间均明显短于常规手术组， 差异均有统计学意义（P<0.05）。结论 加速康复外科在腹腔镜肾癌根治术中的临床应用效果理想， 可加快患者康复速度， 适合在广大医院推广。

【关键词】 腹腔镜肾癌根治术;肾癌;加速康复外科

DOI：10.14163/j.cnki.11-5547/r.2019.16.106

Clinical application of enhanced recovery after surgery in laparoscopic radical nephrectomy   KANG Jian， NIU Ji-rui. Department of Urology ， Heilongjiang Province Hospital， Haerbin 150036， China

【Abstract】 Objective   To discuss the clinical effect of enhanced recovery after surgery in laparoscopic radical nephrectomy. Methods   A total of 72 patients with laparoscopic radical nephrectomy were randomly divided into enhanced recovery after surgery group and conventional surgery group， with 36 cases in each group. enhanced recovery after surgery received perioperative intervention of enhanced recovery after surgery， and conventional surgery group received perioperative intervention of conventional processing. The treatment status of all patients was observed， and the intraoperative bleeding volume， surgical incision length， postoperative exhaust time， postoperative off-bed time and postoperative hospitalization time were compared between the two groups. Results   All patients successfully completed the operation without serious complications and death. Postoperative pathology showed clear cell carcinoma， and no metastasis or recurrence occurred during the follow-up period. Enhanced recovery after surgery group had intraoperative bleeding volume as （50.2±27.1） ml， surgical incision length as （9.5±2.7） cm， postoperative exhaust time as （3.6±2.1） d， postoperative off-bed time as （3.3±1.1） d， postoperative hospitalization time as （5.4±1.6） d， which were （92.3±32.1） ml， （20.1±4.7） cm， （5.5±2.5） d， （6.3±2.2） d and （7.5±2.1） d in conventional surgery group. Enhanced recovery after surgery group had less intraoperative bleeding volume than conventional surgery group， and obviously shorter surgical incision length， postoperative exhaust time， postoperative off-bed time and postoperative hospitalization time than conventional surgery group. Their difference was statistically significant （P<0.05）. Conclusion   Enhanced recovery after surgery shows ideal clinical application effect in laparoscopic radical nephrectomy， and it can speed up the recovery of patients. It is suitable for promotion in hospitals.

【Key words】 Laparoscopic radical nephrectomy; Renal cancer; Enhanced recovery after surgery.

肾癌是泌尿外科常见的恶性肿瘤之一， 并且其在我国呈逐年上升的趋势[1]。目前治疗肾癌的手术方式很多， 包括肾癌根治术、腹腔镜腎癌根治术、肾部分切除手术、腹腔镜肾部分切除术、机器人肾癌根治术与机器人肾部分切除术等[2]。肾癌根治术是临床治疗肾癌的最有效方法之一[3]。而腹腔镜肾癌根治术由于其创伤小、恢复快、切口小、低成本等优点， 逐渐成为治疗肾癌的最佳手段之一[4]。……