山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 107-110.doi: 10.6040/j.issn.1673-3770.1.2020.026

• 临床研究 • 上一篇    下一篇

加速康复外科理念应用于甲状腺癌手术100例

马驰1,郑桂彬1,孙海清1,吴国长1,郭雅文1,孔杨2,宋西成3,郑海涛1   

  1. 1. 青岛大学附属烟台毓璜顶医院 甲状腺外科, 山东 烟台 264000;
    2. 滨州医学院公共卫生与管理学院, 山东 烟台 264000;
    3. 青岛大学附属烟台毓璜顶医院 耳鼻咽喉头颈外科, 山东 烟台 264000
  • 发布日期:2020-06-29
  • 通讯作者: 郑海涛. E-mail:zhenghaitao1972@126.com
  • 基金资助:
    山东省医药卫生科技发展计划项目(2018WS031);烟台市科技计划项目(2017WS098)

Enhanced recovery after surgery applied to 100 cases of thyroid cancer surgery

MA Chi1, ZHENG Guibin1, SUN Haiqing1, WU Guochang1, GUO Yawen1, KONG Yang2, SONG Xicheng3, ZHENG Haitao1   

  1. 1. Thyroid surgery department, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, Shandong, China;
    2. School of Public Health and Management, Binzhou Medical University, Yantai 264000, Shandong, China;
    3. Department of Otorhinolaryngology & Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, Shandong, China
  • Published:2020-06-29

PDF (PC)

379

摘要： 目的 观察加速康复外科(ERAS)在甲状腺癌手术患者围手术期的应用效果。 方法 选取行双侧甲状腺癌根治术的患者150例,随机分为ERAS组(100例)、常规手术组(50例)。ERAS组围手术期采取一系列符合加速康复理念的优化措施,非ERAS组采取传统术前准备措施。比较两组术后疼痛评分、术后恶心、术后住院时间、住院费用、并发症等指标。 结果 ERAS组患者术后疼痛评分、恶心发生例数均较低,引流管拔除时间、住院时间短,住院费用减少;其他术后并发症发生例数均较少且差异无统计学意义。 结论 甲状腺癌手术患者围手术期采用ERAS理念处理可明显降低术后疼痛、恶心等不适,缩短住院时间,节省住院费用。

关键词: 甲状腺癌, 加速康复外科, 围手术期, 术后疼痛, 住院时间

Abstract: Objective To explore the perioperative application value of enhanced recovery after surgery(ERAS)in patients requiring radical surgery for thyroid carcinoma. Methods A total of 150 patients were randomly divided into the ERAS group(100)and control group(50). Both groups underwent radical surgery for thyroid carcinoma. Patients in ERAS group underwent a series of measures as recommended by the enhanced recovery philosophy, and those in the control group were treated by traditional method. Outcomes were assessed in terms of visual analogue scale(VAS), postoperative nausea and vomiting(PONV), postoperative complications, postoperative suction drainage, drainage tube removal time, subcutaneous hydrops, and postoperative stay. Results Compared to the control group, the ERAS group had lower postoperative pain score, fewer PONV cases, lesser medical expenses, and shorter drainage tube removal time and postoperative stay. Few postoperative complications were noted in both groups. Conclusion The application of ERAS in patients requiring radical surgery forthyroid carcinoma can effectively relieve postoperative discomfort such as pain and nausea, and shorten hospital stay.

Key words: Thyroid carcinoma, ERAS, Perioperation, Postoperation pain, Length of hospital stay

中图分类号: 

  • R736
[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, 6(54):413-418.
[2] 中国抗癌协会头颈肿瘤专业委员会. 甲状腺外科ERAS中国专家共识(2018版)[J]. 中国肿瘤, 2019, 1(28):26-38.
[3] Hermann M, Gschwandtner E, Schneider M, et al. Modern thyroid surgery-the surgeon's endocrine-surgical understanding and his responsibility for the extent of surgery and complication rate[J]. Wien Med Wochenschr, 2020,27. doi:10.1007/s10354-020-00750-5.
[4] 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.
[5] Corniola MV, Meling TR, Tessitore E. Enhanced recovery after spine surgery-a multinational survey assessing surgeons' perspectives[J]. Acta Neurochir(Wien), 2020,162(6):1371-1377. doi:10.1007/s00701-020-04293-x.
[6] Derderian SC, Rove KO. Enhanced recovery after surgery among adolescents undergoing bariatric surgery[J]. Semin Pediatr Surg, 2020, 29(1): 150885. doi:10.1016/j.sempedsurg.2020.150885.
[7] Kamal YA, Hassanein A. Do perioperative protocols of enhanced recovery after cardiac surgery improve postoperative outcome?[J]. Interact Cardiovasc Thorac Surg, 2020, 30(5): 706-710. doi:10.1093/icvts/ivaa001.
[8] 宋西成. 加速康复外科理念在头颈肿瘤手术的应用价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 1-4. doi: 10.6040/j.issn.1673-3770.1.2018.010. SONG Xicheng. Application value of enhanced recovery after surgery in head and neck cancer surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 1-4. doi: 10.6040/j.issn.1673-3770.1.2018.010.
[9] Barbero-Mielgo M, García-Fernández J, Alonso-Menarguez B, et al. [Is postoperative acute pain control in colorectal surgery better within an enhanced recovery after surgery program(ERAS)?] [J]. J Healthc Qual Res, 2020, 35(2): 65-72. doi:10.1016/j.jhqr.2020.03.002.
[10] Loh JW, Taib NA, Cheong YT, et al. A double-blind, randomized controlled trial of pre-incision wound infiltration using diclofenac versus bupivacaine for post-operative pain relief in open thyroid and parathyroid surgery[J]. World J Surg, 2020,19. doi:10.1007/s00268-020-05458-6.
[11] 中华医学会外科学分会,中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20.
[12] Papoian V, Handy KG, Villano AM, et al. Randomized control trial of opioid- versus nonopioid-based analgesia after thyroidectomy[J]. Surgery, 2020, 167(6): 957-961. doi:10.1016/j.surg.2020.01.011.
[13] Suzuki S, Yasunaga H, Matsui H, et al. Factors associated with neck hematoma after thyroidectomy: a retrospective analysis using a Japanese inpatient database[J]. Medicine(Baltimore), 2016, 95(7): e2812. doi:10.1097/MD.0000000000002812.
[14] Jiang Q, Mo YC, Jin D, et al. Effect of acupoint stimulation on the quality of recovery in patients with radical thyroidectomy under the concept of enhanced recovery after surgery: a randomized controlled trial[J]. Chin Acupunct Moxibustion, 2019, 39(12): 1289-1293. doi:10.13703/j.0255-2930.2019.12.009.
[15] Narayanan S, Arumugam D, Mennona S, et al. An evaluation of postoperative complications and cost after short-stay thyroid operations[J]. Ann Surg Oncol, 2016, 23(5): 1440-1445. doi:10.1245/s10434-015-5004-3.
[16] Geraci G, D'Orazio B, Chiarenza S, et al. Efficacy of fibrin sealant in thyroid surgery. Is drainage still necessary?[J]. Ann Ital Chir, 2019, 90: 100-105.
[17] Li L, Liu WZ, Tao HS, et al. Efficacy and safety of negative pressure versus natural drainage after thyroid surgery: a systematic review and meta-analysis[J]. Medicine(Baltimore), 2018, 97(31): e11576. doi:10.1097/MD.0000000000011576.
[18] 田文, 张浩. 甲状腺外科能量器械应用专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(9): 992-997. doi:10.19538/j.cjps.issn1005-2208.2017.09.14.
[1] 李丹凤,陈福权,石力,王剑,许敏. 三维影像处理结合影像导航技术在进修医生鼻科围手术期教学中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 113-118.
[2] 王赫,宋西成. 加速康复外科在甲状腺围手术期的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 101-107.
[3] 张轶轶,薛刚,金春亭. 外泌体在甲状腺癌的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 131-135.
[4] 徐建慧,李欣,寸晶晶,叶飞. 加速康复外科在鼻中隔偏曲矫正术围手术期的应用效果[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 21-24.
[5] 潘新良. 加强甲状腺结节及恶性肿瘤的规范治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 1-12.
[6] 陈海兵, 卫亚楠, 许晓泉, 陈曦. 基于XGBoost人工智能结合CT构建甲状腺癌颈部淋巴结转移预测模型[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 40-45.
[7] 邓迪,刘均,李林珂,王吉,刘吉峰,吕丹,王海洋,甘卫刚,王君,李波,陈飞. 皮瓣二期重建策略应用于气管非环周缺损修复重建[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 52-57.
[8] 郑桂彬,张国军,马驰,韦树建,孙海清,吴国长,郭雅文,郑海涛,宋西成. 经口腔前庭入路腔镜甲状腺手术在甲状腺乳头状癌中的安全效用分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 58-63.
[9] 房忠菊, 张永侠, 赵建东, 纵亮, 翟性友, 李新建, 彭新, 任楠, 陈立伟, 刘明波. 甲状腺癌颈清扫术后乳糜漏的综合治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 64-68.
[10] 吕静荣,陈淳,马衍,谢晋. 儿童分化型甲状腺癌的临床特征及危险因素分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 88-94.
[11] 冯云,钟志明,陈国庆. 纳米碳在甲状腺乳头状癌隐匿性侧颈转移淋巴结清扫术中的临床应用价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 101-106.
[12] 王佳说, 郭星, 阎艾慧. 甲状腺乳头状癌颈淋巴结转移形成巨大囊性变的诊断总结[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 111-113.
[13] 高晓倩,姜震,耿琛琛,刘大昱,李荔. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139.
[14] 宋西成. 加速康复外科理念在头颈肿瘤手术的应用价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 1-4.
[15] 吴喜福, 孔维封, 王玮豪, 徐惠清, 戚敏, 杨钦泰. QoR-15在加速康复外科改善慢性鼻-鼻窦炎伴鼻息肉围手术期生活质量评估中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 5-8.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发