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

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] 张中华,王辉,王俊鑫,张美玲,张建,张恩东,潘新良. 腋窝入路腔镜手术和传统颈部开放手术治疗T1甲状腺癌的安全性和有效性对比研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 161-167.
[2] 杨鸣,刘雪霞,张华. m6A识别蛋白IGF2BPs家族在头颈肿瘤中的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 153-161.
[3] 罗露,周恩,肖旭平,林志强,方志杰,吕晓虹. 等离子点状激发技术在儿童OSA扁桃体腺样体切除术联合围手术期快速康复中的应用[J]. 山东大学耳鼻喉眼学报, 2024, 38(5): 26-30.
[4] 张西,邓启成,张震,程瑶,王靖淞,赵锐,刘海. 营养支持对喉癌术后咽瘘影响的Meta分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 51-59.
[5] 冯琰琰,张丹旭,张康大,王林雨,王焕亮. 耳大神经阻滞对人工耳蜗植入术后患儿苏醒期谵妄的影响[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 15-19.
[6] 王安洋,李超友,薛刚,吴靖芳. 肠道菌群与甲状腺疾病的关系[J]. 山东大学耳鼻喉眼学报, 2023, 37(1): 132-139.
[7] 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.
[8] 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.
[9] 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.
[10] 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.
[11] 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.
[12] 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.
[13] 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.
[14] 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.
[15] 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.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!