The Application Of Fast-track Surgery In Perioperative Period Of Patients With Uterine Fibroids

Objective:To analyze the application of Fast-track Surgery(FTS)conception in perioperative management of hysteromyomectomy(PH),meanwhile to explore its efficacy,safety,economic and advantages compared with traditional perioperative management mode.The application and its application value of FTS conception in PH were systemic studied by article retrieval.Aimed to provide guidance for the recovery of the patient and data support for the concept of the FTS in clinical applications.Methods:Relevant literature in the system Pubmed,EMBase,the Cochrane Library datebases,Chinese biomedical literature database(CBM),China national knowledge infrastructure(CNKI)and other datebase by Subject or Keywords dated from January 2001 to December 2017 were retrieved.References in the target literature are also used as reference sources.The literatures about application of FTS conception and traditional surgery in PH were collected.Randomized controlled trial(RCT)and Clinical controlled trial(CCT)were researched.For example,the subject is: Uterine fibroids and(or)Fast-track Surgery and(or)enhanced recovery after surgery,etc..Inclusion criteria and exclusion criteria were strictly formulated and implemented which was used to assessing the quality and extracting the data of literatures.Then the data which collected comprehensively were statistical treated with the method Revman 5.3 software and draw a conclusion.Results:Finally,19 literatures were included,including 18 Chinese randomized controlled trials and 1 English randomized controlled trial with the above clinical data for the application of FTS in the perioperative period of uterine fibroids.A total of 1892 patients were collected,among which 973 were FTS and 919 in the control group.Compared with the control group,the results of Meta-analysis showed that(1)The difference in the incidence of nausea and vomiting was statistically significant(RR=0.33,95%CI[0.25,0.44],P<0.00001),(2)The postoperative pain(RR=0.35,95%CI[0.26,0.48],P<0.00001),(3)Reduction of postoperative complications(postoperative pelvic and incision infection,pulmonary infection,urinary tract infection,etc.)showed significant statistical significance(RR=0.44,95%CI [0.33,0.59],P<0.00001),(4)The postoperative bladder irritability(RR=0.56,95%CI[0.38,0.82],P=0.003),(5)The results showed significant statistical significance(SMD=-1.59,95%CI[-2.48,-0.70],P=0.0004),(6)Shorten the postoperative hospitalization time results statistically significant difference(SMD = 2.0,95% CI /-0.37-0.37,P = 0.02 < 0.05),(7)The difference in results of postoperative hospitalization expenses was significantly statistically significant(SMD=-1.68,95%CI[-2.05,-1.31],P<0.00001),(8)Reduce the intraoperative blood loss results statistically significant difference(SMD = 0.84,95% CI /-1.62-1.62,P = 0.03 < 0.05),(9)To shorten the average operation time results statistically significant difference(SMD = 2.0,95% CI /-0.37-0.37,P = 0.02 < 0.05).Conclusion:The application of FTS in PH is safe and effective and deserves further promotion.