The Clinical Application Of Enhanced Recovery After Surgery In Percutaneous Nephrolithotripsy

ObjectiveTo study the application of Enhanced Recovery After Surgery(ERAS)in perioperative management of percutaneous nephrolithotomy(PCNL).To explore the safety,feasibility and economy of ERAS perioperative concept in PCNL and provide theoretical basis for optimizing the perioperative period of PCNL.MethodsFrom Jan.to Dec.2018,235 patients with upper urinary tract stones admitted to urology ward of the First Affiliated Hospital of Nanhua University were randomly divided into two groups according to the inclusion criteria.According to the concept of ERAS,the two groups were defined as ERAS group(118 cases)and Conventional surgery group(117 cases).The differences of calculus clearance rate,visual analogue scale(VAS),incidence of infection and fever,bleeding and blood transfusion,time of indwelling renal fistula and catheter,hospitalization time and total hospitalization cost,complications such as perirenal hematoma and urinary exosmosis were observed and compared between the two groups.Continuous measurement data are described by mean,standard deviation,variance,minimum,maximum and percentile.T test is used for normal distribution data,Wilcoxon rank test and Mann-Whitney U test are used for non-normal distribution data,and discontinuous grade,counting data are described by use case number and rate.Pearson Chi-Squ test and Fisher Exact Test are used for data.P < 0.05 isconsidered statistically significant.ResultsCompared with the traditional operation group,the stone size,stone clearance rate(92.31% vs 90.06%)and operation time(54.2±12.09 min vs57.97±10.93 min)of the ERAS group had no significant difference(P > 0.05)in general data of patients,such as gender,age(51±11 years vs 52±12 years),diagnosis and basic disease equidistances(P > 0.05).There was no significant difference in VAS score immediately after operation(0.009 vs 0.034,P =0.176),VAS pain score decreased significantly 4 hours after operation(0.795 vs 4.786,P = 0.000);Hemoglobin loss was less after operation(4.79±5.63g/L vs 8.34±7.23g/L,P = 0.000).Although hematuria occurred in both groups after operation(occult urinary blood(? 3+),fewer cases occurred in the ERAS group(2 vs 10,P = 0.040),which actively stopped bleeding.After symptomatic treatment,urine color recovered quickly(urinary occult blood <±),no transfusion,renal artery interventional embolization and nephrectomy occurred;the time of retaining renal fistula after operation(3.6±1.0 vs 5.2±1.1 days,P = 0.000)and the time of catheterization(2.6±1.0 vs 4.2±1.1 days,P = 0.000)were significantly shortened;the total complication rate of ERAS group was significantly less than that of conventional group(15 vs 22,P=0.573);no cases of liver,gallbladder,spleen,pancreas,small intestine,lung and other organ damage were found;the patients in the ERAS group and the conventional surgery group(5 vs 6,P = 1.000)had symptoms of chills and fever(temperature > 38.5?).After symptomatic support treatment,such as upgrading antibiotics and increasing fluid replacement,the symptoms improved quickly,and no infectious shock or death occurred.Postoperative hospitalization time was less in the ERAS group(4.6±1.0 vs 6.2±1.1 days,P= 0.000).The total cost of hospitalization in the two groups was equivalent(21347.79±2404.09 vs 21596.95±2292.77 yuan,P = 0.529).There was no significant difference in other related indicators(P > 0.05).No adversecomplications such as secondary hemorrhage,urinary fistula,perirenal hematoma,recurrence of calculi and acute renal insufficiency were found in the 1-month follow-up.Conclusions1.It is safe and feasible to apply ERAS perioperative concept in PCNL.2.ERAS can effectively reduce the risk of postoperative bleeding,shorten the length of stay with PCNL patients,and it can provide experimental basis for the successive study of ERAS perioperative management and the feasibility of popularization and application.