| ObjectiveTo understand the current research status of domestic and international enhanced recovery after surgery research and gynecological enhanced recovery after surgery through bibliometric method and using CiteSpace to draw a scientific knowledge map.To construct a ERAS program for patients undergoing laparoscopic radical hysterectomy based on the evidence-based medicine and to evaluate its effectiveness and provide reference for accelerating the further application of ERAS in gynecological malignant tumor surgery.Methods1.The literature about ERAS from Web of Science and CNKI was retrieved,the time distribution and keywords of the literatures was analyzed by CiteSpace,the research fields was calculated through bibliometric method,the hot research fields of ERAS at home and abroad from 2007 to 2016 were summarized.And the literatures of gynecological ERAS were further analyzed,the types of disease,interventions and effectevaluation indicators for ERAS applied to gynecology were explored.2.The relevant guidelines and literatures for enhanced recovery after surgery in gynecologic malignancies were reviewed and analyzed,ERAS program for patients undergoing laparoscopic radical hysterectomy focusing on the high-quality guidelines and clinical studies was drafted.And the draft was revised to construct the ERAS program for laparoscopic radical hysterectomy through the multidisciplinary expert meeting.3.Experimental research was used to evaluate the ERAS program.143 patients undergoing laparoscopic radical hysterectomy with cervical cancer cared according to ERAS program from January to December 2017 was experimental group,137 patients with cervical cancer cared according to conventional pathways from January to December 2016 was historical control group.The incidence of postoperative complications,the time of early ambulation,the recovery time of gastrointestinal function,the hospital stay,the hospitalization cost and the readmission rate 30 days after surgery between two groups were compared.Results1.521 relevant English literatures were detected in the WOS database,and 181 related Chinese literatures were detected in the CNKI database.The number of clinical research literatures on ERAS at home and abroad showed an upward trend.Domestic and international ERAS research focused on the field of gastrointestinal surgery.29 literatures on ERAS inthe field of gynecology at home and abroad mainly related to benign gynecological diseases.A total of 18 interventions and 19 types of effect evaluation indicators were mentioned in the literatures.2.A total of 9 clinical research literatures,1 gynecological ERAS guideline were reviewed through the literature search and quality evaluation,the ERAS program for patients undergoing laparoscopic radical hysterectomy was drafted based on summary of evidences.Ten experts participated in the multidisciplinary expert meeting and the expert authority coefficient(Cr)was higher than 0.8.The formal ERAS program included19 perioperative items was revised.3.The total incidence of postoperative complications in the experimental group was 23.08%,significantly lower than that in the historical control group(38.69%),with statistically significant differences(P<0.05).The median time to get out of bed(2 days)in the experimental group was lower than that in the historical control group(3 day),with statistically significant differences(P<0.05).The median time of initial feeding(1 day)in the experimental group was lower than that in the historical control group(2 days),with statistically significant differences(P<0.05).The median time of exhaust(1.5 days)in the experimental group was lower than that in the historical control group(2 days),with statistically significant differences(P<0.05).And the median time of defecation(3 days)in the experimental group was lower than that in thehistorical control group(4 days),with statistically significant differences(P<0.05).The postoperative hospital stay(10.55±2.69 days),cost(24931.72±9150.30 yuan),and the re-admission rate after surgery(2.10%)showed no difference with the postoperative hospital stay(10.41±3.07days),cost(25847.49±6094.87 yuan)and re-admission rate after surgery(2.19%)in the historical control group(P>0.05).ConclusionFurther ERAS researches in the field of gynecology,especially in the field of gynecological malignant tumors are needed.ERAS program for laparoscopic radical hysterectomy based on the evidence-based medicine method and revised by experts meeting can reduce the incidence of postoperative complications,shorten the time of getting out of bed and intestinal function recovery for cervical cancer patients underwent laparoscopic radical hysterectomy.The program could be well applied in the perioperative period of gynecologic malignant tumor surgery. |
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