Wang Yuesheng,Zhang Jing,Li Xiaoqin,et al.Clinical study of enhanced recovery after surgery plus colonoscopy for colorectal polypi in children[J].Journal of Clinical Pediatric Surgery,2022,21(11):1075-1080.[doi:10.3760/cma.j.cn101785-202008070-014]
加速康复外科理念联合结肠镜技术治疗儿童肠息肉的临床研究
- Title:
- Clinical study of enhanced recovery after surgery plus colonoscopy for colorectal polypi in children
- Keywords:
- Enhanced Recovery After Surgery; Colonoscopy; Intestinal Polyps; Natural Orifice Endoscopic Surgery
- 摘要:
- 目的 探讨加速康复外科理念（enhanced recovery after surgery，ERAS）联合结肠镜技术在儿童肠息肉治疗中的应用价值及安全性。方法 收集2018年1月至2020年1月郑州大学附属儿童医院消化内科收治的200例拟行内镜下肠息肉电切术的患儿作为研究对象，采用随机数字表法分为加速康复外科联合结肠镜肠息肉切除术组（ERAS组，100例）和传统围手术期处理联合结肠镜肠息肉切除术组（对照组，100例）。记录两组患儿围手术期处理方式、临床症状、手术指标、生化指标及术后不良反应，并进行对比分析。结果 ERAS组和对照组手术时间分别为（27.77±8.76） min和（33.88±6.58） min；术后排便时间分别为（1.50±0.50） d和（3.50±1.00） d；住院天数分别为（3.00±1.00） d和（6.00±1.00） d。ERAS组术后血糖较术前明显升高[5.75（5.15，6.08） mmol/L比5.10（4.80，5.90） mmol/L，Z=-3.807，P<0.001]；ERAS组术后血胰岛素水平较术前明显升高[16.30（15.70，16.90） mU/L比7.55（6.30，9.05） mU/L，Z=-8.682，P<0.001]；ERAS组术后胰岛素抵抗指数较术前明显升高[4.07（3.77，4.34）比1.72（1.46，2.02），Z=-8.682，P<0.001]。对照组术后血糖较ERAS组术后血糖明显升高[9.60（8.90，10.80） mmol/L比5.75（5.15，6.08） mmol/L，U=21.000，P<0.001]；对照组术后血胰岛素较ERAS组术后血胰岛素明显升高[22.80（21.72，23.68） mU/L比16.30（15.70，16.90） mU/L，P<0.001]；对照组术后胰岛素抵抗指数较ERAS组术后胰岛素抵抗指数明显升高[9.77（8.89，10.77）比4.07（3.77，4.34），P<0.001]。ERAS组和对照组手术过程中均无一例发生误吸，两组分别发生腹痛6例和21例；腹泻4例和5例；呕吐5例和24例；头晕23例和5例。对照组视觉模拟量表评分明显高于ERAS组[（6.00±1.00）分比（3.50±1.00）分，χ2=38.000，P<0.001]。结论 ERAS方案可以加速结肠镜治疗肠息肉患儿的康复，减少术后并发症，在内镜手术管理中具有一定的安全性与可行性。
- Abstract:
- Objective To explore the clinical value and safety of enhanced recovery after surgery (ERAS) plus colonoscopy for colorectal polypi in children.Methods Clinical data were retrospectively reviewed for 200 children undergoing endoscopic resection of colorectal polypi.They were randomized into two groups of ERAS plus colonoscopic polypectomy (n=100) and conventional perioperative management plus colonoscopic polypectomy (n=100).Perioperative treatment, clinical symptoms, surgical parameters, biochemical indices and postoperative adverse reactions were recorded.Results Operative duration of ERAS and control groups was[(27.77±8.76) vs.(33.88±6.58) min], postoperative defecation time[(1.50±0.50) vs.(3.50±1.00) days]and hospitalization duration[(3.00±1.00) vs.(6.00±1.00) days].In ERAS children, blood glucose post-operation was significantly higher than that pre-operation[5.75(5.15, 6.08) vs.5.10(4.80, 5.90), Z=-3.807, P<0.001], blood insulin spiked significantly post-operation[16.30(15.70, 16.90) vs.7.55(6.30, 9.05), Z=-8.682, P<0.001], insulin resistance index post-operation was significantly higher than that pre-operation[4.07(3.77, 4.34) vs.1.72(1.46, 2.02), Z=-8.682, P<0.001], blood glucose post-operation in control group was significantly higher than that in ERAS group[9.60(8.90, 10.80) vs.5.75(5.15, 6.08), U=21.000, P<0.001], blood insulin was significantly higher in control group than that in ERAS group[22.80(21.73, 23.68) vs.16.30(15.70, 16.90), P<0.001]and insulin resistance index was significantly higher in control group than that in ERAS group[9.77(8.89, 10.77) vs.4.07(3.77, 4.34), P<0.001].Two group are no aspiration during operation and abdominal pain was (6 vs.21), diarrhea (4 vs.5), vomiting (5 vs.24) and dizziness (23 vs.5).VAS was significantly higher in control group than that in ERAS group[(6.00±1.00) vs.(3.50±1.00), χ2=38.000, P<0.001].Conclusion After colonoscopy for colorectal polypi, ERAS can accelerate the rehabilitation and lower postoperative complications in children.It is both safe and feasible in the management of endoscopic surgery.
参考文献/References:
[1] Memtsoudis SG, Fiasconaro M, Soffin EM, et al.Enhanced recovery after surgery components and perioperative outcomes:a nationwide observational study[J].Br J Anaesth, 2020, 124(5):638-647.DOI:10.1016/j.bja.2020.01.017.
[2] 李小芹, 王跃生.儿童结直肠息肉的内镜治疗[J].中国实用儿科杂志, 2018, 33(11):831-836.DOI:10.19538/j.ek2018110605. Li XQ, Wang YS.Endoscopic therapy for colorectal polyps in children[J].Chin J Pract Pediatr, 2018, 33(11):831-836.DOI:10.19538/j.ek2018110605.
[3] 茆康卫, 练敏, 刘志峰, 等.儿童结直肠息肉670例临床分析[J].临床儿科杂志, 2018, 36(10):738-740.DOI:10.3969/j.issn.1000-3606.2018.10.003. Mao KW, Lian M, Liu ZF, et al.Clinical analysis of colorectal polyps in 670 children[J].J Clin Pediatr, 2018, 36(10):738-740.DOI:10.3969/j.issn.1000-3606.2018.10.003.
[4] 杨洪彬, 方莹, 任晓侠, 等.儿童结肠息肉内镜治疗术后并发症的相关因素研究[J].中国实用儿科杂志, 2019, 34(8):694-698.DOI:10.19538/j.ek2019080618. Yang HB, Fang Y, Ren XX, et al.Study on related factors of postoperative complications after endoscopic treatment for colon polyps in children[J].Chin J Pract Pediatr, 2019, 34(8):694-698.DOI:10.19538/j.ek2019080618.
[5] 中华医学会消化内镜学分会儿科协作组.中国儿童胃镜结肠镜检查规范操作专家共识[J].中华消化内镜杂志, 2019, 36(1):6-9.DOI:10.3760/cma.j.issn.1007-5232.2019.01.003. Pediatric Group, Chinese Society of Digestive Endoscopology.Expert Consensus on Standardized Operation of Gastroscopy and Colonoscopy in Children in China[J].Chin J Dig Endos, 2019, 36(1):6-9.DOI:10.3760/cma.j.issn.1007-5232.2019.01.003.
[6] 彭琨, 周崇高, 李碧香, 等.加速康复外科理念在胆道闭锁围手术期的应用研究[J].临床小儿外科杂志, 2019, 18(12):1043-1048.DOI:10.3969/j.issn.1671-6353.2019.12.011. Peng K, Zhou CG, Li BX, et al.Application of enhanced recovery after surgery in perioperative managemengt of biliary atresia[J].J Clin Ped Sur, 2019, 18(12):1043-1048.DOI:10.3969/j.issn.1671-6353.2019.12.011.
[7] Roh CK, Son SY, Lee SY, et al.Clinical pathway for enhanced recovery after surgery for gastric cancer:a prospective single-center phase II clinical trial for safety and efficacy[J].J Surg Oncol, 2020, 121(4):662-669.DOI:10.1002/jso.25837.
[8] Kobayashi S, Segami K, Hoshino H, et al.Risk factors for failure of early recovery from pancreatoduodenectomy despite the use of enhanced recovery after surgery protocols and a physical aging score to predict postoperative risks[J].J Hepatobiliary Pancreat Sci, 2018, 25(4):231-239.DOI:10.1002/jhbp.540.
[9] Scott AV, Stonemetz JL, Wasey JO, et al.Compliance with surgical care improvement project for body temperature management (SCIP Inf-10) is associated with improved clinical outcomes[J].Anesthesiology, 2015, 123(1):116-125.DOI:10.1097/ALN.0000000000000681.
[10] Wang WK, Tu CY, Shao CX, et al.Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients:a randomized clinical trial[J].Braz J Med Biol Res, 2019, 52(5):e8265.DOI:10.1590/1414-431X20198265.
[11] Gianotti L, Biffi R, Sandini M, et al.Preoperative oral carbohydrate load versus placebo in major elective abdominal surgery (PROCY):a randomized, placebo-controlled, multicenter, phase III trial[J].Ann Surg, 2018, 267(4):623-630.DOI:10.1097/SLA.0000000000002325.
[12] Nygren J, Thorell A, Ljungqvist O.Preoperative oral carbohydrate therapy[J].Curr Opin Anaesthesiol, 2015, 28(3):364-369.DOI:10.1097/ACO.0000000000000192.
[13] 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暨路径管理指南(2018)[J].中华麻醉学杂志, 2018, 38(1):8-13.DOI:10.3760/cma.j.issn.0254?1416.2018.01.003. Surgery Branch of Chinese Medical Association, Anesthesiology Branch of Chinese Medical Association.Consensus on ERAS and Guidelines for Pathway Management in China (2018)[J].Chin J Anesthesiol, 2018, 38(1):8-13.DOI:10.3760/cma.j.issn.0254?1416.2018.01.003.
[14] 舒强, 钭金法.加速康复外科在小儿外科中的应用与展望[J].临床小儿外科杂志, 2019, 18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001. Shu Q, Tou JF.Applications and future prospects of enhanced recovery after surgery during pediatric surgery[J].J Clin Ped Sur, 2019, 18(4):253-256.DOI:10.3969/j.issn.1671-6353.2019.04.001.
[15] Pan JR, Hei ZQ, Li LP, et al.The advantage of implementation of enhanced recovery after surgery (ERAS) in acute pain management during elective cesarean delivery:a prospective randomized controlled trial[J].Ther Clin Risk Manag, 2020, 16:369-378.DOI:10.2147/TCRM.S244039.
[16] 林松, 苏迎春, 周思海, 等.加速康复外科理念在穿孔性阑尾炎中的应用[J].临床小儿外科杂志, 2019, 18(4):267-271.DOI:10.3969/j.issn.1671-6353.2019.04.004. Lin S, Su YC, Zhou SH, et al.Application of enhanced recovery after surgery for perforated appendicitis[J].J Clin Ped Sur, 2019, 18(4):267-271.DOI:10.3969/j.issn.1671-6353.2019.04.004.
[17] Ge LN, Wang L, Wang F.Effectiveness and safety of preoperative oral carbohydrates in enhanced recovery after surgery protocols for patients with diabetes mellitus:a systematic review[J].Biomed Res Int, 2020, 2020:5623596.DOI:10.1155/2020/5623596.
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备注/Memo
收稿日期:2020-08-29。
基金项目:2018年度河南省医学科技攻关计划项目（2018020639）
通讯作者:李小芹,Email:lixiaoqinys@126.com