摘要
目的 探讨加速康复外科(ERAS)模式在显微镜下行精索静脉高位结扎术(以下简称精索静脉显微结扎术)中的应用效果。方法 收集2018年1月至2022年3月首都医科大学附属北京友谊医院收治的50例原发性精索静脉曲张患者的临床资料,将2018年1月至2019年12月未应用ERAS模式的23例患者作为常规组,将2020年1月至2022年3月应用ERAS模式的27例患者作为ERAS组。比较两组患者的临床指标,包括手术时间、术中出血量、胃肠功能恢复时间、术后切口疼痛程度[视觉模拟评分法(VAS)评分]、住院时间。比较两组患者的临床疗效,术前和术后3个月精子质量指标(精子数量、精子密度、a+b级精子活力、活精率)、激素指标[促卵泡激素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)、催乳素(PRL)]水平。观察并比较两组患者术后并发症发生情况。结果 ERAS组患者的术后胃肠功能恢复时间、住院时间均短于常规组患者,术后切口VAS评分低于常规组患者(P<0.05)。ERAS组患者的临床疗效优于常规组患者(P<0.05)。ERAS组患者的a+b级精子活力、活精率均高于常规组患者(P<0.05)。术后3个月,两组患者的FSH、LH、PRL均较本组术前下降,T均较本组术前升高(P<0.05)。术后3个月,两组患者的E2、PRL比较,差异均无统计学意义(P>0.05);ERAS组患者的FSH、LH均明显低于常规组患者,T明显高于常规组患者(P<0.01)。两组患者的术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论 ERAS模式能够辅助提高精索静脉显微结扎术的临床疗效,促进患者术后恢复,提高精子活力与活精率,在一定范围内改善患者的激素水平,值得临床应用。
Objective To explore the application effect of the application enhanced recovery after surgery(ERAS)mode in microligation of varicocele. Method The clinical data of 50 patients with primary varicocele admitted to Beijing Friendship Hospital, Capital Medical University from January 2018 to March 2022 were collected. The 23 patients who did not apply the ERAS mode from January 2018 to December 2019 were regarded as the routine group, and the 27 patients who received the ERAS mode from January 2020 to March 2022 were regarded as the ERAS group. The clinical indicators,including operation time, intraoperative blood loss, gastrointestinal function recovery time, postoperative incision pain [visual analogue scale(VAS) score], hospitalization time of the two groups were compared. The clinical efficacy and sperm quality indexes(sperm quantity, sperm density, a+b grade sperm motility, live sperm rate), hormone level indexes [folliclestimulating hormone(FSH), luteinizing hormone(LH), testosterone(T), estradiol(E2), prolactin(PRL)] levels before and 3 months after operation were also compared between the two groups. The postoperative complications of the two groups were also observed and compared. Result The postoperative gastrointestinal function recovery time and hospitalization time of the patients in the ERAS group were shorter than those in the routine group, and the postoperative incision VAS score was lower than that in the routine group(P<0.05). The clinical effect of patients in the ERAS group was better than that in the routine group(P<0.05). The live sperm rate and a+b grade sperm motility in the ERAS group were higher than those in the routine group(P<0.05). At 3 months after the operation, FSH, LH, and PRL in the two groups were all lower than those in the same group before the operation, and T was higher than that in the same group before the operation(P<0.05). At 3 months after the operation, there were no significant differences in E2 and PRL between the two groups(P>0.05). The FSH and LH of patients in the ERAS group were significantly lower than those in the routine group, and T was significantly higher than that in the routine group(P<0.01). There was no significant difference in the total incidence rate of postoperative complications between the two groups(P>0.05). Conclusion ERAS mode could help improve the clinical effect of microscopic ligation of spermatic vein, promote postoperative recovery, improve sperm motility and live sperm rate, and control the hormone level of patients within a certain range, which is worthy of clinical application.
作者
杨秋月
高雪
郭晓博
Yang Qiuyue;Gao Xue;Guo Xiaobo(Department of Urology Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《血管与腔内血管外科杂志》
2022年第12期1467-1471,共5页
Journal of Vascular and Endovascular Surgery
