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Eur Uro:ERAS方案应用于根治性膀胱切除术中的优点。

2017-08-11 fengxiangxin MedSci原创

促进术后恢复(enhanced recovery after surgery,ERAS)方案,是一种多模式的围手术期综合诊疗路径。其目的是通过对手术进行风险评估和干预,优化治疗共存病症包括心血管、呼吸系统和/或肾脏疾病,同时治疗和维持患者在围手术期重要脏器官的功能,了解和处理患者存在的社会和行为因素,比如非法药物的使用情况以及对烟草和酒精的依赖等等,减少术中和术后患者身体对外科手术的严重应激反应。

促进术后恢复(enhanced recovery after surgery,ERAS)方案,是一种多模式的围手术期综合诊疗路径。其目的是通过对手术进行风险评估和干预,优化治疗共存病症包括心血管、呼吸系统和/或肾脏疾病,同时治疗和维持患者在围手术期重要脏器官的功能,了解和处理患者存在的社会和行为因素,比如非法药物的使用情况以及对烟草和酒精的依赖等等,减少术中和术后患者身体对外科手术的严重应激反应。这个计划以往主要用于结直肠手术、血管外科手术、胸外科手术的病人,近年来也扩大到根治性膀胱手术的病人。多模式ERAS的应用明显改善了结直肠手术的疗效,为了进一步探讨该方案在泌尿外科中的应用价值,研究者收集了在单一机构连续行RC患者的相关结果。控制因素包括:组成康复训练的26个部分、同一天入院、碳水化合物负荷、术中液体复苏、区域麻醉、鼻胃管的停用、不做口服法肠道准备、今早去除导尿管的使用、动员尽早下地活动、嚼口香糖和审查。共有453位连续接受RC的患者,其中393(87%)位实施了ERAS方案。实施了ERAS方案的患者相比没有实施的患者,住院时间缩短了(中位数[间距范围]:8 [ 6-13 ]天

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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Aug 13 05:57:52 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232712, encodeId=e8b0232e1249, content=好好看下,实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Aug 12 06:44:39 CST 2017, time=2017-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232616, encodeId=d524232616bf, content=不错学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-13 jeanqiuqiu
  6. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-13 1e10c84am36(暂无匿称)

    文章不错,赞赞赞

    0

  7. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-12 忠诚向上

    好好看下,实用

    0

  8. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Aug 13 05:57:52 CST 2017, time=2017-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232712, encodeId=e8b0232e1249, content=好好看下,实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Aug 12 06:44:39 CST 2017, time=2017-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232616, encodeId=d524232616bf, content=不错学习下, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 林3301

    不错学习下

    0

  9. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuBA90ng5ibXMmibn1feGOQ2cjw0S48DKsF0icicFlmRxwHibIic2TNGd22vVqkKRMj2cRSWbpqZAPBPgdt/0, createdBy=81031668757, createdName=林3301, createdTime=Fri Aug 11 23:41:54 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232582, encodeId=3f9f2325823f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Fri Aug 11 22:33:43 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=232581, encodeId=076b232581de, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 1771ae4158m

    学习一下很不错

    0

  10. 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level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0aa31415219, createdName=orangesking, createdTime=Fri Aug 11 22:33:10 CST 2017, time=2017-08-11, status=1, ipAttribution=)]
    2017-08-11 orangesking

    学习

    0

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根治性膀胱切除术后发生尿道癌的危险因素分析

目前,膀胱肿瘤的发病率已居我国男性恶性肿瘤的第7位,对于MIBC、高危膀胱癌等的标准手术方式是根治性膀胱切除术,但术后部分患者会发生尿道癌。众多研究报道,根治性膀胱切除术后尿道癌的发生率为0~18%。Stenzl等的荟萃分析结果显示,根治性膀胱切除术后尿道癌的发生率约为8.1%。本组350例患者术后尿道癌发生率为8%,与文献报道相符。既往NMIBC病史是根治性膀胱切除术后尿道癌复发的独立危险因素。

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