| Part Ⅰ Enhanced recovery after surgery in the perioperative period of elderly patients with gynecological malignant tumorsObjective:To explore the clinical effect of enhanced recovery after surgery surgery in the elderly patients with gynecological malignant tumor during perioperative period,and to evaluate its safety,effectiveness and feasibility.Methods:1.From January 2016 to December 2021,239 inpatients who were diagnosed as gynecological malignancy by gynecological operation and pathology in the Affiliated Hospital of Chengde Medical College and were over 60 years old were selected.According to the concept of ERAS implemented since January 2019,90 patients with traditional concept of perioperative management from January 2016 to December 2018 were included in the traditional group,and 149 patients with accelerated rehabilitation surgery perioperative management concept from January 2019 to December 2011 were included in the ERAS group.Both groups were performed by the same surgery,anesthesia and the corresponding nursing team.Compared two groups of intraoperative blood loss,intraoperative rehydration quantity for the first time,operation time,postoperative exhaust time defecate,remoal of drainage tube time,interval of first postoperative chemotherapy,postoperative hospital stay,total hospital stay,hospitalization expenses,the incidence of complications 30 days after the operation,the rate of re-admission 30 days after the operation,and the mortality 30 days after the operation postoperative complication,and to evaluate the gynecologic malignant tumor in elderly patients with perioperative application effect.2.Using SPSS 25.0 statistical software,the measurement data were tested by t-test,the counting data by c2 test,and the grade data by rank sum test.P < 0.05 means the difference is statistically significant.Results:1.There was no significant difference in age,BMI,disease type,surgical stage and mode of operation between the two groups(P > 0.05).2.The intraoperative blood loss[100(50,200)ml vs 200(100,300)ml],intraoperative fluid infusion volume [1725.91 ±640.36 ml vs 1919.56±665.02ml] and operation time[120.72 ±49.27 min vs 147.79 ±67.96min] in ERAS group were significantly less than those in CG group(P < 0.05).3.There were statistically significant differences between the two groups in postoperative exhaust [2.34±0.71 d vs 2.74±0.83d],defecation time[2.93±1.49 d vs 4.02±1.69d],interval time between the first postoperative chemotherapy [9.99±1.84 d vs 13.32±4.25d],length of postoperative hospital stay [6.74±2.67 d vs 9.33±7.47d],total length of hospital stay [12.05±4.14 d vs 16.51±8.91d],in which ERAS group was shorter than CG group(P <0.05).There was no statistical significance in the time of removal of drainage tube and hospitalization cost(P > 0.05).4.The incidence of postoperative complications in the ERAS group was significantly lower than that in the CG group at 30 days after surgery[15(10.1%)vs 27(30.0%)](P < 0.05).Conclusions:It is safe and feasible to apply the concept of ERAS in the perioperative period of elderly patients with gynecological malignant tumor,which reduces the amount of bleeding and fluid replacement during operation,shortens the operation time,the first postoperative exhaust,defecation time,the interval between the first postoperative chemotherapy,the postoperative hospitalization time and the total hospitalization time,and reduces the occurrence of postoperative complications.Part Ⅱ Enhanced recovery after surgery in the perioperative management of gynecological malignant tumors: a Meta-analysisObjective:To investigate the effect of enhanced recovery after surgery in the perioperative management of gynecological malignant tumor patients.Methods:Eight databases including Pub Med,EMBASE,Web of Science,Cochrane Library,CNKI,Wan Fang,VIP and CBM were searched.The clinical trials comparing the effect of enhanced recovery after surgery concept and traditional concept in the perioperative period of gynecological malignant tumor patients from the establishment of the database to October2021 were retrieved,including randomized controlled trails,cohort studies and case-control studies.Cochrane risk bias tool and Newcastle Ottawa scale were used to evaluate the literature quality of randomized controlled trials and non-randomized controlled trials respectively.Rev Man 5.4 was selected for meta-analysis.Results:There were 28 studies included eventually,with a total of 3901 patients.Among them,there were 1897 cases in the experimental group and 2004 cases in the control group.Meta-analysis showed that there were significant differences between enhanced recovery after surgery group and traditional group in the operative time,the time of the first postoperative exhaust and defecation,getting out of bed and eating,the postoperative hospital stay,and the postoperative complications(P < 0.01).Conclusions:Compared with the traditional concept,the perioperative application of ERAS concept in gynecological malignant tumor patients can shorten the operative time,the time of the first postoperative exhaust and defecation,getting out of bed and eating,the postoperative hospital stay,and the postoperative complications,which is a safe and feasible measure and can be further popularized and applied in clinic. |
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