Observation of fast track surgery in patients with thyroid neoplasm

doi:10.3877/cma.j.issn.1674-0793.2010.05.016

Abstract

Abstract:

Objective

To observe the feasibility and safety of fast track surgery in patients with thyroid neoplasm.

Methods

116 patients with thyroid neoplasm were randomly divided into two groups: fast track group (58 cases, fast track surgery) and control group(58 cases, traditional surgery). The operative time, blood loss, postoperative hospital stay, postoperative complications, postoperative nausea and vomiting and medical cost were compared.

Results

There were no significant differences in opeative time[(110.33±28.79) min vs (112.72±33.63) min] and blood loss[(100.86±42.27) ml vs (95.22±32.54) ml] between two groups. The postoperative hospital stay[(2.24±0.82) d vs (3.84±1.02) d], postoperative nausea and vomiting(34/58 vs 44/58) and medical cost[(4980.13±575.38)Yuan vs (7843.14±473.63) Yuan] in fast track group patients were significantly lower than those in non-fast track group patients, P<0.05. Patients in fast track group had no more complications than those in control group.

Conclusions

Fast track surgery can shorten postoperative hospital stay, save medical cost and accelerate rehabilitation of patients with thyroid neoplasm.

Key words: Thyroid neoplasms, Fast track surgery

Dong-sheng WANG, Bei ZHONG, Xue-ling LIU, Yan-bing ZHOU. Observation of fast track surgery in patients with thyroid neoplasm[J]. Chinese Archives of General Surgery(Electronic Edition), 2010, 04(05): 457-460.

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Figures/Tables 3

References 20

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项目		对照组	加速康复组	t/χ²	P值
年龄(岁)		51.03±11.56	49.81±12.18	0.505	0.580
性别（女/男）		53/5	54/4	0.120	0.729
身高(cm)		161.02±5.89	162.46±6.22	0.077	0.202
BMI (kg/m²)		23.63±2.96	23.17±3.72	0.433	0.457
手术方式(例)
	单侧甲状腺叶次全切除	14	12	0.198	0.656
	双侧甲状腺叶切除	8	10	0.263	0.608
	双侧甲状腺叶次全切除	27	28	0.035	0.852
	单侧甲状腺叶切除+对侧腺叶大部/部分切除	9	8	0.069	0.793

项目		对照组	加速康复组	t/χ²	P值
年龄(岁)		51.03±11.56	49.81±12.18	0.505	0.580
性别（女/男）		53/5	54/4	0.120	0.729
身高(cm)		161.02±5.89	162.46±6.22	0.077	0.202
BMI (kg/m²)		23.63±2.96	23.17±3.72	0.433	0.457
手术方式(例)
	单侧甲状腺叶次全切除	14	12	0.198	0.656
	双侧甲状腺叶切除	8	10	0.263	0.608
	双侧甲状腺叶次全切除	27	28	0.035	0.852
	单侧甲状腺叶切除+对侧腺叶大部/部分切除	9	8	0.069	0.793

措施	加速康复组	对照组
相关加速康复教育	入院后与患者及家属进行充分交流，告之围术期加速康复治疗措施，进行相关康复教育	无
术前禁食	禁食6 h，术前2 h仍给予250 ml 5%糖盐水口服	禁食10h，禁水8h
术中麻醉	颈丛+局部浸润+静脉复合，必要时全身麻醉（尽量选择半衰期短的麻醉药）	气管插管全麻
切口	不影响手术视野显露的小切口	根据手术需要，未特别注意
术中保温	术中严格执行各种保温措施	常规处理
引流管放置	不放置	常规放置
皮肤缝合	可吸收线缝合，无需拆线	一般缝合，需拆线
术后镇痛方法	切口周围局部浸润麻醉+口服非甾体抗炎药，避免使用阿片类药物	常规处理
早期下床活动	清醒后即要求患者主动下床活动	患者自愿（鼓励患者早期活动）
早期进食	清醒后即要求患者恢复流质、半流质饮食	患者自愿（鼓励患者早期进食）

措施	加速康复组	对照组
相关加速康复教育	入院后与患者及家属进行充分交流，告之围术期加速康复治疗措施，进行相关康复教育	无
术前禁食	禁食6 h，术前2 h仍给予250 ml 5%糖盐水口服	禁食10h，禁水8h
术中麻醉	颈丛+局部浸润+静脉复合，必要时全身麻醉（尽量选择半衰期短的麻醉药）	气管插管全麻
切口	不影响手术视野显露的小切口	根据手术需要，未特别注意
术中保温	术中严格执行各种保温措施	常规处理
引流管放置	不放置	常规放置
皮肤缝合	可吸收线缝合，无需拆线	一般缝合，需拆线
术后镇痛方法	切口周围局部浸润麻醉+口服非甾体抗炎药，避免使用阿片类药物	常规处理
早期下床活动	清醒后即要求患者主动下床活动	患者自愿（鼓励患者早期活动）
早期进食	清醒后即要求患者恢复流质、半流质饮食	患者自愿（鼓励患者早期进食）

组别	手术时间(min)	术中失血量(ml)	术后住院		术后恶心呕吐(例)
组别	手术时间(min)	术中失血量(ml)	治疗费用(元)	时间(d)	术后恶心呕吐(例)
对照组	112.72±33.63	95.22±32.54	3.84 ±1.02	44/58	7843.14±473.63
加速康复组	110.33±28.79	100.86±42.27	2.24±0.82	34/58	4980.13±575.38
t/χ²值	0.412	0.805	9.302	3.914	29.258
P值	0.681	0.423	0.000	0.048	0.000

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