Objectives: Pseudomyxoma peritonei (PMP) is a rare low-grade malignant tumor, which is difficult to operate with many postoperative complications. In recent years, enhanced recovery after surgery (ERAS) has been greatly developed in the perioperative management of surgical diseases, and it plays an important role in improving the postoperative prognosis of surgical patients. This study was conducted to explore the application of ERAS in the perioperative management of PMP patients, and to study the effect of ERAS on postoperative respiratory and digestive tract complications.
Methods: We retrospectively analyzed clinical data of patients with PMP from January 2014 to December 2018. These patients were treated with surgery in our center and they were divided into an observation group and a control group. The patients in the control group didn't perform ERAS in perioperative period, and patients in the observation group was performed ERAS. Then, we analyzed and compared the postoperative pulmonary complications (PPC) and gastrointestinal function between the 2 groups.
Results: There was no significant difference in the incidence of atelectasis, pleural effusion, pulmonary infection and acute respiratory distress syndrome (ARDS) between the two groups, but the total incidence of PPC in the observation group was significantly lower than that in the control group (P=0.032). The incidence of postoperative gastrointestinal dysfunction (PGID) in the observation group was significantly lower than that in the control group (P=0.025), and the postoperative first exhaust time, first defecation time, oral feeding time, and albumin level in the observation group were all better than those in the control group (all P<0.05).
Conclusions: ERAS can significantly reduce the incidence of postoperative PPC and PGID in the PMP patients and improve their postoperative recovery.
目的: 腹膜假黏液瘤(pseudomyxoma peritonei，PMP)是一种罕见的低度恶性肿瘤，其手术难度大，术后并发症多。近年来，加速康复外科(enhanced recovery after surgery，ERAS)在外科疾病的围手术期处理中得到了极大的发展，对改善外科手术患者预后起重要作用。本研究探讨ERAS对PMP患者术后呼吸道和消化道相关并发症发生率的影响。方法: 收集中南大学湘雅医院老年外科2014年1月至2018年12月PMP患者的临床数据，根据是否采取ERAS干预措施将患者分为观察组和对照组。比较两组术后肺部并发症(postoperative pulmonary complications，PPC)及胃肠道功能恢复相关指标的差异。结果: 两组肺不张、胸腔积液、肺部感染及急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)的发生率无明显差异，但观察组PPC的总体发生率(P=0.032)和术后总体胃肠道功能障碍(postoperative gastrointestinal dysfunction，PGID)的发生率(P=0.025)明显低于对照组，且观察组患者的术后初次排气时间、术后初次排便时间、术后恢复经口进食时间及术后1周白蛋白水平均明显优于对照组(均P<0.05)。结论: 采取ERAS干预措施的PMP患者术后PPC和PGID的发生明显减少，恢复明显加快。.
Keywords: enhanced recovery after surgery; postoperative gastrointestinal dysfunction; pseudomyxoma peritonei; pulmonary complications.