[1]张静夏瑜孙可①陆希②安宁宁毛文娟③张勍烨④王永军**.妇科良性疾病腹腔镜手术围术期胃肠道临床管理路径的随机对照研究[J].中国微创外科杂志,2026,01(3):0.
　Zhang Jing*,Xia Yu*,Sun Ke,et al.Randomized Controlled Trial of a Perioperative Gastrointestinal Clinical Management Pathway in Laparoscopic Surgery for Benign Gynecological Diseases[J].Chinese Journal of Minimally Invasive Surgery,2026,01(3):0.
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妇科良性疾病腹腔镜手术围术期胃肠道临床管理路径的随机对照研究()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年3期
页码:
0
栏目:
临床研究
出版日期:
2026-03-26

文章信息/Info

Title:
Randomized Controlled Trial of a Perioperative Gastrointestinal Clinical Management Pathway in Laparoscopic Surgery for Benign Gynecological Diseases
作者:
张静夏瑜孙可①陆希②安宁宁毛文娟③张勍烨④王永军**
(首都医科大学附属北京积水潭医院妇产科，北京100035)
Author(s):
Zhang Jing*;  Xia Yu*;  Sun Ke;  et al.
*Department of Obstetrics and Gynecology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035,China
关键词:
腹腔镜手术; 妇科良性疾病; 胃肠道临床管理路径
Keywords:
Laparoscopic surgery; Benign gynecological diseases; Gastrointestinal clinical management pathway
文献标志码:
A
摘要:
目的探讨妇科良性疾病腹腔镜围术期胃肠道临床管理路径的可行性和安全性。方法基于加速康复外科理念，构建具体、流程化、实操性强的围术期胃肠道管理临床路径，采用开放标签的随机对照研究，纳入2020年9月~2024年2月因妇科良性疾病行腹腔镜手术治疗患者340例，分为研究组(采用围术期临床管理路径)175例和对照组(采用传统管理方案)165例。比较2组术前饥饿感发生率，术后排气时间，腹胀发生率，术前空腹、入手术室前、术后即刻、术后第1天空腹血糖，术后第1天尿酮体≥3+发生率，术后1、2周和1个月肠梗阻发生率等指标。结果研究组术前饥饿感发生率更低［149%(26/175) vs.26.1%(43/165), χ2=6.590，P=0.010］,术后排气时间显著短于对照组［(11.1±7.9)h vs.(16.0±88)h，t=-5.400，P=0.000］，术后第1天尿酮体≥3+发生率显著低于对照组［2.3%(4/175) vs.7.9%(13/165)， χ2=5593，P=0.018］。2组患者术后呕吐、腹胀发生率差异无显著性(P>0.05)。剔除研究组使用镇痛泵9例，对照组使用镇痛泵56例后，2组患者恶心、呕吐发生率差异无显著性［22.9%(38/166) vs. 26.1%(28/109), χ2=0.282，P=0.595；13.3%(22/166) vs.128%(14/109), χ2=0.010，P=0.922］。按术中出血量和手术时间进行亚组分析，结果与未分组前基本一致。不同时间点血糖水平差异有显著性(F=103.373,P=0.000)，除入手术室前与术后第1天空腹血糖差异无显著性(P=1.000)外，其他各时间点两两比较差异均有显著性(均P=0.000)；组别差异无显著性(F=2.025，P=0.156)，时间×组别交互作用不显著(F=1.221，P=0.302)。2组术后1、2周和1个月均无肠梗阻发生。结论构建的胃肠道临床管理路径，加速了妇科腹腔镜术后胃肠功能的恢复，在不增加并发症风险的前提下，优化了患者的围术期体验。
Abstract:
ObjectiveTo explore the feasibility and safety of a perioperative gastrointestinal clinical management pathway for patients undergoing laparoscopic surgery for benign gynecological diseases.MethodsGuided under the enhanced recovery after surgery (ERAS) concept, we developed a specific, standardized, and highly practical pathway for perioperative gastrointestinal management. In this openlabel randomized controlled trial, 340 patients who underwent laparoscopic surgery for benign gynecological diseases between September 2020 and February 2024 were randomly divided into the study group (clinical management pathway, n=175) or the control group (traditional management, n=165). The incidence of preoperative hunger, time to first postoperative flatus, incidence of abdominal distension, fasting blood glucose levels before surgery, before entering the operating room, immediately after surgery, and on the first postoperative day, as well as postoperative urinary ketone levels (≥3+) on the first postoperative day and the incidence of intestinal obstruction at 1 week, 2 weeks, and 1 month postoperatively were compared between the two groups.ResultsThe study group had a significant lower incidence of preoperative hunger ［14.9% (26/175) vs. 26.1% (43/165), χ2=6590, P=0.010］ and a shorter time to first flatus than the control group ［(11.1±7.9)h vs. (16.0±8.8)h, t=-5.400, P=0000］. The study group had a significantly lower incidence of ketonuria (≥3+) than the control group on the first postoperative day ［2.3%(4/175) vs. 7.9%(13/165), χ2=5.593, P=0.018］. There were no significant differences in the incidence of postoperative vomiting or abdominal distension (P＞0.05). After excluding patients using patientcontrolled analgesia (9 in the study group and 56 in the control group), no significant differences were found in the incidence of nausea ［22.9%(38/166) vs. 26.1%(28/109), χ2=0.282, P=0.595］ or vomiting ［13.3%(22/166) vs. 128%(14/109), χ2=0.010, P=0.922］. Subgroup analyses based on intraoperative blood loss and operative time yielded results consistent with the overall findings. Significant differences in blood glucose levels were observed across different time points (F=103373, P=0.000). Except for the nonsignificant difference in fasting blood glucose before entering the operating room and on the first postoperative day (P=1.000), all pairwise comparisons at other time points showed significant differences (all P=0000). There was no significant difference between groups (F=2.025, P=0.156), and the interaction between time and group was not significant (F=1.221, P=0.302). No cases of intestinal obstruction occurred in both groups at 1 week, 2 weeks, and 1 month postoperatively.ConclusionThe perioperative gastrointestinal clinical management pathway established in this study significantly facilitates the recovery of gastrointestinal function after laparoscopic gynecological surgery and optimizes the perioperative experience for patients without increasing the risk of complications.

参考文献/References:

[1]Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation， Br J Anaesth,1997,78(5):606-617.
[2]Schwenk W, Flemming S, GironaJohannkmper M, et al. Structured implementation of fasttrack pathways to enhance recovery after elective colorectal resection: First results from five German hospitals. Chirurgie(Heidelb),2024,95(2):148-156.
[3]Helander EM, Webb MP, Menard B, et al. Metabolic and the surgical stress response considerations to improve postoperative recovery. Curr Pain Headache Rep,2019,23(5):33.
[4]Gustafsson UO, Scott MJ, Hubner M, et al.Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery(ERAS) Society recommendations: 2018. World J Surg,2019,43(3):659-695.
[5]中华医学会妇产科学分会加速康复外科协作组.妇科手术加速康复的中国专家共识.中华妇产科杂志，2019,54(2):73-79.
[6]金颖,李幸霞,齐佳燕,等.加速康复外科指南在我国25个省份三级甲等医院妇科的应用情况调查.中华护理杂志,2018,53(9):1084-1088.
[7]Husslein H, Franz M, Gutschi M, et al. Postoperative gum chewing after gynecologic laparoscopic surgery. Obstet Gynecol,2013,122:85-90.
[8]Park SH, Choi MS. Metaanalysis of the effect of gum chewing after gynecologic surgery. J Obstet Gynecol Neonatal Nurs,2018,47(3):362-370.
[9]Lim L, Park SJ, Kang C, et al. Perioperative urinary ketosis and metabolic acidosis in patients fasted for undergoing gynecologic surgery. Acta Anaesthesiol Scand,2024,68(7):913-922.
[10]Wendler E, Nassif PAN, Malafaia O, et al. Shorten preoperative fasting and introducing early eating assistance in recovery after gastrojejunal bypass? Arq Bras Cir Dig,2022,34(3):e1606.
[11]Leenen J, Hentzen J, Ockhuijsen H. Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: A systematic review and metaanalysis. Updates Surg,2019,71(2):227-236.
[12]梁琼心,冯子懿,刘琦芳,等.无机械性肠道准备对妇科良性疾病腹腔镜手术影响的研究.现代妇产科进展,2020,29(8):602-607.
[13]Charoenkwan K, Nantasupha C, Muangmool T, et al. Early versus delayed oral feeding after major gynaecologic surgery. Cochrane Database Syst Rev,2024,8(8):CD00450.
[14]马文静，倪新莉.围手术期血糖状态对患者预后的影响.国际麻醉学与复苏杂志,2018,39(11):1067-1071.

备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项-自主创新项目（首发2020-2-8022）**通讯作者，Email：wyongjunhys@163.com①（首都医科大学附属北京积水潭医院麻醉科，北京100035）②（北京大学国际医院麻醉科，北京102206）③（北京大学国际医院妇产科，北京102206）④（首都医科大学附属北京积水潭医院营养科，北京100035）
更新日期/Last Update: 2026-03-26