Objective: It has been demonstrated that fast track (FT) surgery can accelerate the recovery of the patients in limited urologic procedures, but there are no reports regarding FT surgery within retroperitoneal laparoscopic adrenalectomy (RLA). This study aims at evaluating the impact of FT surgery on recovery after RLA. Methods: One hundred patients in our centre are randomly assigned to FT group and conventional group. The patients who have undergone RLA receive either conventional care or an FT recovery program. Surgical outcome, complications, gastrointestinal function, visual analogue scale (VAS) general state and VAS pain scores are compared between the two groups. In addition, white blood cell count, serum interleukin-6 and C-reactive protein levels are measured. Patients are discharged home when they meet discharge criteria. Results: Compared with the conventional group, the time of first flatus (18.97±8.45 vs. 37.66±17.17 h), initiation of normal diet (18.76±4.94 vs. 53.15±15.99 h), the time of first ambulation (19.64±6.23 vs. 51.89±18.19 h), length of post-operation hospital stay (2.35±0.87 vs. 5.23±1.62 d), duration of drainage (18.19±5.19 vs. 68.10±18.06 h) and catheter (17.19±4.49 vs. 60.83±25.53 h) are markedly shorter in FT group (P<0.01). Post-operative coughing pain scores at 2 h (1.00±0.61 vs. 1.42±1.18), 12 h (0.96±0.78 vs. 2.00±1.40), 24 h (1.10±0.97 vs. 4.22±1.53) and resting pain scores at 12 h (0.64±0.56 vs. 1.44±0.91), 24 h (0.66±0.63 vs. 1.22±0.86) are consistently lower in the FT group. The level of CRP, IL-6 at 2 h and 24 h post-operation are lower than that of control group, and white blood cell count is lower than conventional group at 24 h after surgery (P<0.01). FT patients have a overall higher level of post-operative VAS general state than conventional groups (P<0.01). Age, sex, tumor size and side, BMI, ASA score, operation time, blood loss and complications are similar in both groups. Conclusions: FT surgery within RLA shortens the length of post-operative hospital stay without increasing the postoperative complication, lowers patients’ VAS pain scores, and reduces inflammatory response intensity and improves the general state. Therefore, FT can be applied feasibly and safely in RLA.
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机译：目的：已证明快速通道（FT）手术可以在有限的泌尿外科手术中加速患者的康复，但尚无关于腹膜后腹腔镜肾上腺切除术（RLA）内FT手术的报道。本研究旨在评估FT手术对RLA术后恢复的影响。方法：将我中心100例患者随机分为FT组和常规组。经历了RLA的患者将接受常规护理或FT恢复计划。比较两组的手术结果，并发症，胃肠功能，视觉模拟量表（VAS）总体状态和VAS疼痛评分。另外，测量白细胞计数，血清白介素6和C反应蛋白水平。符合出院标准的患者可以出院。结果：与常规组相比，第一次肠胃胀气的时间（18.97±8.45 vs. 37.66±17.17 h），开始正常饮食的时间（18.76±4.94 vs. 53.15±15.99 h），第一次下床活动（19.64±6.23） vs.51.89±18.19 h），术后住院时间（2.35±0.87 vs.5.23±1.62 d），引流时间（18.19±5.19 vs.68.10±18.06 h）和导管（17.19±4.49 vs.60.83）在FT组中，±25.53 h）明显缩短（P <0.01）。术后2 h的咳嗽疼痛评分（1.00±0.61 vs.1.42±1.18），12 h（0.96±0.78 vs.2.00±1.40），24 h（1.10±0.97 vs.4.22±1.53）和静息疼痛评分分别为FT组的12 h（0.64±0.56 vs. 1.44±0.91），24 h（0.66±0.63 vs. 1.22±0.86）始终较低。术后2 h和24 h的CRP，IL-6水平低于对照组，术后24 h白细胞计数低于常规组（P <0.01）。 FT患者的术后VAS总体状态总体水平高于常规组（P <0.01）。两组的年龄，性别，肿瘤大小和侧面，BMI，ASA评分，手术时间，失血和并发症相似。结论：RLA内的FT手术可缩短术后住院时间，而不会增加术后并发症，降低患者的VAS疼痛评分，降低炎症反应强度并改善总体状况。因此，可以在RLA中安全可靠地应用FT。
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