加速康复外科在小儿腹股沟疝的应用价值

doi:10.3877/cma.j.issn.1674-392X.2019.04.019

目的

探讨加速康复外科（ERAS）在小儿腹股沟疝治疗中的安全性、可行性和时效性。

方法

回顾性分析2017年1月至2018年6月，深圳市龙区妇幼保健院开展的腹股沟疝腔镜手术患儿86例，按照治疗方案的不同分为2组。其中腹腔镜常规治疗组46例，ERAS组40例。记录所有患儿术中及术后情况，比较2组的手术时间、切口长度、出血量、皮下气肿发生率、麻醉复苏时间、住院时间、并发症发生率和复发率等情况。

结果

常规腹腔镜组和ERAS组在手术时间、切口长度、出血量和皮下气肿发生率方面比较，差异无统计学意义（P均>0.05）；ERAS组的手术切口选择在脐周的皮肤褶皱里，患儿及家属的满意度较常规腹腔镜组高，差异有统计学意义（P<0.05）。2组在术后麻醉复苏时间和住院时间方面比较，差异有统计学意义（P均<0.05），在并发症发生率和复发率方面比较，差异无统计学意义（P均>0.05）。

结论

ERAS在小儿腹股沟疝这一单病种中具有安全性高、可行性高、麻醉复苏时间短、住院时间短及患儿家属满意度高的优点，值得临床推广。

关键词: 疝，腹股沟, 儿童, 腹腔镜下疝囊高位结扎, 快速康复

Objective

To explore the safety, feasibility and timeliness of enhanced recovery after surgery (ERAS) in the treatment of children with inguinal hernia.

Methods

A retrospective analysis of 86 children with inguinal hernia who underwent laparoscopic operation from January 2017 to June 2018 in Longgang District Maternal and Child Health Hospital, including 46 patients in the laparoscopic routine treatment group and 40 patients in the ERAS group. All patients were recorded during and after surgery. The operation time, length of incision, amount of bleeding, incidence of subcutaneous emphysema, time of anesthesia recovery, hospital time, rate of complications and recurrence were compared between the two groups.

Results

In the two group, there was no statistically significant difference in the operation time, length of incision, amount of bleeding and incidence of subcutaneous emphysema (P>0.05). The surgical incision in the REAS group was selected in the skin folds of the umbilical cord, and the satisfaction of children and children's families was higher than that of laparoscopic routine treatment group. There was a statistically significant difference in satisfaction, postoperative anesthesia recovery time and hospital time (P<0.05). There was no statistically significant difference in the number of complications and the number of recurrence cases (P>0.05).

Conclusion

ERAS has the advantages of high safety, high feasibility, short anesthesia resuscitation time, short hospital stay and high satisfaction of children's families in the single disease of inguinal hernia in children, which is worthy of clinical promotion.

Key words: Hernia, inguinal, Child, Laparoscopic high ligation of hernia sac, Rapid recovery

表1 2组患儿术中情况比较

组别	例数	手术时间(min,±s)	切口长度(mm,±s)	出血量(ml,±s)	皮下气肿[例(%)]
腹腔镜组	45	28.37±2.42	10.50±2.01	1.35±3.27	1(2)
ERAS组	40	29.22±2.01	10.48±2.21	1.33±2.96	0
检验值	?	0.446	0.573	0.698	0.899
P值	?	0.436	0.570	0.670	0.529

表1 2组患儿术中情况比较

组别	例数	手术时间(min,±s)	切口长度(mm,±s)	出血量(ml,±s)	皮下气肿[例(%)]
腹腔镜组	45	28.37±2.42	10.50±2.01	1.35±3.27	1(2)
ERAS组	40	29.22±2.01	10.48±2.21	1.33±2.96	0
检验值	?	0.446	0.573	0.698	0.899
P值	?	0.436	0.570	0.670	0.529

表2 2组患儿术后情况比较

组别	例数	麻醉复苏时间(min,±s)	住院时间(h,±s)	并发症[例(%)]	复发[例(%)]
腹腔镜组	45	50.46±5.23	48.09±2.33	2(4)	0
ERAS组	40	30.37±4.35	24.01±2.35	0	0
检验值	?	44.785	44.262	1.821	-
P值	?	<0.001	<0.001	0.277	-

表2 2组患儿术后情况比较

组别	例数	麻醉复苏时间(min,±s)	住院时间(h,±s)	并发症[例(%)]	复发[例(%)]
腹腔镜组	45	50.46±5.23	48.09±2.33	2(4)	0
ERAS组	40	30.37±4.35	24.01±2.35	0	0
检验值	?	44.785	44.262	1.821	-
P值	?	<0.001	<0.001	0.277	-

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Application value of Enhanced Recovery after Surgery in children with inguinal hernia

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Application value of Enhanced Recovery after Surgery in children with inguinal hernia