腹腔镜腹股沟疝修补术日间手术模式的临床效益评价

doi:10.3877/cma.j.issn.1674-392X.2021.01.005

目的

比较日间手术模式和住院手术模式在腹腔镜腹股沟疝修补术的临床效益。

方法

选取2017年1～12月昆明医科大学第二附属医院就诊的120例单侧腹股沟疝患者作为研究对象。将所有患者按照随机数字表法随机分成日间手术模式组和住院手术模式组，各60例。观察2组患者的手术时间、术中出血量、术后下床活动时间、尿潴留发生率、阴囊积液发生率、异物感发生率、总并发症发生率、医疗费用及满意度。

结果

所有患者均顺利完成手术，半年随访期内无复发。日间手术模式组与住院手术模式组患者的手术时间、术中出血量、术后下床活动时间、尿潴留发生率、阴囊积液发生率、异物感发生率、总并发症发生率比较，差异均无统计学意义（P>0.05）。日间手术组患者住院时间要明显比住院手术组患者短，日间手术组患者总住院费比住院手术组患者低，日间手术组患者对治疗过程满意程度明显高于对照组患者，差异均有统计学意义（P<0.05）。

结论

日间手术模式下行腹腔镜腹股沟疝修补术安全有效，且可降低总费用，加快周转率，提高了医疗资源的利用率，提高了患者的满意度。

关键词: 腹腔镜, 疝，腹股沟, 疝修补术, 日间手术, 住院手术, 效益评价, 随机对照试验

Objective

To compare the clinical benefits of laparoscopic inguinal herniorrhaphy between day surgery mode and inpatient surgery mode.

Methods

A total of 120 cases of unilateral inguinal hernia who treated in Second Affiliated Hospital of Kunming Medical University from January 2017 to December 2017 were collected prospectively, and they were randomly divided into 2 groups: day surgery group (60 cases) and inpatient surgery group (60 cases). The operative time, blood loss, postoperative ambulation time, incidence of urinary retention, incidence of scrotal effusion, incidence of foreign body sensation, incidence of total complications, medical expenses and satisfaction between the two groups were compared.

Results

The operation was successfully completed in both groups. No recurrence was found during 6 months follow-up. There were no significant differences in operation time, intraoperative bleeding volume, postoperative ambulation time, incidence of urinary retention, incidence of scrotal effusion, incidence of foreign body sensation, and incidence of total complications between the two groups (P>0.05). However, the duration of hospitalization in the day surgery group was shorter than that in the inpatient surgery group (P<0.05). The total cost of hospitalization in the day surgery group was lower than that in the inpatient surgery group (P<0.05), and the score of satisfaction in the day surgery group was significantly better than that in the inpatient surgery group (P<0.05).

Conclusion

Laparoscopic inguinal herniorrhaphy in the day surgery mode is safe and effective, and can reduce the total cost, speed up turnover rate, improve the utilization of medical resources, and improve patient satisfaction.

Key words: Laparoscopes, Hernia, inguinal, Herniorrhaphy, Day surgery, Inpatient surgery, Benefits analysis, Randomized

表1 2组患者的临床资料比较

临床资料		日间手术(60例)	住院手术组(60例)	P值
年龄(岁, ±s)		38.58±1.78	40.28±1.23	>0.05
性别(例)				>0.05
	男性	53	52
	女性	7	8
病程(年, ±s)		4.58±1.02	5.10±1.21	>0.05
疝分型(例)				>0.05
	Ⅰ型	8	9
	Ⅱ型	34	36
	Ⅲ型	18	15
疝类型(例)				>0.05
	直疝	7	9
	斜疝	53	51

表1 2组患者的临床资料比较

临床资料		日间手术(60例)	住院手术组(60例)	P值
年龄(岁, ±s)		38.58±1.78	40.28±1.23	>0.05
性别(例)				>0.05
	男性	53	52
	女性	7	8
病程(年, ±s)		4.58±1.02	5.10±1.21	>0.05
疝分型(例)				>0.05
	Ⅰ型	8	9
	Ⅱ型	34	36
	Ⅲ型	18	15
疝类型(例)				>0.05
	直疝	7	9
	斜疝	53	51

表2 2组患者疗效和经济指标比较

指标	日间手术组(60例)	住院手术组(60例)	P值
TAPP/TEP(例)	41/19	40/20	>0.05
手术时间(min, ±s)	31.0±5.2	32.0±6.1	>0.05
术中出血量(ml, ±s)	5.0±1.8	5.1±1.3	>0.05
并发症(例)	8	9	>0.05
尿潴留(例)	2	3	>0.05
阴囊积液(例)	3	4	>0.05
异物感(例)	3	2	>0.05
复发(例)	0	0	>0.05
术后下床活动时间(h, ±s)	0.82±0.10	1.15±0.14
住院时间(d, ±s)	1.50±0	7.56±0.22	<0.05
总费用(元, ±s)	7 626.21±35.32	9 671.31±48.45	<0.05
满意度评分(分, ±s)	5.37±0.96	3.82±0.85	<0.05

表2 2组患者疗效和经济指标比较

指标	日间手术组(60例)	住院手术组(60例)	P值
TAPP/TEP(例)	41/19	40/20	>0.05
手术时间(min, ±s)	31.0±5.2	32.0±6.1	>0.05
术中出血量(ml, ±s)	5.0±1.8	5.1±1.3	>0.05
并发症(例)	8	9	>0.05
尿潴留(例)	2	3	>0.05
阴囊积液(例)	3	4	>0.05
异物感(例)	3	2	>0.05
复发(例)	0	0	>0.05
术后下床活动时间(h, ±s)	0.82±0.10	1.15±0.14
住院时间(d, ±s)	1.50±0	7.56±0.22	<0.05
总费用(元, ±s)	7 626.21±35.32	9 671.31±48.45	<0.05
满意度评分(分, ±s)	5.37±0.96	3.82±0.85	<0.05

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Clinical benefits analysis of day surgery for laparoscopic inguinal herniorrhaphy

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Clinical benefits analysis of day surgery for laparoscopic inguinal herniorrhaphy