加速康复外科在腹腔镜治疗小儿嵌顿性腹股沟斜疝的应用

doi:10.3877/cma.j.issn.1674-392X.2021.04.009

目的

探究加速康复外科（ERAS）在小儿嵌顿性腹股沟斜疝围手术期的应用及对患儿转归的影响。

方法

选取徐州医科大学附属徐州市儿童医院普外一科于2018年11月至2020年1月收治入院的46例腹腔镜治疗小儿嵌顿性腹股沟斜疝的患儿作为研究对象，随机分为加速康复组（ERAS组）与对照组（NC组）。ERAS组患儿22例，对照组患儿24例，ERAS组患儿在围手术期采用加速康复外科管理模式及腹腔镜单针双线法术式治疗小儿嵌顿性腹股沟斜疝。比较2组患儿手术时间，术后FLACC评分，术后住院时间，24 h出院率及相关术后并发症发生率（皮下硬结，线结反应，斜疝复发）。

结果

2组患儿年龄、手术时间、术后斜疝复发等方面比较，差异无统计学意义（P>0.05）；ERAS组与对照组患儿术后疼痛评分[（2.36±1.02）比（2.92±1.29）]，术后住院时间[（44.82±33.66）h比（64.92±27.46）h]，及24 h出院率（31.8%比4.2%）比较，差异有统计学意义（P<0.05）；ERAS组与对照组患儿术后皮下硬结发生率（0.00%比70.83%），线结反应发生率（0.00%比20.83%）比较，差异有统计学意义（P<0.05）。

结论

加速康复外科在小儿嵌顿性腹股沟斜疝的应用是可行的，可减少患儿围手术期应激反应，减轻患儿术后疼痛，缩短住院时间，减少术后相关并发症的发生。

关键词: 儿童, 嵌顿性腹股沟斜疝, 加速康复外科, 患儿围手术期

Objective

To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of children with incarcerated indirect inguinal hernia and the impact on the prognosis of children.

Methods

A total of 46 children hospitalized with incarcerated indirect inguinal hernia in Xuzhou Children's Hospital were selected as the research objects, which were randomly divided into the ERAS group and the control group. There were 22 children in the ERAS group and 24 children in the control group. The patients in ERAS group were treated with enhanced recovery after surgery in the perioperative period and laparoscopic treatment (single-needle & double-line) of incarcerated indirect inguinal hernia. The parameters of operative time, postoperative FLACC scores, length of stay, 24-hour discharge rate and the incidence of postoperative complications (subcutaneous induration, suture reaction, hernia recurrence) were compared between the two groups.

Results

No significant difference existed in age, operative time and hernia recurrence between the two groups. ERAS group and control groups were compared in postoperative FLACC scores [(2.36±1.02) vs (2.92±1.29)], length of stay [(44.82±33.66) hours vs (64.92±27.46) hours], 24-hour discharge rate [(31.8%) vs (4.2%)], the differences were statistically significant (P<0.05). ERAS group and control group were compared in the incidence of subcutaneous induration (0.00% vs. 70.83%) and suture reaction (0.00% vs. 20.83%), the differences were statistically significant (P<0.05).

Conclusion

The application of enhanced recovery after surgery in incarcerated indirect inguinal hernia is feasible, which can reduce the perioperative stress response, postoperative pain, length of stay and postoperative complications.

Key words: Child, Incarcerated indirect inguinal hernia, Enhanced recovery after surgery, Perioperative period of children

表1 ERAS组与对照组术中及术后一般情况比较（±s）

组别	例数	手术时间(min,±s)	术后4 h FLACC疼痛评分(分,±s)	术后住院时间(h,±s)	24 h出院率[例(%)]
ERAS组	22	34.32±19.67	2.36±1.02	44.82±33.66	31.8
对照组	24	34.58±18.20	2.92±1.29	64.92±27.46	4.2
t/χ²值		-	-4.943	-29.531	25.558
P值		>0.05	<0.05	<0.05	<0.05

表1 ERAS组与对照组术中及术后一般情况比较（±s）

组别	例数	手术时间(min,±s)	术后4 h FLACC疼痛评分(分,±s)	术后住院时间(h,±s)	24 h出院率[例(%)]
ERAS组	22	34.32±19.67	2.36±1.02	44.82±33.66	31.8
对照组	24	34.58±18.20	2.92±1.29	64.92±27.46	4.2
t/χ²值		-	-4.943	-29.531	25.558
P值		>0.05	<0.05	<0.05	<0.05

表2 ERAS组与对照组术术后相关并发症比较[例（%）]

组别	例数	皮下硬结	线结反应	斜疝复发
ERAS组	22	0(0.00)	0(0.00)	0(0.00)
对照组	24	17(70.83)	5(20.83)	1(4.17)
χ²值		21.77	5.03	0.00
P值		<0.05	<0.05	>0.05

表2 ERAS组与对照组术术后相关并发症比较[例（%）]

组别	例数	皮下硬结	线结反应	斜疝复发
ERAS组	22	0(0.00)	0(0.00)	0(0.00)
对照组	24	17(70.83)	5(20.83)	1(4.17)
χ²值		21.77	5.03	0.00
P值		<0.05	<0.05	>0.05

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Application of enhanced recovery after surgery for laparoscopic treatment of incarcerated indirect inguinal hernia in children

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Application of enhanced recovery after surgery for laparoscopic treatment of incarcerated indirect inguinal hernia in children