快速康复外科理念在成人腹股沟疝日间手术的应用体会

doi:10.3877/cma.j.issn.1674-392X.2022.06.025

目的

探讨快速康复外科理念指导下的成人腹股沟疝日间手术的安全性及有效性。

方法

采用前瞻性研究方法，将符合入选条件的67例患者分为试验组与对照组。试验组采用快速康复外科理念指导下的日间手术治疗成人腹股沟疝，麻醉方式为局部浸润麻醉；对照组为住院手术患者，常规采用椎管内麻醉。分析比较2组术后2 h疼痛评分、术后下床活动时间及术后进食或饮水时间、术后并发症发生情况及平均住院费用；记录试验组15 d内非计划再次入院率、日间手术延迟出院率。

结果

试验组术后2 h疼痛评分（3.6±1.1）分、术后下床活动时间（3.2±1.1）h、术后进食或饮水时间（2.3±0.9）h及平均住院费用（4060.0±91.3）元与对照组（6.0±1.0）分、（7.2±1.1）h、（7.1±0.9）h、（5635.6±229.0）元比较，差异均有统计学意义（P<0.05）。2组术后并发症发生情况差异无统计学意义（P>0.05），术后随访4~16个月，均无复发。试验组无15 d内非计划再次入院及日间手术延迟出院患者。

结论

快速康复外科理念指导下的成人腹股沟疝日间手术，安全有效。

关键词: 疝，腹股沟, 成人, 日间手术, 快速康复外科

Objective

To explore the safety and effectiveness of ambulatory surgery for adult inguinal hernia under the guidance of the concept of fast track surgery.

Methods

A prospective study method was used, and 67 patients eligible for inclusion were divided into the treatment group and the control group. The treatment group was treated with ambulatory surgery under the guidance of the concept of fast track r surgery with local infiltration anesthesia. The patients in the control group were routine hospitalized patients with spinal anesthesia. The VAS pain score at 2-hours postoperatively, postoperative ambulation time, postoperative eating or drinking time, the incidence of postoperative complications and the average cost of hospitalization were analyzed and compared between the two groups. Meanwhile, the rate of unplanned readmission within 15 days and delayed discharge rate after ambulatory surgery in the treatment group were recorded.

Results

The VAS pain score at 2-hours postoperatively (3.6±1.1 vs 6.0±1.0), postoperative ambulation time (3.2±1.1 h vs 7.2±1.1 h), postoperative eating or drinking time (2.3±0.9 h vs 7.1±0.9 h) and average hospitalization cost (4060.0±91.3 vs 5635.6±229.0 yuan) in the treatment group were significantly lower than those in the control group (P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P>0.05). There was no recurrence after the follow-up of 4~16 months in both groups. There was no unplanned readmission within 15 days and delayed discharge of ambulatory surgery in the treatment group.

Conclusion

It is safe and effective for adult patients with inguinal hernia to receive ambulatory surgery under the guidance of the concept of fast track surgery.

Key words: Hernia, inguinal, Adult, Ambulatory surgery, fast track surgery

表1 2组患者一般资料比较

组别	例数	性别[例(%)]			年龄(岁,±s)		体质量指数(kg/m²,±s)		ASA评分[例(%)]				疝分型[例(%)]
组别	例数	男	女		年龄(岁,±s)		体质量指数(kg/m²,±s)		Ⅰ		Ⅱ	Ⅲ	Ⅰ型		Ⅱ型	Ⅲ型
试验组	35	32(91.4)	3(8.6)	55.6±10.6		23.8±3.0		16(45.7)		12(34.3)		7(15.6)	5(14.3)	12(34.3)		18(51.4)
对照组	32	30(93.8)	2(6.3)	58.8±10.2		24.6±3.3		12(37.5)		16(50.0)		4(12.5)	6(18.8)	15(46.9)		11(34.4)
t/χ²值		0.00			1.24		1.03		1.83				1.16
P值		1.00			0.22		0.31		0.40				0.59

表1 2组患者一般资料比较

组别	例数	性别[例(%)]			年龄(岁,±s)		体质量指数(kg/m²,±s)		ASA评分[例(%)]				疝分型[例(%)]
组别	例数	男	女		年龄(岁,±s)		体质量指数(kg/m²,±s)		Ⅰ		Ⅱ	Ⅲ	Ⅰ型		Ⅱ型	Ⅲ型
试验组	35	32(91.4)	3(8.6)	55.6±10.6		23.8±3.0		16(45.7)		12(34.3)		7(15.6)	5(14.3)	12(34.3)		18(51.4)
对照组	32	30(93.8)	2(6.3)	58.8±10.2		24.6±3.3		12(37.5)		16(50.0)		4(12.5)	6(18.8)	15(46.9)		11(34.4)
t/χ²值		0.00			1.24		1.03		1.83				1.16
P值		1.00			0.22		0.31		0.40				0.59

表2 2组患者术后指标及住院费用比较

组别	例数	术后2 h疼痛评分(±s)	下床活动时间(h,±s)	进食或饮水时间(h,±s)	住院费用(元,±s)	并发症[例(%)]
试验组	35	3.6±1.1	3.2±1.1	2.3±0.9	4060.0±91.3	7(20.0)
对照组	32	6.0±1.0	7.2±1.1	7.1±0.9	5635.6±229.0	5(15.6)
t/χ²值		9.0	15.4	21.0	36.4	0.22
P值		0.00	0.00	0.00	0.00	0.64

表2 2组患者术后指标及住院费用比较

组别	例数	术后2 h疼痛评分(±s)	下床活动时间(h,±s)	进食或饮水时间(h,±s)	住院费用(元,±s)	并发症[例(%)]
试验组	35	3.6±1.1	3.2±1.1	2.3±0.9	4060.0±91.3	7(20.0)
对照组	32	6.0±1.0	7.2±1.1	7.1±0.9	5635.6±229.0	5(15.6)
t/χ²值		9.0	15.4	21.0	36.4	0.22
P值		0.00	0.00	0.00	0.00	0.64

[18]	王明镜, 黄鹤光, 林贤超, 等. 腹腔镜经腹膜前腹股沟疝修补术中残端疝囊处理方式对术后血清肿影响的前瞻性研究[J]. 中华消化外科杂志, 2020, 19(1): 81-86.
[1]	Hoggett L, Anderton MJ, Khatri M. 30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre[J]. Ann R Coll Surg Engl, 2019, 101(1): 50-54.
[2]	Solodkyy A, Feretis M, Fedotovs A, et al. Elective "True Day Case" Laparoscopic Inguinal Hernia Repair in a District General Hospital: Lessons Learned from 1000 Consecutive Cases[J]. Minim Invasive Surg, 2018, 2018: 7123754.
[3]	Wang L, Baser O, Wells P, et al. Benefit of early discharge among patients with low-risk pulmonary embolism[J]. PLoS One, 2017, 12(10): e0185022.
[4]	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
[5]	Kehlet H. Enhanced Recovery After Surgery(ERAS): good for now, but what about the future?[J]. Can J Anaesth, 2015, 62(2): 99-104.
[6]	Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review[J]. JAMA Surg, 2017, 152(3): 292-298.
[7]	Liu VX, Rosas E, Hwang J, et al. Enhanced Recovery After Surgery Program Implementation in 2 Surgical Populations in an Integrated Health Care Delivery System[J]. AMA Surg, 2017, 152(7): e171032.
[8]	Mortensen K, Nilsson M, Slim K, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery(ERAS) Society recommendations[J]. Br J Surg, 2014, 101(10): 1209-1229.
[9]	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J]. 中国实用外科杂志, 2018, 38(7): 704-706.
[10]	Bona S, Molteni M, Riccardo R, et al. Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience[J]. World J Gastroenterol, 2014, 20(46): 17578-17587.
[11]	申英末, 孙立, 陈杰. 腹股沟疝日间手术的发展历程及诊疗经验[J]. 中华消化外科杂志, 2020, 19(7): 725-728.
[12]	中国医师协会外科医师分会疝和腹壁外科学组,中华医学会外科学分会疝与腹壁外科学组全国卫生产业企业管理协会疝和腹壁外科产业及临床研究分会,中华疝和腹壁外科杂志(电子版)编辑委员会,等.腹股沟疝日间手术规范化流程专家共识(2020版)[J]. 中华消化外科杂志, 2020,19(7):714-719.
[13]	刘子嘉, 黄会真, 黄宇光. 从加速康复外科理念看日间手术:英国2019年日间手术指南解读[J]. 协和医学杂志, 2019, 10(6): 570-574.
[14]	Grant MC, Yang D, Wu CL, et al. Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections: Results From a Systematic Review and Meta-analysis[J]. Ann Surg, 2017, 265(1): 68-79.
[15]	陈杰, 申英末. 腹股沟疝日间手术规范化流程专家共识(2019版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(3): 193-197.
[16]	冷希圣, 韦军民, 刘连新, 等. 普通外科围手术期疼痛处理专家共识[J]. 中华普通外科杂志, 2015, 30(2): 166-173.
[17]	中华医学会麻醉学分会. 成人日间手术后镇痛专家共识(2017)[J]. 临床麻醉学杂志, 2017, 33(8): 812-815.

[1]	李涛, 陈纲, 李世拥. 腹腔镜下右侧腹股沟斜疝修补术（TAPP）[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 598-598.
[2]	刘跃刚, 薛振峰. 腹腔镜腹股沟疝日间手术在老年患者中的安全性分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 711-714.
[3]	杨瑞洲, 李国栋, 吴向阳. 腹股沟疝术后感染的治疗方法探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 715-719.
[4]	徐金林, 陈征. 抗菌药物临床应用监测对腹股沟疝修补术预防用药及感染的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 720-723.
[5]	于智慧, 赵建军. 后路腰方肌阻滞复合全身麻醉在腹股沟斜疝经腹腹膜前手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 734-739.
[6]	田静, 方秀春. 超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 740-744.
[7]	李静如, 王江玲, 吴向阳. 简易负压引流在腹股沟疝术后浅部感染中的疗效分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 745-749.
[8]	王红艳, 马艳丽, 郑洁灿. 手术室综合护理在腹股沟疝手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 755-758.
[9]	代格格, 杨丽, 胡媛媛, 周文婷. 手术室综合干预在老年腹股沟疝患者中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 759-763.
[10]	王敏, 蒋家斌, 李茂新. 预警宣教联合个性化疼痛管理对腹股沟疝手术患者的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 764-767.
[11]	王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[12]	朱青青, 卫贞祺. 腹股沟疝患者围手术期自我能效管理探讨[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 773-777.
[13]	戴玮, 江桂林, 车兆平, 张姣, 王星星, 赵海涛. 无缝手术护理在腹股沟疝腹腔镜手术围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 778-781.
[14]	李芳, 许瑞, 李洋洋, 石秀全. 循证医学理念在儿童腹股沟疝患者中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 782-786.
[15]	中华医学会骨科分会关节学组. 中国髋、膝关节置换日间手术围手术期管理专家共识[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 321-332.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of the concept of fast track surgery in ambulatory surgery of adult inguinal hernia

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of the concept of fast track surgery in ambulatory surgery of adult inguinal hernia