切换至 "中华医学电子期刊资源库"

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 37 -41. doi: 10.3877/cma.j.issn.1674-392X.2024.01.007

疝外科日间手术专栏

日归手术管理模式下疝修补术的加速康复实践分析
孙义元1, 马洪升1, 雷文章2, 宋应寒3,()   
  1. 1. 610041 成都,四川大学华西医院日间手术中心;610041 成都,四川大学华西天府医院日间手术中心
    2. 610041 成都,四川大学华西医院胃肠疝外科
    3. 610041 成都,四川大学华西医院日间手术中心
  • 收稿日期:2024-01-05 出版日期:2024-02-18
  • 通信作者: 宋应寒
  • 基金资助:
    四川省科技计划项目重点研发项目(2022YFS0230)

Analysis of enhanced recovery practice in hernia repair under the same-day surgery management model

Yiyuan Sun1, Hongsheng Ma1, Wenzhang Lei2, Yinghan Song3,()   

  1. 1. Day Surgery Center of West China Hospital, Sichuan University, Chengdu, 610041, China; Day Surgery Center of West China Tianfu Hospital, Sichuan University, Chengdu, 610041, China
    2. Department of Gastrointestinal Hernia, West China Hospital, Sichuan University, Chengdu, 610041, China
    3. Day Surgery Center of West China Hospital, Sichuan University, Chengdu, 610041, China
  • Received:2024-01-05 Published:2024-02-18
  • Corresponding author: Yinghan Song
引用本文:

孙义元, 马洪升, 雷文章, 宋应寒. 日归手术管理模式下疝修补术的加速康复实践分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(01): 37-41.

Yiyuan Sun, Hongsheng Ma, Wenzhang Lei, Yinghan Song. Analysis of enhanced recovery practice in hernia repair under the same-day surgery management model[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(01): 37-41.

目的

探讨日归手术模式下疝修补术的加速康复临床实践效果,分析评价其可行性和安全性。

方法

采用回顾性研究方法,收集2022年3月至2023年3月四川大学华西天府医院日间手术中心收治的671例接受疝修补术患者的围手术期及随访资料。分析患者术后观察时间、当日停台率、过夜率、转科率、术后非计划镇痛使用率、出院后24 h疼痛评分、术后并发症、出院后1个月内再就诊和再入院率、出院后满意度等。观察临床疗效并总结经验。

结果

研究共纳入671名患者,男性573例,女性98例,全身麻醉140例,局部麻醉531例。所有患者术后观察时间2.35(0.04,22.33)h;当日停台率0.45%(3/671),过夜率9.84%(66/671),日归率90.16%(605/671),无转科病例。无非计划镇痛病例,出院24 h VAS疼痛评分为1(0,3)分。11例患者出现不同程度并发症,予保守治疗,1例发生补片感染,经补片取出术后痊愈。院内术后并发症发生率0.15%(1/671),再就诊率1.04%(7/671),再住院率0.45%(3/671)。术后1个月随访整体满意度为99.7%(669/671),术后随访6个月无复发病例。

结论

局部麻醉和全身麻醉下疝修补术均可以在日间手术中心安全地进行,在合理运用加速康复理念和多团队协作的情况下,可以纳入日归手术模式进行管理。

Objective

To explore the clinical practice effect of accelerated rehabilitation of hernia repair surgery under the same-day surgery mode and to analyze and evaluate its feasibility and safety.

Methods

A retrospective study was used to collect the perioperative and follow-up data of 671 patients who received hernia repair from March 2022 to March 2023 in the Ambulatory Surgery Center of West China Tianfu Hospital, Sichuan University, and analyze the postoperative data of the patients. We analyzed the postoperative observation time, day-stop rate, overnight rate, transfer rate, unplanned analgesic use rate, 24-hour pain score after discharge, postoperative complications, re-visit and re-admission within one month after discharge, and satisfaction after discharge. To observe clinical efficacy and summarize experience.

Results

A total of 671 patients were included in the study, including 573 males and 98 females, 140 under general anesthesia, and 531 under local anesthesia. The postoperative observation time of all patients was 2.35 (0.04, 22.33) hours. The day-stop rate was 0.45% (3/671), overnight rate was 9.84% (66/671), the daily return rate was 90.16% (605/671), and no transfer cases. All patients had no unplanned analgesia. The VAS pain score was 1 (0, 3) after discharge 24 hours. 11 patients had complications of varying degrees and were treated conservatively; and 1 patient had a patch infection, which recovered after patch removal. The incidence of postoperative complications in the hospital was 0.15% (1/671). The re-visit and re-admission rates within one month after discharge were 1.04% (7/671) and 0.45% (3/671), respectively. The overall satisfaction rate was 99.7% (669/671) after one month of follow-up, and there were no recurrence cases in six months of follow-up.

Conclusion

Hernia repair under local and general anesthesia can be safely performed in a day surgery center and can be included in the same-day surgery mode for management under the condition of rational use of the concept of accelerated recovery and multi-team collaboration.

[1]
Guillaumes S, Hidalgo NJ, Bachero I, et al. Outpatient inguinal hemia repair in spain a popu1ation based study of 1 163 039 patients c1inica1 and socioeconomic factors associated with the choice of day surgery[J]. Updates Surg, 2023, 75(1): 65-75.
[2]
陈德键, 缪传文, 傅晟静, 等. 以日间手术模式开展单孔腹腔镜完全腹膜外腹股沟疝修补术的实践[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(6): 699-703.
[3]
HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165.
[4]
蒋丽莎, 马洪升. 日归手术——中国日间手术的升华[J]. 华西医学, 2022, 37(2): 161-164.
[5]
郭强, 吐尔干艾力·阿吉, 宋涛, 等. 加速康复外科在日间老年腹股沟疝修补术中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(5): 489-491.
[6]
田孝东, 杨尹默. 理念更新引领行为进步: 《加速康复外科中国专家共识及路径管理指南(2018版)》外科部分解读[J]. 协和医学杂志, 2018, 9(6): 485-489.
[7]
钟锴, 鲁发顺, 穆热艾合买提江·穆塔里夫, 等. 加速康复外科理念在日间腹腔镜腹股沟疝修补术中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(1): 84-87.
[8]
刘茜, 戴燕, 雷甜甜, 等. 加速康复外科模式下成人腹股沟疝修补术日归手术的应用效果分析[J]. 华西医学, 2023, 38(2): 196-200.
[9]
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, 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.
[10]
Engbæk J, Bartholdy J, Hjortsø NC. Return hospital visits and morbidity within 60 days after day surgery: a retrospective study of 18, 736 day surgical procedures[J]. Acta Anaesth Scand, 2006, 50(8): 911-919.
[11]
刘剑, 马新福, 吴迪, 等. 基层医院开展疝环填充式腹股沟疝日间手术的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(2): 196-199.
[12]
宁彩虹, Aziz BA, 黄耿文. 2018版腹股沟疝国际指南解读(日间手术部分)[J]. 中国普通外科杂志, 2019, 28(10): 1177-1180.
[13]
中国日间手术合作联盟疝和腹壁外科专业日间手术专家委员会, 《中华疝和腹壁外科杂志(电子版)》编辑委员会, 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, 等. 腹股沟疝日间手术规范化流程与标准中国专家指南(2023版)[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(5): 497-503.
[14]
Amato B, Compagna R, Fappiano F, et al. Day-surgery inguinal hernia repair in the elderly: single centre experience[J]. BMC Surgery, 2013, 13(suppl 2): 1-3.
[15]
Meier J, Stevens A, Berger M, et al. Racial and Ethnic Disparities in Access to Local Anesthesia for Inguinal Hernia Repair[J]. J Surg Res, 2021, 266: 366-372.
[16]
de Lange DH, Kreeft M, van Ramshorst GH, et al. Inguinal hernia surgery in The Netherlands: are patients treated according to the guidelines?[J]. Hernia, 2009, 14(2): 143-148.
[17]
李为明, 许青文, 李奕俊, 等. 腹腔镜腹股沟疝修补术日间手术模式的临床效益评价[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(1): 19-21.
[18]
宁彩虹, 黄耿文, 林嘉晏, 等. 腹腔镜经腹腹膜前疝修补日间手术的临床价值分析[J]. 中国普通外科杂志, 2021, 30(4): 399-405.
[19]
Majholm B, Engbæk J, Bartholdy J, et al. Is day surgery safe? A Danish multicentre study of morbidity after 57, 709 day surgery procedures[J]. Acta Anaesthesiol Scand, 2012, 56(3): 323-331.
[20]
Harryman C, Plymale MA, Stearns E, et al. Enhanced value with implementation of an ERAS protocol for ventral hernia repair[J]. Surg Endosc, 2020, 34(9): 3949-3955.
[21]
Louis V, Diab S, Villemin A, et al. Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study[J]. Hernia, 2023, 27(4): 873-881.
[22]
Skovgaards DM, Diab HMH, Midtgaard HG, et al. Causes of prolonged hospitalization after open incisional hernia repair: an observational single-center retrospective study of a prospective database[J]. Hernia, 2021, 25(4): 1027-1034.
[23]
Ueland W, Walsh-Blackmore S, Nisiewicz M, et al. The contribution of specific enhanced recovery after surgery(ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair[J]. Surg Endosc, 2020, 34(10): 4638-4644.
[24]
Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic(TEP) treatment of inguinal Hernia [International Endohernia Society(IEHS)][J]. Surg Endosc, 2011, 25(9): 2773-2843.
[25]
Bjurstrom MF, Nicol AL, Amid PK, et al. Pain control following inguinal herniorrhaphy: current perspectives[J]. J Pain Res, 2014, 7: 277-290.
[26]
Peterman DE, Knoedler BP, Ewing JA, et al. Implementation of an Evidence-Based Protocol Significantly Reduces Opioid Prescribing After Ventral Hernia Repair[J]. Am Surg, 2020, 86(11): 1602-1606.
[1] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[2] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[3] 周正阳, 陈凯, 仇多良, 邵乐宁, 吴浩荣, 钟丰云. 腹腔镜腹股沟疝修补术后出血原因分析及处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 660-664.
[4] 顾熙, 徐子宇, 周澍, 张吴楼, 张业鹏, 林昊, 刘宗航, 嵇振岭, 郑立锋. 腹股沟疝腹膜前间隙无张力修补术后补片感染10 例报道[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 665-669.
[5] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
[6] 高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[7] 于新峰, 曾琦, 后强, 徐浩, 操谢芳. 腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 681-686.
[8] 方辉强, 黄杰, 随冰琰. 腰方肌阻滞与腹横肌平面阻滞对腹股沟疝腹腔镜手术患者术后镇痛效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 697-702.
[9] 朱佳琳, 方向, 贵诗雨, 黄丹, 周小雨, 郭文恺. 大鼠切口疝腹膜前间隙补片修补术后血清中VEGF 和Ang-1 的表达情况[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 703-707.
[10] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[11] 杨媛媛, 林贤超, 林荣贵, 陆逢春, 黄鹤光. 肌后/腹膜前补片修补巨大切口疝术后并发症防治[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 645-648.
[12] 玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.
[13] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[14] 王小琴, 汪丽, 崔建英. 无张力疝修补术治疗慢性肾功能衰竭合并腹股沟疝患者的疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 538-542.
[15] 陈金水, 陈金福, 郑开福, 祝晓路, 王铁虎, 谭俊, 李正平. 腹腔镜疝修补术治疗原发性耻骨上疝七例的临床体会[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 548-551.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?