摘要
目的探讨加速康复外科理念指导下日间手术模式治疗小于1岁腹股沟斜疝患儿的价值。方法收集浙江大学医学院附属儿童医院2015年2月至2018年11月收治的小于1岁的腹股沟斜疝患儿571例作为研究对象。根据是否采用日间手术模式治疗将患儿分为日间组和对照组(常规住院流程治疗),进一步根据是否采用腹腔镜手术分为腔镜日间组(n=41)、腔镜对照组(n=211)、开放日间组(n=192)和开放对照组(n=127)。腔镜日间组和腔镜传统组患儿平均年龄分别为(8.2±2.6)个月和(8.9±2.4)个月,差异无统计学意义(t=-1.536,P=0.126);双侧腹股沟斜疝比例分别为34.14%(14/41)和40.76%(86/211),差异无统计学意义(χ^2=0.627,P=0.428)。开放日间组和开放传统组患儿平均年龄分别为(8.7±2.8)个月和(7.1±3.6)个月,差异有统计学意义(t=-4.126,P<0.001),双侧腹股沟斜疝的比例分别为16.67%(32/192)和21.26%(27/127),差异无统计学意义(χ^2=1.070,P=0.301)。比较加速康复外科理念指导的日间手术模式和传统住院手术模式在住院时间、住院费用、术后并发症发生率、非计划再次就诊率、非计划再次入院率和日间手术延迟出院率等方面的差异。结果日间组在住院时间和住院费用上优于对照组(P<0.05)。日间组当日手术取消率为4.72%(11/233),低于对照组的13.31%(45/338),差异有统计学意义(χ^2=11.512,P=0.001)。日间组术前禁清饮时间(132±5)min,短于对照组的(148±13)min,差异有统计学意义(t=19.483,P<0.001)。日间组术后初次进食清饮和奶的时间分别为(49±7)min和(124±12)min,短于对照组的(124±12)min和(305±35)min,差异均有统计学意义(P<0.001)。2018年10月起日间流程患儿术前予右美托咪定滴鼻镇静,进入手术室的哭吵发生率为22.2%(6/27),低于对照组的73.33%(33/45),差异有统计学意义(χ^2=17.757,P<0.001)。日间组术后哭吵发生率为30.39%(31/102),低于对照组的61.80%(55/89),差异有统计学意义(χ^2=18.939,P<0.001)。在并发症方面,日间组术后发热和呕吐的发生率分别为5.15%和3.00%,低于对照组的10.36%和11.83%,差异有统计学意义(P<0.05);而非计划就诊率日间组为2.15%,与对照组(2.07%)比较差异无统计学意义(χ^2=0.004,P=0.951)。两组患儿均无非计划入院患儿,日间组有3例(1.29%)延迟出院,对照组有1例腹股沟斜疝复发。结论加速康复外科理念指导下日间手术模式治疗小于1岁腹股沟斜疝安全可行,并优于传统住院手术模式。
Objective To evaluate the effect of enhanced recovery after surgery(ERAS)guideline implementation on hospitalization stay,patient outcomes and hospitalization expense in infantile inguinal hernia.Methods A retrospective analysis was conducted for 571 infants with inguinal hernia from February 2015 to November 2018.In this cohort,233 patients underwent ambulatory surgery(AS group)and another 338 patients were treated conventionally(control group).AS and control groups were both comprised of two subgroups(laparoscopy subgroup comprised of patients with laparoscopic hernia repair and open subgroup with open hernia repair).Age at herniorrhaphy showed no significant deference between laparoscopy AS and laparoscopy control subgroups(8.2±2.6 vs 8.9±2.4 months,P=0.126);the age of open AS subgroup at herniorrhaphy was elder than that of open control subgroup(8.7±2.8 vs 7.1±3.6 months,P<0.001).The ratios of bilateral inguinal hernia of laparoscopy AS subgroup(34.14%)vs laparoscopy control subgroup(40.76%)and open AS subgroup(16.67%)vs open control subgroup(21.26%)showed no significant difference(P=0.428 and P=0.301 respectively).The length of stay,hospitalization expense and patient outcomes were compared between groups.Results The hospitalization stay of laparoscopy AS subgroup was shorter than that of laparoscopy control subgroup(1 vs 4.6±1.5 days,P<0.001)and open AS subgroup versus open control subgroup(1 vs 4.5±1.7 days,P<0.001).Hospitalization expense of laparoscopy AS subgroup was lower than that of laparoscopy control subgroup(8 439±2 492 vs 10 645±2 014 yuan,P<0.001)and open AS subgroup versus open control subgroup(4 654±1 418 vs 6437±1 716 yuan,P<0.001).The cancellations on day of surgery was lower in AS group than that in control group(4.72%vs 13.31%,P=0.001).The duration of preoperative water fasting was shorter in AS group than that in control group(132±5 vs 148±13 min,P<0.001).The duration of postoperative water/milk intake was also shorter in AS group than that in control group(49±7 vs 142±10 min,124±12 vs 305±35 min respectively,both P<0.001).The incidence of postoperative fever of AS group was lower than that of control group(5.15%vs 10.36%,P=0.026).The incidence of postoperative omit of AS group was lower than that of control group(3.00%vs 11.83%,P<0.001).The incidence of non-programmed consultation showed no significant deference between AS and control groups(2.15%vs 2.07%,P=0.951).No hospital readmission was found for either group.There was only 1 recurrent case in control group while no recurrence in AS group.Conclusion ERAS guideline implementation during ambulatory surgery is both safe and preferred for infantile inguinal hernia.
作者
黄寿奖
吕成杰
钱云忠
秦琪
王东披
胡艳
李灿萍
陈锐
赵晓霞
钭金法
Huang Shoujiang;Lv Chengjie;Qian Yunzhong;Qin Qi;Wang Dongpi;Hu Yan;Li Canping;Chen Rui;Zhao Xiaoxia;Tou Jinfa(Department of Ambulatory Surgery,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Neonatal Surgery,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Anesthesiology,Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)
出处
《临床小儿外科杂志》
CAS
2019年第4期261-266,共6页
Journal of Clinical Pediatric Surgery
基金
浙江省医药卫生科技计划项目(编号:2013KYB151)
关键词
疝
腹股沟/外科学
加速康复外科
手术期间
应激
外科手术
微创性
Hernia Inguinal/SU
Enhanced Recovery After Surgery
Intraoperative Period
Stress
Minimally Invasive
