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  

Clinical application of ambulatory laparoscopic inguinal hernia repair based on enhanced recovery after surgery concept

作　　者：钟锴 鲁发顺 穆热艾合买提江·穆塔里夫 郑晓洁[2] 蒋铁民 冉博 张瑞青 郭强 Zhong Kai;Lu Fashun;Mureaihemaitijiang·Mutalifu;Zheng Xiaojie;Jiang Tiemin;Ran Bo;Zhang Ruiqing;Guo Qiang(Department of Hepatobiliary&Hydatid Diseases,Digestive&Vascular Surgery Center,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Subject Construction Section of the Department of Teaching and Research,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心肝胆包虫外科,新疆医科大学第一附属医院新疆维吾尔自治区包虫及肝胆疾病临床医学研究中心,乌鲁木齐830054 [2]新疆医科大学第一附属医院教学科研部学科建设科,乌鲁木齐830054

出　　处：《中华普外科手术学杂志（电子版）》2021年第1期84-87,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：新疆医科大学临床医学高峰学科校内配套经费资助(33-0104006020801#);新疆维吾尔自治区“十三五”重点学科(高峰学科)【新教研(2016)7号】;新疆维吾尔自治区自然科学基金(2018D01C220)。

摘　　要：目的分析和评价加速康复外科理念(ERAS)下日间腹腔镜经腹腔腹膜前腹股沟疝修补术(TAPP)与传统理念下行TAPP的临床疗效。方法回顾性分析2017年6月至2019年2月收治的接受TAPP术式的99例患者的临床资料,其中在日间病房接受ERAS理念管理的TAPP患者为ERAS组(57例),在普通病房接受传统围手术期管理的TAPP患者为传统组(42例),应用SPSS21.0统计学软件进行数据分析,两组患者术中术后相关指标、疼痛评分、满意度评分等计量资料用(x±s)表示,采用独立t检验;患者并发症发生率等计数资料采用检验,P<0.05表示差异有统计学意义。结果99例患者均成功完成手术达到临床治愈。ERAS组在术后6 h、12 h疼痛评分,术后胃肠道通气时间,首次下床活动时间、患者满意度、住院时间[(34.7±3.9)vs.(72.3±9.8)h]、住院费用[(1.6±0.1)vs.(1.8±0.1)万元]等方面均优于传统组(P<0.05);术后并发症方面,ERAS组恶心呕吐发生率低于传统组(P<0.05)。结论基于ERAS理念下的日间模式行TAPP是安全、可行的。具有手术创伤小,术后恢复快、住院时间短等诸多优势。Objective To analyze and evaluate the clinical efficacy of ambulatory laparoscopic Transabdominal preperitoneal (TAPP) inguinal hernia repairguided by the enhanced recovery after surgery(ERAS) concept.Methods From June 2017 to February 2019,Retrospective analysis of the clinical data were performed in 99 patients who underwent TAPP.99 patients were divided into ERAS group(57 cases) and traditional group (42 cases).Statistical analysis were performed by using SPSS21.0software.Measurement data such as perioperative related indicators,pain score,satisfaction score,were expressed as (x±s) deviation and were examined by using independent t test.Count data such as the incidence of complications were examined by using chi-square test.A P value of<0.05 was considered as statistically significant.Results All of the 99 patients received successful operation with satisfactory clinical outcome.In terms of the pain score after surgery,the time of anal exhaust and off-bed,patient satisfaction,hospital stays of[(34.7±3.9) H vs.(72.3±9.8) H],total costs of[(1.6±0.1) vs.(1.8±0.1) RMB]in ERAS group were better than those in traditional group respectively (P<0.05);the incidence of nausea and vomiting in ERAS group was lower than that in traditional group (P<0.05).Conclusion The day surgery mode of TAPP based on ERAS concept is safe and feasible.It has the advantages of less surgical trauma,quick postoperative recovery and short hospital stay.

关 键 词：疝 腹股沟 腹腔镜 加速康复外科 日间住院医疗 

分 类 号：R65[医药卫生—外科学]