日间模式应用于腹腔镜胆囊切除术的疗效分析  

Curative effect analysis of ambulatory pattern in laparoscopic cholecystectomy

作　　者：鲁发顺 钟锴 穆热艾合买提江·穆塔里夫 郑晓洁[3] 蒋铁民 冉博[1,2] 郭强 张瑞青[1,2] 邵英梅 吐尔干艾力·阿吉[1,2] LU Fashun;ZHONG Kai;Mureaihemaitijiang·Mutalifu;ZHENG Xiaojie;JIANG Tiemin;RAN Bo;GUO Qiang;ZHANG Ruiqing;SHAO Yingmei;Tuerganaili·Aji(Department of Hepatobiliary&Hydatid Diseases,Digestive&Vascular Surgery Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China;Xinjiang Uygur Autonomous Region Hydatid and Hepatobiliary Disease Clinical Medicine Research Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.China;Department of Discipline Construction,Teaching and Research Department,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,P.R.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,乌鲁木齐830054 [2]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 [3]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：《中国普外基础与临床杂志》2021年第7期856-860,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金资助项目(项目编号:81960377);国家重点研发计划精准医学研究重点专项项目(项目编号:2017YFC0909903);新疆维吾尔自治区自然科学基金资助项目(项目编号:2018D01C220);新疆维吾尔自治区重点实验室开放课题项目(项目编号:2017D04004);新疆维吾尔自治区“十三五”重点学科(高峰学科)[项目编号:新教研(2016)7号]。

摘　　要：目的评价和分析日间模式应用于腹腔镜胆囊切除术(LC)的临床疗效。方法收集2017年6月至2019年2月期间于新疆医科大学第一附属医院行LC患者,根据入院流程模式分为日间LC组(ALC)和常规LC组(CLC组),ALC组在日间手术病房接受LC,CLC组在普通病房接受LC。比较2组患者术前等待时间、术后胃肠道功能恢复时间、术后6 h疼痛评分、总住院时间、总住院费用、患者满意度、术后并发症。结果本研究共纳入LC患者433例,其中ALC组176例,CLC组257例。2组患者除体质量指数外,年龄、性别、胆囊疾病类型等基线资料比较差异均无统计学意义(P>0.05)。ALC组与CLC组患者均临床治愈后出院,无围手术期死亡病例,CLC组中有1例患者中转开腹后治愈出院。与CLC组比较,ALC组的术前等待时间、术后胃肠道功能恢复时间及总住院时间均更短(P<0.05),术后疼痛评分更低(P<0.05),总住院费用更少(P<0.05),患者满意占比更高(P<0.05)。2组均未出现胆管损伤、出血、胆汁漏,ALC组和CLC组各有1例切口感染和术区腹腔积液,ALC组和CLC组分别有1例和3例发热,2组总体并发症发生率比较差异无统计学意义(P>0.05)。随访6~26个月2组患者均无再入院情况发生。结论基于日间手术模式行LC患者恢复快,住院费用少,患者满意度高。Objective To evaluate and analyze the clinical effect of ambulatory surgery applied to laparoscopic cholecystectomy(LC).Methods The patients who underwent LC in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to February 2019 were collected,then were assigned to ambulatory surgery applied to LC group(ALC group)and conventional LC group(CLC group)according to the admission process mode.The patients in the ALC group received LC in the ambulatory ward and the patients in the CLC group received LC in the conventional ward.The preoperative waiting time,postoperative gastrointestinal recovery time,postoperative 6 h pain score,total hospitalization time,total hospitalization cost,patient satisfaction,and postoperative complications were compared between the two groups.Results A total of 433 patients underwent LC were included in this study,including 176 patients in the ALC group and 257 patients in the CLC group.There were no significant differences in the age,gender,type of gallbladder diseases,etc.between the two groups(P>0.05)except body mass index(P<0.05).There was no perioperative death in the two groups.One patient converted to laparotomy in the CLC group.Compared with the CLC group,the preoperative waiting time,postoperative gastrointestinal recovery time,and the total hospitalization time were shorter,the postoperative pain score was lower,the total hospitalization cost was less,and the satisfaction rate of patients was higher in the ALC group(P<0.05).There was 1 case of incision infection and 1 case of ascites in the operation area in the ALC group and CLC group,1 case of fever in the ALC group and 3 cases of fever in the CLC group,respectively.There was no difference in the overall incidence of complications between the two groups(P>0.05).During the follow-up of 6 to 26 months,there was no readmission in both groups.Conclusion Patients who undergone LC based on ambulatory surgery mode recover quickly,and hospitalization cost is less,satisfaction rate is higher.

关 键 词：胆囊疾病 日间手术 腹腔镜 胆囊切除术 疗效 

分 类 号：R657.4[医药卫生—外科学]