日间手术及加速康复外科用于胸腔镜胸交感神经切除术的探索及实践  

Exploration and practice of day surgery and enhanced recovery after surgery for thoracic sympathectomy

作　　者：施琴朗 黄丕来 郑硕 付强 王延锋 尹丹颖 王思思[2] 向凝[1] 乔坤[1] Shi;Qinlang;Huang Pilai;Zheng Shuo;Fu Qiang;Wang Yanfeng;Yin Danying;Wang Sisi;Xiang Ning;Qiao Kun(Department of Thoracic Surgery,The Third People′s Hospital of Shenzhen/The Second Affiliated Hospital of Southern University of Science and Technology,Shenzhen 518000,China;Anesthesia Operating Room,The Third People′s Hospital of Shenzhen/The Second Affiliated Hospital of Southern University of Science and Technology,Shenzhen 518000,China)

机构地区：[1]深圳市第三人民医院,南方科技大学第二附属医院胸外科,518000 [2]深圳市第三人民医院,南方科技大学第二附属医院麻醉手术室,518000

出　　处：《中华腔镜外科杂志（电子版）》2022年第4期233-237,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：广东省医学科研基金项目(A2021413);广东省基础与应用基础研究基金(2019A15110489);深圳市三名工程(SZSM201812058)。

摘　　要：目的探索日间手术及加速康复外科(enhanced recovery after surgery,ERAS)胸交感神经切除术应用的安全性、可行性。方法回顾性分析2016年1月至2020年12月期间,深圳市第三人民医院胸外科657例接受胸交感神经切除术的原发性多汗症(primary hyperhidrosis,PHH)患者资料,其中男273例、女384例,年龄14~43岁、平均(24±5)岁,分为日间组及过夜组。分析两组的住院时间、手术时间、并发症、满意度、术后代偿性出汗、手术预约取消率、非计划再次手术、非计划再次住院等指标。结果两组手术时间、麻醉时间、手术有效、代偿性出汗发生、非计划再次手术、非计划再次住院等,差异无统计学意义(P>0.05)。相比过夜组,日间组住院时间短[(9.6±1.1)h比(24.8±6.6)h,P<0.05],术后恶心和呕吐少(7例比23例,P<0.05),手术预约取消率高(15例比0例,P<0.05),患者满意度高[90分(90分,95分)比85分(80分,90分)]。结论日间手术及ERAS理念可安全应用于胸腔镜胸交感神经切除术。Objective To explore the safety and feasibility of day surgery and enhanced recovery surgery in thoracic sympathectomy.Methods The data of 657 patients with primary hyperhidrosis who underwent thoracic sympathectomy from Jan.2016 to Dec.2020 in the Thoracic Department of The Third People′s Hospital of Shenzhen were retrospectively analyzed.Among them,273 were male and 384 were female.14-43(24±5)years,divided into day group and overnight group.The hospitalization time,operation time,complications,satisfaction,postoperative compensatory sweating,surgical appointment cancellation rate,unplanned reoperation,unplanned rehospitalization and other indicators were analyzed between the two groups.Results There was no statistical significance in the operation time,anesthesia time,number of effective cases,the number of cases of compensatory sweating,the number of unplanned reoperations,and the number of unplanned rehospitalizations between the two groups(P>0.05).Compared with the overnight group,the patients in the day group had a shorter hospital stay[(9.6±1.1)h vs(24.8±6.6)h,P<0.05],and fewer postoperative nausea and vomiting(7 cases vs 23 cases,P<0.05).Surgical appointment cancellation rate was high(15 cases vs 0 case,P<0.05),and patient satisfaction was high[90(90,95)vs 85(80,90)].Conclusions The concept of day surgery and enhanced recovery surgery can be safely used in thoracoscopic thoracic sympathectomy.

关 键 词：日间手术 加速康复外科 原发性多汗症 胸交感神经切除术 电视胸腔镜手术 

分 类 号：R656[医药卫生—外科学]