加速康复外科指导下改良腹腔镜阑尾切除术的应用效果研究  

Application effect of modified laparoscopic appendectomy under the guidance of enhanced recovery after surgery

作　　者：许英晨[1] 邢冰琛 沈凯[1] 杨伯钊[1] 计嘉军[1] 张立军[1] 张东欣 伍冀湘 XU Ying-chen;XING Bing-chen;SHEN Kai(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院普通外科,北京100730

出　　处：《腹腔镜外科杂志》2022年第12期917-920,925,共5页Journal of Laparoscopic Surgery

基　　金：北航-首医大数据精准医疗高精尖创新中心同仁分中心开放基金项目(BHTR-KFJJ-202011)。

摘　　要：目的:将传统腹腔镜阑尾切除术(LA)的实施过程予以细化改良,使之更符合快速康复外科理念,通过与传统LA进行对比分析,最终明确改良LA的临床应用效果。方法:回顾分析2016年12月至2021年12月施行的397例LA的临床资料,其中改良组160例,传统组197例,开腹组40例,比较各组患者年龄、性别、病理类型、手术时间、排气时间、出血量等手术相关指标。结果:三组患者年龄、性别差异无统计学意义;改良组与传统组阑尾病理类型差异无统计学意义;开腹组与另两组相比阑尾病理类型差异有统计学意义;改良组手术时间最短[(54.81±21.96)min],术中出血量最少[(5.64±7.86)mL],改良组70.63%的患者于术后24 h内排气,传统组与开腹组术后24 h内排气的患者分别占51.27%与65.00%,三组手术时间、术中出血量、术后排气时间差异有统计学意义。结论:改良LA安全、可行,与传统LA相比,手术时间、禁饮食时间短,术中出血量少,流程上更加符合快速康复外科理念,易于青年医师学习,适于临床推广。Objective:To refine and improve the implementation process of traditional laparoscopic appendectomy to make it more consistent with the concept of enhanced recovery after surgery,and to finally clarify the clinical application effect of modified laparoscopic appendectomy by comparing and analyzing with traditional operation.Methods:A retrospective analysis was made on the clinical data of 397 cases of laparoscopic appendectomy from Dec.2016 to Dec.2021,including 160 cases in modified group,197 cases in traditional group and 40 cases in open group.The age,gender,pathological type,operation time,exhaust time,blood loss and other indicators related to the operation were compared among the three groups.Results:There was no significant difference in age and gender a mong the three groups.There was no significant difference in the pathological types of appendix between the modified group and the traditional group,but there were statistically significant differences in the pathological types of appendix between modified group,traditional group and open group.The modified group had the shortest operation time[(54.81±21.96)min]and the least intraoperative blood loss[(5.64±7.86)mL].70.63%of the patients in the modified group,51.27%of the patients in the traditional group and 65.0%of the patients in the open group exhausted within 24 h after operation.There were significant differences in operation time,i ntraoperative blood loss and postoperative exhaust time among the three groups.Conclusions:Compared with traditional laparoscopic appendectomy,modified laparoscopic appendectomy is safe and feasible,has shorter operation time,shorter fasting time,fewer intraopera-tive blood loss,and more consistence with the concept of enhanced recovery after surgery,it is easy for young doctors to learn and suita-ble for clinical promotion.

关 键 词：阑尾炎 阑尾切除术 腹腔镜检查 加速康复外科 

分 类 号：R656.8[医药卫生—外科学]