加速康复外科联合腹腔镜下梅克尔憩室切除术的应用研究  

Application of enhanced recovery after surgery in children undergoing laparoscopic resection of Meckel's diverticulum

作　　者：王有亮[1] 祁英文 史卫东 李尕梅[1] 王翠翠[1] Wang Youliang;Qi Yingwen;Shi Weidong;Li Gamei;Wang Cuicui(Department of Pediatric Surgery,Gansu Provincial Maternal&Children's Health Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院小儿外科,兰州730050

出　　处：《中华小儿外科杂志》2023年第6期534-539,共6页Chinese Journal of Pediatric Surgery

基　　金：甘肃省卫生健康行业科研计划项目(GSWSHL2020-01);甘肃省卫生健康行业科研项目(GSWSKY2021-015)。

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)措施联合腹腔镜技术在治疗儿童梅克尔憩室中的应用效果。方法回顾性分析2019年4月至2022年6月在甘肃省妇幼保健院诊断为梅克尔憩室并行腹腔镜下梅克尔憩室切除术治疗的40例患儿临床资料,患儿年龄范围为3~7岁。将2019年4月至2021年1月围手术期采用传统治疗方案的18例患儿设为对照组,其中男16例,女2例,年龄为(4.61±1.50)岁。2021年1月至2022年6月围手术期采用ERAS方案的22例患儿设为ERAS组,其中男18例,女4例,年龄为(4.73±1.55)岁。手术均由同一手术团队完成,比较两组患儿的手术时间、术中出血量、术后首次排气时间、术后首次进食时间、住院时间、住院费用、术后并发症发生率等指标的差异;并比较两组患儿术后2 h、6 h、12 h、24 h的镇痛评分的差异。计量资料以±s表示,两组比较采用独立样本t检验;计数资料比较采用χ^(2)检验或Fisher确切概率法。结果患儿均顺利完成手术,ERAS组与对照组在手术时间、术中出血量等指标上差异无统计学意义(P≥0.05),ERAS组术后首次排气时间、术后首次进食时间、住院时间、住院费用分别为(20.50±4.10)h、(1.59±0.50)d、(6.18±0.91)d、(17540.24±2108.96)元,对照组上述指标分别为(41.94±6.44)h、(3.89±0.76)d、(8.39±1.29)d、(22822.67±2467.50)元,两组比较差异均有统计学意义(均P<0.05),且ERAS组较对照组显著降低。两组患儿术后2 h、6 h、12 h、24 h的FLACC镇痛评分,ERAS组均低于对照组,差异有统计学意义(P<0.05)。两组患儿均无伤口感染、吻合口瘘等并发症发生。结论加速康复外科措施应用于儿童腹腔镜下梅克尔憩室切除术中,可以缩短住院时间,减轻患儿围手术期疼痛,减少住院费用,加速患儿术后康复。Objective To explore the efficacy of enhanced recovery after surgery(ERAS)plus laparoscopy for Meckel's diverticulum(MD)in children.Methods Retrospective review was performed for clinical data of 40 MD children with an age range of(3-7)years undergoing laparoscopic Meckel's diverticulectomy from April 2019 to June 2022.Eighteen children receiving traditional treatment during perioperative period from April 2019 to January 2021 were assigned into control group.There were 16 boys and 2 girls with an age range of(4.61±1.50)years.From January 2021 to June 2022,22 children on ERAS protocol during perioperative period were assigned into ERAS group.There were 18 boys and 4 girls with an age range of(4.73±1.55)years.All operations were completed by the same surgical team.Two groups were compared with regards to operative duration,intraoperative hemorrhage,postoperative initial exhaust time,postoperative initial meal time,hospitalization stay,hospitalization expenditure and postoperative complication rate.And pain relief scores were recorded at 2/6/12/24h post-operation.SPSS 23.0 software was utilized for analysis.The measurement data were expressed as±s and independent sample t-test was utilized for inter-group comparisons;Counting data were compared byχ^(2) test or Fisher exact probability method.Results All procedures were successfully completed.No statistically significant inter-group differences existed in operative duration or intraoperative hemorrhage(P≥0.05).The ERAS group had(20.50±4.10)hours of postoperative initial exhaust time,(1.59±0.50)days of postoperative initial meal time,(6.18±0.91)days of hospital stay,(17540.24±2108.96)yuan of hospital expenditure respectively.The control group had(41.94±6.44)hours,(3.89±0.76)days,(8.39±1.29)days and(22822.67±2467.50)yuan.Both groups showed statistically significant differences(both P<0.05).ERAS group showed a significant decrease as compared to control group.FLACC pain relief scores of ERAS group were lower than those of control group at 2/6/12/24h posto

关 键 词：腹腔镜 梅克尔憩室 加速康复外科 儿童 多模式镇痛 

分 类 号：R726.5[医药卫生—儿科]