基于加速康复外科理念的日间经阴道闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁的可行性和安全性研究  

Feasibility and safety of tension-free vaginal tape-obturator for female stress urinary incontinence under the daytime surgical mode based on the concept of enhanced recovery after surgery

作　　者：郑志斌[1] 吉祥 栾潇 郑晓宇 姚佳沛[1] 申吉泓[2] 柯坤彬[2] 高振华[2] 珠珠[1] ZHENG Zhibin;JI Xiang;LUAN Xiao;ZHENG Xiaoyu;YAO Jiapei;SHEN Jihong;KE Kunbin;GAO Zhenhua;ZHU Zhu(Day Surgery Center,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,P.R.China;The First Department of Urology,the First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,P.R.China)

机构地区：[1]昆明医科大学第一附属医院日间手术中心,昆明650032 [2]昆明医科大学第一附属医院泌尿外一科,昆明650032

出　　处：《华西医学》2024年第2期208-212,共5页West China Medical Journal

基　　金：国家自然科学基金(82260297)。

摘　　要：目的 探讨基于加速康复外科理念的日间手术模式下经阴道闭孔无张力尿道中段悬吊术治疗女性压力性尿失禁的可行性和安全性。方法 回顾性分析2019年6月-2023年6月昆明医科大学第一附属医院的女性压力性尿失禁患者的临床资料。根据患者围手术期管理模式将其分为日间手术组和常规手术组。比较两组患者的基本情况、术中情况和术后情况。结果 最终纳入183例患者,常规手术组91例,日间手术组92例。所有患者均顺利完成手术。两组患者的年龄、术前合并基础疾病、手术主刀医生、手术时长差异无统计学意义(P>0.05)。日间手术组的住院后术前等待时长[(0.00±0.00)vs.(2.42±0.58)d]、住院费用[(13 815.10±2 906.01)vs.(18 095.21±3 586.67)元]、总手术费用[(3 961.36±707.35)vs.(4 440.19±1 016.31)元]、麻醉费用[(718.53±61.06)vs.(755.30±74.65)元]、西药费用[(818.07±259.30)vs.(1 282.14±460.75)元]、住院总时长[(1.11±0.31)vs.(5.77±1.30)d]、术后住院时长[(1.11±0.31)vs.(3.35±1.42)d]低于常规组手术(P<0.05)。两组患者的术后并发症(呼吸道并发症、发热、恶心呕吐、阴道出血、尿潴留、腹膜炎)、满意情况、术后疼痛和症状改善的自我感受情况差异无统计学意义(P>0.05)。结论 基于加速康复外科理念的女性压力性尿失禁日间手术安全、可行,可缩短住院时长,降低住院费用。Objective To explore the feasibility and safety of tension-free vaginal tape-obturator for female stress urinary incontinence under the daytime surgical mode based on the concept of enhanced recovery after surgery.Methods The clinical data of female patients with stress urinary incontinence at the First Affiliated Hospital of Kunming Medical University between June 2019 and June 2023 were retrospectively analyzed.According to the perioperative management mode of patients,they were divided into daytime surgery group and routine surgery group.The basic,intraoperative,and postoperative conditions of two groups of patients were compared.Results Finally,183 patients were included,including 91 in the routine surgery group and 92 in the daytime surgery group.All patients successfully completed the surgery.There was no statistically significant difference in age,preoperative comorbidities,surgeon in chief,or operation duration between the two groups of patients(P>0.05).The preoperative waiting time after hospitalization[(0.00±0.00)vs.(2.42±0.58)d],hospitalization expenses[(13815.10±2906.01)vs.(18095.21±3586.67)yuan],total surgical expenses[(3961.36±707.35)vs.(4440.19±1016.31)yuan],anesthesia expenses[(718.53±61.06)vs.(755.30±74.65)yuan],western medicine expenses[(818.07±259.30)vs.(1282.14±460.75)yuan],total hospitalization duration[(1.11±0.31)vs.(5.77±1.30)d],and postoperative hospitalization duration[(1.11±0.31)vs.(3.35±1.42)d]in the daytime surgery group were lower than those in the routine surgery group(P<0.05).There was no significant difference between the two groups in postoperative complications(respiratory complications,fever,nausea and vomiting,vaginal bleeding,urinary retention,peritonitis),satisfaction,postoperative pain or self perception of symptom improvement(P>0.05).Conclusion The daytime surgery for female stress urinary incontinence based on the concept of enhanced recovery after surgery is safe and feasible,which can shorten hospitalization duration and reduce hospitalization costs.

关 键 词：女性压力性尿失禁 经阴道闭孔无张力尿道中段悬吊术 日间手术 加速康复外科 

分 类 号：R197.3[医药卫生—卫生事业管理]