多学科诊疗联合加速康复外科模式在食管裂孔疝诊疗中的应用  

Application of the multi-disciplinary team combined with enhanced recovery after surgery model in the diagnosis and treatment of hiatal hernia

作　　者：邱雨豪 黄金向[1] 朱小轩 罗峰 黄河[1] 姚晖 汪雪[1] Qiu YuHao;Huang Jinxiang;Zhu Xiaoxuan;Luo Feng;Huang He;Yao Hui;Wang Xue(The Department of General Surgery,the Chengdu Fifth People's Hospital,Chengdu 611100,China)

机构地区：[1]成都市第五人民医院普通外科,611100

出　　处：《中华疝和腹壁外科杂志(电子版)》2025年第1期56-62,共7页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨多学科诊疗联合加速康复外科模式(MDT-ERAS 模式)在食管裂孔疝诊断和治疗中的安全性及有效性。方法回顾性分析2021 年1 月至2024 年1 月在成都市第五人民医院行腹腔镜下食管裂孔疝修补术+胃底折叠术的100 例食管裂孔疝患者的临床资料。根据是否采用MDT-ERAS 模式管理,分为MDT-ERAS 组49 例和常规组51 例。比较2 组患者的一般情况、术中指标、术后恢复情况、术后并发症(肠梗阻、消化道漏、尿潴留、切口感染、腹腔感染、肺部感染、泌尿系感染)、术后不良反应、住院时间、疼痛评分、满意度评分。结果2 组患者的出血量(15.6±6.5 ml比15.8±6.5 ml;t=-0.194,P=0.846)、手术时间(62.6±5.7 min 比62.5±5.8 min;t=0.054,P=0.957)、引流管留置率(1/49 比2/51;χ^(2)=0.000,P>0.999)差异均无统计学意义。MDT-ERAS 组的术中补液量更少(1353.1±295.2 ml 比1721.6±330.6 ml;t=-5.871,P<0.001)。MDT-ERAS 组较常规组患者术后首次排气时间(17.6±4.2 h 比25.5±3.0 h;t=-10.823,P<0.001)、首次流质饮食时间(6.6±1.2 h 比18.8±4.8 h;Z=-8.762,P<0.001)、首次半流质饮食时间(24.9±1.3 h 比48.8±3.5 h;Z=-8.750,P<0.001)、首次下床时间(6.7±1.3 h 比25.1±3.1 h;Z=-8.821,P<0.001)、导尿管留置时间(1.2±0.6 d 比1.8±0.7 d;Z=-5.239,P<0.001)更短。2 组术后并发症发生率差异均无统计学意义。MDT-ERAS 组较常规组术后腹胀(1/49 比8/51;χ^(2)=4.137,P=0.042)、恶心呕吐(2/49比10/51;χ^(2)=4.329,P=0.037)的发生率更低,差异有统计学意义;2 组非感染性发热、吞咽困难发生率差异无统计学意义;MDT-ERAS组较常规组疼痛VAS评分更低(3.2±1.2比5.2±1.4;Z=-6.175,P<0.001),平均住院时间更短(3.3±0.7 d 比3.8±0.8 d;Z=-3.222,P=0.001);MDT-ERAS 组满意度评分更高(4.4±0.7 比3.6±0.8;Z=-4.384,P<0.001),差异均有统计学意义。MDT-ERAS组平均随访时间为(20.6±7.2)个月,常规组为(20.1±7.1)个月;随访2 组各有1 例复发,1 例常规组患�ObjectiveTo investigate the safety and efficacy of the multi-disciplinary team combined with enhanced recovery after surgery model (MDT-ERAS model) in the diagnosis and treatment of hiatal hernia.MethodsThis study retrospectively analyzed the clinical data of 100 patients with hiatal hernia who underwent laparoscopic hiatal hernia repair+ fundoplication at the Chengdu Fifth People&apos;s Hospital from January 2021 to January 2024.According to whether the patients were managed under the MDT-ERAS mode, they were divided into the MDT-ERAS group with 49 cases and the conventional group with 51 cases.Two groups of patients were compared in terms of general condition, intraoperative indicators, postoperative recovery, postoperative complications (including intestinal obstruction,gastrointestinal leakage, urinary retention, incision infection, abdominal infection, pulmonary infection,urinary system infection, postoperative adverse reactions, length of stay, pain score, and satisfaction score.ResultsThere were no significant differences between the two groups in terms of blood loss (15.6±6.5 ml vs.15.8±6.5 ml;t=-0.194, P=0.846), operation time (62.6±5.7 min vs.62.5±5.8 min;t=0.054, P=0.957), and drainage tube retention rate (1/49 vs.2/51;χ^(2)=0.000, P>0.999).In terms of intraoperative fluid infusion volume, the MDT-ERAS group was lower (1353.1±295.2 ml vs.1721.6±330.6 ml;t=-5.871, P<0.001).The time of first postoperative exhaust (17.6±4.2 h vs.25.5±3.0 h;t=-10.823, P<0.001), the time of first liquid diet (6.6±1.2 h vs.18.8±4.8 h;Z=-8.762, P<0.001), the time of first semi-liquid diet (24.9±1.3 h vs.48.8±3.5 h;Z=-8.750, P<0.001), the time of first getting out of bed (6.7±1.3 h vs.25.1±3.1 h;Z=-8.821,P<0.001), and the time of urinary catheter indwelling (1.2±0.6 d vs.1.8±0.7 d;Z=-5.239, P<0.001) in the MDT-ERAS group were shorter than those in the conventional group.There was no statistically significant difference in the incidence of postoperative complications between the two groups.The incidence of post

关 键 词：疝 食管裂孔 胃食管反流病 多学科诊疗 加速康复外科 

分 类 号：R47[医药卫生—护理学]