加速康复外科理念在日间腹腔镜腹股沟疝修补术中的应用

doi:10.3877/cma.j.issn.1674-3946.2021.01.024

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 84 -87. doi: 10.3877/cma.j.issn.1674-3946.2021.01.024

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论著

加速康复外科理念在日间腹腔镜腹股沟疝修补术中的应用

钟锴¹, 鲁发顺¹, 穆热艾合买提江·穆塔里夫¹, 郑晓洁², 蒋铁民¹, 冉博¹, 张瑞青¹, 郭强¹^,^†(

)

^1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心肝胆包虫外科，新疆医科大学第一附属医院新疆维吾尔自治区包虫及肝胆疾病临床医学研究中心
^2. 830054　乌鲁木齐，新疆医科大学第一附属医院教学科研部学科建设科

收稿日期:2020-05-12 出版日期:2021-02-10
通信作者: 郭强

Clinical application of ambulatory laparoscopic inguinal hernia repair based on enhanced recovery after surgery concept

Kai Zhong¹, Fashun Lu¹, Mutalifu Mureaihemaitijiang·¹, Xiaojie Zheng², Tiemin Jiang¹, Bo Ran¹, Ruiqing Zhang¹, Qiang Guo¹^,^†()

^1. Department of Hepatobiliary & Hydatid Diseases, Digestive & Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
^2. Subject Construction Section of the Department of Teaching and Research; The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China

Received:2020-05-12 Published:2021-02-10
Corresponding author: Qiang Guo
Supported by:
School supporting funds for clinical medicine peak disciplines of Xinjiang medical university(33-0104006020801#); Key discipline of the 13th five-year plan of autonomous region (Peak discipline)(New Teaching Research (2016) No. 7); Natural Science Foundation of Xinjiang Uygur Autonomous Region(2018D01C220)

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钟锴, 鲁发顺, 穆热艾合买提江·穆塔里夫, 郑晓洁, 蒋铁民, 冉博, 张瑞青, 郭强. 加速康复外科理念在日间腹腔镜腹股沟疝修补术中的应用[J]. 中华普外科手术学杂志(电子版), 2021, 15(01): 84-87.

Kai Zhong, Fashun Lu, Mutalifu Mureaihemaitijiang·, Xiaojie Zheng, Tiemin Jiang, Bo Ran, Ruiqing Zhang, Qiang Guo. Clinical application of ambulatory laparoscopic inguinal hernia repair based on enhanced recovery after surgery concept[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(01): 84-87.

目的

分析和评价加速康复外科理念(ERAS)下日间腹腔镜经腹腔腹膜前腹股沟疝修补术(TAPP)与传统理念下行TAPP的临床疗效。

方法

回顾性分析2017年6月至2019年2月收治的接受TAPP术式的99例患者的临床资料，其中在日间病房接受ERAS理念管理的TAPP患者为ERAS组(57例)，在普通病房接受传统围手术期管理的TAPP患者为传统组(42例)，应用SPSS21.0统计学软件进行数据分析，两组患者术中术后相关指标、疼痛评分、满意度评分等计量资料用(±s)表示，采用独立t检验；患者并发症发生率等计数资料采用检验，P<0.05表示差异有统计学意义。

结果

99例患者均成功完成手术达到临床治愈。ERAS组在术后6 h、 12 h疼痛评分，术后胃肠道通气时间，首次下床活动时间、患者满意度、住院时间[(34.7±3.9) vs. ( 72.3±9.8) h]、住院费用[(1.6±0.1) vs. (1.8±0.1)万元]等方面均优于传统组(P<0.05)；术后并发症方面，ERAS组恶心呕吐发生率低于传统组(P<0.05)。

结论

基于ERAS理念下的日间模式行TAPP是安全、可行的。具有手术创伤小，术后恢复快、住院时间短等诸多优势。

关键词: 疝, 腹股沟, 腹腔镜, 加速康复外科, 日间住院医疗

Objective

To analyze and evaluate the clinical efficacy of ambulatory laparoscopic Transabdominal preperitoneal (TAPP) inguinal hernia repairguided by the enhanced recovery after surgery (ERAS) concept.

Methods

From June 2017 to February 2019, Retrospective analysis of the clinical data were performed in 99 patients who underwent TAPP.99 patients were divided into ERAS group (57 cases) and traditional group (42 cases). Statistical analysis were performed by using SPSS21.0 software. Measurement data such as perioperative related indicators, pain score, satisfaction score, were expressed as (±s) deviation and were examined by using independent t test. Count data such as the incidence of complications were examined by using chi-square test. A P value of <0.05 was considered as statistically significant.

Results

All of the 99 patients received successful operation with satisfactory clinical outcome. In terms of the pain score after surgery, the time of anal exhaust and off-bed, patient satisfaction, hospital stays of [(34.7 ± 3.9) H vs. (72.3 ± 9.8) H], total costs of [(1.6 ± 0.1) vs. (1.8 ± 0.1) RMB] in ERAS group were better than those in traditional group respectively (P< 0.05); the incidence of nausea and vomiting in ERAS group was lower than that in traditional group (P <0.05).

Conclusion

The day surgery mode of TAPP based on ERAS concept is safe and feasible. It has the advantages of less surgical trauma, quick postoperative recovery and short hospital stay.

Key words: Hernia, inguinal, Laparoscopes, Enhanced recovery after surgery, Day care

表1 99例行TAPP治疗腹股沟疝患者不同围术期管理两组患者一般资料比较[(±s)，例]

组别	例数	年龄(岁)	BMI(kg/m²)	性别	疝类型
组别	例数	年龄(岁)	BMI(kg/m²)	男/女	A/B/C
传统组	42	57.3±7.6	21.0±1.9	33/9	26/13/3
ERAS组	57	59.4±6.1	21.7±2.0	44/13	38/15/4
t/χ²值		-1.469	-1.761	0.027	0.269
P值		>0.05	>0.05	>0.05	>0.05

表1 99例行TAPP治疗腹股沟疝患者不同围术期管理两组患者一般资料比较[(±s)，例]

组别	例数	年龄(岁)	BMI(kg/m²)	性别	疝类型
组别	例数	年龄(岁)	BMI(kg/m²)	男/女	A/B/C
传统组	42	57.3±7.6	21.0±1.9	33/9	26/13/3
ERAS组	57	59.4±6.1	21.7±2.0	44/13	38/15/4
t/χ²值		-1.469	-1.761	0.027	0.269
P值		>0.05	>0.05	>0.05	>0.05

表2 99例行TAPP治疗腹股沟疝患者不同围术期管理两组患者术中术后各项指标比较(±s)

组别	例数	手术时间(min)	住院费用(万元)	术后胃肠道通气时间(h)	首次术后下床活动时间(h)
传统组	42	56.9±6.5	1.8±0.1	7.8±0.9	9.3±0.9
ERAS组	57	54.8±9.1	1.6±0.1	5.4±1.0	6.5±0.8
t值		1.362	10.247	12.869	16.849
P值		>0.05	<0.05	<0.05	<0.05
组别	例数	VAS评分(分)		住院时间(h)	满意度评分(分)
组别	例数	6 h	12 h	住院时间(h)	满意度评分(分)
传统组	42	3.5±1.1	2.8±0.8	72.3±9.8	92.6±2.1
ERAS组	57	2.1±0.7	1.9±0.7	34.7±3.9	96.4±1.4
t值		6.703	6.686	23.539	-10.131
P值		<0.05	<0.05	<0.05	<0.05

表2 99例行TAPP治疗腹股沟疝患者不同围术期管理两组患者术中术后各项指标比较(±s)

组别	例数	手术时间(min)	住院费用(万元)	术后胃肠道通气时间(h)	首次术后下床活动时间(h)
传统组	42	56.9±6.5	1.8±0.1	7.8±0.9	9.3±0.9
ERAS组	57	54.8±9.1	1.6±0.1	5.4±1.0	6.5±0.8
t值		1.362	10.247	12.869	16.849
P值		>0.05	<0.05	<0.05	<0.05
组别	例数	VAS评分(分)		住院时间(h)	满意度评分(分)
组别	例数	6 h	12 h	住院时间(h)	满意度评分(分)
传统组	42	3.5±1.1	2.8±0.8	72.3±9.8	92.6±2.1
ERAS组	57	2.1±0.7	1.9±0.7	34.7±3.9	96.4±1.4
t值		6.703	6.686	23.539	-10.131
P值		<0.05	<0.05	<0.05	<0.05

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