日间手术模式在腹股沟疝修补术中的应用价值

Application value of ambulatory surgery mode in inguinal hernia repair

  • 摘要:
    目的 探讨日间手术模式在腹股沟疝修补术中的应用价值。
    方法 采用回顾性描述性研究方法。收集2020年1月至2022年1月四川大学华西医院眉山医院收治的416例腹股沟疝患者的临床资料;男374例,女42例;年龄为52(25~70)岁。患者均行腹股沟疝修补术,诊断与治疗过程采用日间手术模式。观察指标:(1)手术情况。(2)随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示,计数资料以绝对数表示。
    结果 (1)手术情况。416例患者中,采用全身麻醉行腹腔镜经腹腹膜前疝修补术(TAPP)258例,采用局部麻醉行开放腹股沟疝修补术158例(李金斯坦修补术98例、腹膜前修补术60例)。术中测量疝环缺损最大径为1.9(0.9~3.2)cm,手术时间为52(35~80)min。患者住院时间均<48 h,其中395例患者住院时间≤24 h,21例患者(术后疼痛12例、全身麻醉不良反应8例、术后血清肿1例)延迟出院。(2)随访情况。416例患者术后随访12个月。随访期间均未发生腹股沟疝复发、伤口感染、肠瘘或肠梗阻等严重并发症,术后1个月行腹股沟区超声检查均未发现血肿或血清肿。腹腔镜TAPP患者术后视觉模拟评分法(VAS)评分由术后3 d的(2.70±0.10)分降至术后12个月的0分;李金斯坦修补术患者术后VAS评分由术后3 d的(3.20±0.20)分降至术后12个月的0分;腹膜前修补术患者术后VAS评分由术后3 d的(3.00±0.10)分降至术后12个月的0分,所有患者未发生>3个月的慢性疼痛。416例患者通过电话进行满意度调查,均为非常满意或满意,满意度为100.00%(416/416)。
    结论 日间手术模式运用于腹股沟疝修补术安全、可行。

     

    Abstract:
    Objective To investigate the application value of ambulatory surgery mode in inguinal hernia repair.
    Methods The retrospective and descriptive study was conducted. The clinical data of 416 patients with inguinal hernia who were admitted to the Meishan People′s Hospital, West China Hospital of Sichuan University from January 2020 to January 2022 were collected. There were 374 males and 42 females, aged 52(range, 25-70)years. All patients underwent inguinal hernia repair with the ambulatory surgery mode. Observation indicators: (1) surgical situations; (2) follow⁃up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers.
    Results (1) Surgical situations. Of the 416 patients, 258 patients underwent laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) under general anesthesia and 158 patients underwent open inguinal hernia repair under local anesthesia (98 cases of Lichtenstein repair and 60 cases of preperitoneal repair). The intraoperative measured diameter of hernia ring defect and operation time of the 416 patients were 1.9 (range, 0.9-3.2)cm and 52 (range, 35-80)minutes. The duration of hospital stay of the 416 patients <48 hours, including 395 cases with the duration of hospital stay <24 hours. There were 21 patients with delayed discharge including 12 cases as post-operative pain, 8 cases as adverse reactions to general anesthesia, and 1 case as postoperative seroma. (2) Follow‑up. All 416 patients were followed up for 12 months after surgery. During the follow‑up period, there was no serious complication such as recurrent inguinal hernia, wound infection, intestinal fistula or obstruction. At 1 month after surgery, ultrasound examination of the inguinal area did not reveal any serum swelling or seroma. The postoperative visual analogue scale of pain in patients undergoing laparoscopic TAPP was 2.70±0.10 at postoperative 3 days and 0 at postoperative 12 months. The above indicator in patients undergoing Lichtenstein repair and pre-peritoneal repair was from 3.20±0.20 and 3.00±0.10 at postoperative 3 days to 0 and 0 at post-operative 12 months, respectively. All patients did not experience chronic pain for more than 3 months. All 416 patients conducted satisfaction surveys over the phone, and all of them were very satisfied or satisfied, with a satisfaction rate as 100.00%(416/416).
    Conclusion Ambulatory surgery mode in inguinal hernia repair is safe and feasible.

     

/

返回文章
返回