中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
Chinese Journal of Digestive Surgery
2015年
10期
823-826
,共4页
腹股沟疝%日间手术%疗效%质量控制
腹股溝疝%日間手術%療效%質量控製
복고구산%일간수술%료효%질량공제
Inguinal hernia%Ambulatory surgery%Efficacy%Quality control
目的 探讨腹股沟疝日间手术的临床疗效.方法 回顾性分析2009年11月至2015年6月四川大学华西医院收治的1 892例行腹股沟疝日间手术患者的临床资料.完善术前检查,包括血常规、血生化、血电解质、凝血常规、输血前全套、血型、胸部X线片、心电图.对需暂缓日间手术的情况,纠正相关异常指标后重新预约手术时间.术前一般不预防性使用抗生素.患者采用局部浸润麻醉,应用腹膜前间隙无张力修补法或巴西尼法.记录患者麻醉方式、手术方法、修补材料、手术时间、转入住院部的例数及原因、治疗费用.日间手术中心于出院时对患者进行满意度问卷调查.主刀医师于术后1、3、6、12个月定期对患者进行随访.随访内容包括并发症发生情况、慢性疼痛发生情况、疝复发情况、再入院患者例数及原因.随访时间截至2015年7月.正态分布的计量资料以x-±s表示.结果 1 892例患者中,1 889例在局部麻醉下完成手术,3例改为全身麻醉;1 874例采用无张力修补法,其中采用超普疝材料1 592例,超普网塞材料264例,普理灵疝材料8例,戈尔平片6例,聚丙烯三维网塞材料4例;18例采用巴西尼法.无围术期死亡患者.1892例患者手术时间为(28±12)min.1例患者因术后切口疼痛拒绝出院,1例因皮下血肿,1例因饱食后腹胀,转入住院部,均经处理后顺利出院.出院后26例患者发生并发症,其中12例为切口浅层感染,换药后痊愈,无补片取出患者;5例出现阴囊及腹股沟区水肿;3例出现皮下血肿;2例出现恶心呕吐;2例出现尿潴留;2例出现切口裂开,均经对症处理后顺利恢复.1 892例患者治疗费用为(6 956±249)元/侧(腹股沟疝).出院时患者满意率为99.049％(1 874/1 892).患者随访率为86.152％(1 630/1 892),随访时间为1～67个月,中位随访时间为35个月.随访期间,4例患者出现慢性疼痛,经镇痛、理疗等治疗后好转;3例腹股沟疝复发,其中1例为复发疝,2例为巨大直疝.结论 腹股沟疝日间手术安全有效,并发症少,患者满意度高,治疗费用低.
目的 探討腹股溝疝日間手術的臨床療效.方法 迴顧性分析2009年11月至2015年6月四川大學華西醫院收治的1 892例行腹股溝疝日間手術患者的臨床資料.完善術前檢查,包括血常規、血生化、血電解質、凝血常規、輸血前全套、血型、胸部X線片、心電圖.對需暫緩日間手術的情況,糾正相關異常指標後重新預約手術時間.術前一般不預防性使用抗生素.患者採用跼部浸潤痳醉,應用腹膜前間隙無張力脩補法或巴西尼法.記錄患者痳醉方式、手術方法、脩補材料、手術時間、轉入住院部的例數及原因、治療費用.日間手術中心于齣院時對患者進行滿意度問捲調查.主刀醫師于術後1、3、6、12箇月定期對患者進行隨訪.隨訪內容包括併髮癥髮生情況、慢性疼痛髮生情況、疝複髮情況、再入院患者例數及原因.隨訪時間截至2015年7月.正態分佈的計量資料以x-±s錶示.結果 1 892例患者中,1 889例在跼部痳醉下完成手術,3例改為全身痳醉;1 874例採用無張力脩補法,其中採用超普疝材料1 592例,超普網塞材料264例,普理靈疝材料8例,戈爾平片6例,聚丙烯三維網塞材料4例;18例採用巴西尼法.無圍術期死亡患者.1892例患者手術時間為(28±12)min.1例患者因術後切口疼痛拒絕齣院,1例因皮下血腫,1例因飽食後腹脹,轉入住院部,均經處理後順利齣院.齣院後26例患者髮生併髮癥,其中12例為切口淺層感染,換藥後痊愈,無補片取齣患者;5例齣現陰囊及腹股溝區水腫;3例齣現皮下血腫;2例齣現噁心嘔吐;2例齣現尿潴留;2例齣現切口裂開,均經對癥處理後順利恢複.1 892例患者治療費用為(6 956±249)元/側(腹股溝疝).齣院時患者滿意率為99.049％(1 874/1 892).患者隨訪率為86.152％(1 630/1 892),隨訪時間為1～67箇月,中位隨訪時間為35箇月.隨訪期間,4例患者齣現慢性疼痛,經鎮痛、理療等治療後好轉;3例腹股溝疝複髮,其中1例為複髮疝,2例為巨大直疝.結論 腹股溝疝日間手術安全有效,併髮癥少,患者滿意度高,治療費用低.
목적 탐토복고구산일간수술적림상료효.방법 회고성분석2009년11월지2015년6월사천대학화서의원수치적1 892례행복고구산일간수술환자적림상자료.완선술전검사,포괄혈상규、혈생화、혈전해질、응혈상규、수혈전전투、혈형、흉부X선편、심전도.대수잠완일간수술적정황,규정상관이상지표후중신예약수술시간.술전일반불예방성사용항생소.환자채용국부침윤마취,응용복막전간극무장력수보법혹파서니법.기록환자마취방식、수술방법、수보재료、수술시간、전입주원부적례수급원인、치료비용.일간수술중심우출원시대환자진행만의도문권조사.주도의사우술후1、3、6、12개월정기대환자진행수방.수방내용포괄병발증발생정황、만성동통발생정황、산복발정황、재입원환자례수급원인.수방시간절지2015년7월.정태분포적계량자료이x-±s표시.결과 1 892례환자중,1 889례재국부마취하완성수술,3례개위전신마취;1 874례채용무장력수보법,기중채용초보산재료1 592례,초보망새재료264례,보리령산재료8례,과이평편6례,취병희삼유망새재료4례;18례채용파서니법.무위술기사망환자.1892례환자수술시간위(28±12)min.1례환자인술후절구동통거절출원,1례인피하혈종,1례인포식후복창,전입주원부,균경처리후순리출원.출원후26례환자발생병발증,기중12례위절구천층감염,환약후전유,무보편취출환자;5례출현음낭급복고구구수종;3례출현피하혈종;2례출현악심구토;2례출현뇨저류;2례출현절구렬개,균경대증처리후순리회복.1 892례환자치료비용위(6 956±249)원/측(복고구산).출원시환자만의솔위99.049％(1 874/1 892).환자수방솔위86.152％(1 630/1 892),수방시간위1～67개월,중위수방시간위35개월.수방기간,4례환자출현만성동통,경진통、리료등치료후호전;3례복고구산복발,기중1례위복발산,2례위거대직산.결론 복고구산일간수술안전유효,병발증소,환자만의도고,치료비용저.
Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia.Methods The clinical data of 1 892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed.Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients.Operation time was rescheduled after abnormal indexes were corrected for elective surgery.Preventive use of antibiotics was not needed.Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia.Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded.Ambulatory surgery center did satisfaction survey on patients at the discharge.Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons.Measurement data with normal distribution were presented as x ± s.Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia.There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS) , 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperative death.The operation time of 1 892 patients was (28 ± 12) minutes.Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment.Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment.Treatment expense of the 1 892 patients was (6 956 ± 249) yuan per hermia.Satisfaction rate of patients was 99.049％ (1 874/1 892) when discharged.The follow-up rate was 86.152％ (1 630/1 892).The follow-up time was 1-67 months with a median time of 35 months.During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia.Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses.
