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1892例腹股沟疝日间手术的临床疗效

Clinical efficacies of ambulatory surgery for inguinal hernia in 1892 patients

摘要:

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.

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abstracts:

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.

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作者: 宋应寒 [1] 雷文章 [1]
期刊: 《中华消化外科杂志》2015年14卷10期 823-826页 ISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.1673-9752.2015.10.008
发布时间: 2015-11-06
基金项目:
四川省卫生和计划生育委员会科研课题
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