中国实用外科杂志

中国实用外科杂志

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日间手术模式下腹股沟疝腹腔镜手术规范化实践及与开放手术对比分析

缪传文，陈德键   

  1. 上海交通大学附属第一人民医院日间医疗部（疝中心），上海 201600
  • 出版日期:2020-05-01 发布日期:2020-05-15

  • Online:2020-05-01 Published:2020-05-15

摘要：  目的    对比分析日间手术模式下腹腔镜腹股沟疝修补术（LIHR）与开放疝修补术的临床特点，探讨规范化LIHR日间手术的安全性、合理性、有效性。方法    回顾性分析上海交通大学附属第一人民医院自2014年1月至2018年12月行腹股沟疝日间手术1223例病人临床资料，其中行LIHR573例（腹腔镜组），行开放疝修补术650例（开放手术组）。结果    腹腔镜组病人术后4 h疼痛视觉模拟评分（VAS）低于开放手术组，术后下床时间短于开放组，术后2周及4周恢复非限制活动率高于开放手术组（P均<0.05），两组术后急性尿潴留发生率差异无统计学意义（P>0.05）。中位随访时间19（6~36）个月，随访率98.6%。术后并发症为血清肿、伤口感染、慢性疼痛、复发，两组比较差异无统计学意义（P>0.05），两组均无严重并发症发生。结论    相较于开放手术，LIHR日间手术具有疼痛轻，恢复快的优点，是安全、可行的。全面流程设计与规范化运作是LIHR日间手术规模化、标准化建设的根本措施。

关键词: 腹股沟疝, 日间手术, 腹腔镜, 疝修补术

Abstract: Standard practice of laparoscopic inguinal hernia surgery in ambulatory surgery mode and comparison with open surgery        MIAO Chuan-wen, CHEN De-jian. Department of Day Care(Hernia Center), Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 201600, China
Corresponding author: CHEN De-jian,E-mail: cdj2458@163.com
Abstract    Objective    To compare the clinical features of laparoscopic inguinal hernia repair (LIHR) and open surgery in ambulatory surgery mode, and to explore the rationality, safety and effectiveness of standardized LIHR in ambulatory mode. Methods    A total of 1223 patients who underwent inguinal hernia repair from January 2014 to December 2018 in Shanghai General Hospital of Shanghai Jiao Tong University, including 573 cases in laparoscope group (patients underwent LIHR) and 650 cases in open surgery group (open hernia repair) were analyzed retrospectively. Results    In laparoscope group, the visual analogue scale (VAS) was lower, the off-bed activity time was shorter , the unrestricted activity rate at 2 weeks and 4 weeks after surgery was higher (all P<0.05). There was no significant difference between the two groups in the incidence of acute urinary retention after operation (P>0.05).  The follow-up time ranged from 6 to 36 months (median time 19 months), and the follow-up rate was 98.6%. Postoperative complications were seroma, wound infection, chronic pain and recurrence, there was no significant difference between the two groups (P>0.05). There was no serious complication in the two groups.  Conclusion    Compared with open surgery, the laparoscopic daytime operation for inguinal hernia has the advantages of light pain and quick recovery, which is safe and feasible. Comprehensive process design and standardized operation are the fundamental measures for the scale and standardization of LIHR.

Key words: inguinal hernia, ambulatory surgery；laparoscope；hernia repair