基于日间管理模式的高龄腹股沟疝Lichtenstein手术25例分析

Analysis of 25 elderly patients with inguinal hernia undergoing Lichtenstein surgery based on ambulatory surgery management mode

目的探讨高龄(≥85岁)腹股沟疝Lichtenstein手术的日间模式的可行性。方法回顾性分析空军军医大学第一附属医院2017年3月至2019年2月期间以日间手术模式进行围手术期管理的高龄腹股沟疝Lichtenstein手术病例,收集纳入病例的手术时间、术中出血量、住院时间、术后并发症发生率、术后复发率及因术后并发症或复发的再入院率等指标。结果按标准共纳入25例患者,均为男性,中位年龄为86.0(85.0,92.0)岁,其中,中位手术时间为50.0(30.0,115.0)min,中位术中出血量为10.0(5.0,20.0)ml,平均住院时间(0.9±0.2)d。术后发生脂肪液化1例、慢性疼痛1例,随访期内无因并发症或复发再入院病例和无复发病例。结论严格按照标准筛选患者、合理选择麻醉方式,并以日间手术模式进行围手术期全程风险管理、安全指导和康复指导,高龄腹股沟疝Lichtenstein手术可能是安全可行的,但仍需大样本量研究进一步验证。

Objective To explore the feasibility of ambulatory surgery management mode of Lichtenstein surgery for inguinal hernia in elderly patients(≥85 years).Methods Retrospective analysis was performed on the elderly patients of inguinal hernia who received Lichtenstein surgery and ambulatory surgery perioperative management mode in The First Affiliated Hospital of Air Force Medical University from March 2017 to February 2019.The operative time,intraoperative blood loss,duration of hospitalization,the incidence of postoperative complications,postoperative recurrence rate,and readmission rate due to postoperative complications or recurrence were collected.Results A total of 25 male patients were included according to the inclusion criteria,with a median age of 86.0(85.0,92.0)years.The median operative time was 50.0(30.0,115.0)minutes with a median intraoperative blood loss of 10.0(5.0,20.0)ml,and the average duration of hospitalization was(0.9±0.2)days.There was one patient with incision fat liquefaction,one patient with chronic pain,no readmission due to complications or recurrence,and no recurrence cases during the follow-up period.Conclusion This small sample retrospective study showed that it may be safe and feasible to conduct Lichtenstein surgery for elderly patients with inguinal hernia based on strict screening according to the criteria,reasonably selecting anesthesia methods,conducting perioperative risk management,safety and rehabilitation guidance according to the ambulatory surgery management mode.However,it still needs to be further verified by large sample size studies.