加速康复外科在老年腹股沟疝无张力疝修补术中的应用价值

Application value of enhanced recovery after surgery in perioperation of tension-free hernioplasty in elderly patients with inguinal hernia

目的探讨加速康复外科在老年腹股沟疝无张力疝修补术围术期中的应用价值。方法收集2015年9月至2016年12月大兴安岭地区人民医院收治的137例老年腹股沟疝行无张力疝修补术患者的临床资料,其中2016年5月至12月收治的65例患者围术期采用ERAS处理方案,设为ERAS组;2015年9月至2016年4月收治的72例患者围术期采用传统处理方案,设为传统组。比较两组术后并发症、术后康复情况和卫生经济学指标等。结果 (1)术后并发症:ERAS组术后恶心呕吐、切口疼痛与尿潴留的发生率明显低于传统组,差异有统计学意义(P<0.01);而术后切口感染、血清肿/局部血肿、阴囊水肿、复发、暂时性神经感觉异常等并发症的发生率与传统组相当,差异无统计学意义(P>0.05)。(2)术后康复情况及卫生经济学指标:术后ERAS组下床活动时间、肛门排气时间、进食时间、术后住院时间及住院费用等情况均明显优于传统组,差异均有统计学意义(P<0.01)。结论加速康复外科应用于老年腹股沟疝无张力疝修补术围术期安全有效,可加快患者术后康复,缩短住院时间,值得推广应用。

Objective To investigate the application value of fast-track surgery in perioperation of tension-free hernioplasty in elderly patients with inguinal hernia.Methods The clinical data of 137 elderly patients with inguinal hernia who underwent tension-free hernioplasty in the People＇ s Hospital of the Greater Khingan Rang from September 2015 to December 2016 were collected.Sixty-five patients from May to December 2016 were treated with ERAS planning during perioperation,and were enrolled as ERAS group.Seventy-two from September 2015 to April 2016 were treated with traditional perioperative management,and were enrolled as traditional group.The incidence of complications,postoperative recovery and medical economics indices were compared between the two groups.Results （1） Postoperative complications： The incident rates of nausea and emesis,incision pain and uroschesis were significantly lower in the ERAS group compared with the traditional group （P〈0.01）.There were no significant differences in the incident rates of incision infection,seroma/hematoma,hydrocele,relapse and temporary nerve paresthesia between the two groups （P〉 0.05）.（2） Postoperative recovery and medical economics indices： duration for ambulation,anus exhaust and food intake,hospital stay and hospitalization cost in the ERAS group were obviously superior to those in the traditional group （P〈0.01）.Conclusion Application of ERAS to perioperation of tension-free repair in elderly patients with inguinal hernia is safe and effective,can accelerate the postoperative recovery of patients and shorten the hospital stay,and is worthy of promotion and application.