加速康复外科理念在穿孔性阑尾炎中的应用

Application of enhanced recovery after surgery for perforated appendicitis

目的探讨加速康复外科理念联合腹腔镜技术在小儿穿孔性阑尾炎中的应用。方法选取新疆乌鲁木齐市儿童医院2015年8月至2018年8月收治的小儿穿孔性阑尾炎126例作为研究对象,根据是否采用加速康复外科理念分为ERAS组(n=63)与对照组(n=63)。观察两组手术时间、伤口感染情况及腹盆腔脓肿形成等临床指标,比较术后住院时间、住院费用、肠道功能恢复情况、并发症发生情况以及患儿家长满意度等指标。结果研究组术后肛门排气时间为(16.38±3.45)h,对照组为(22.45±5.32)h,差异有统计学意义(t=7.985,P<0.001)。术后肠鸣音恢复时间和经口进食时间分别为(9.84±3.48)h和(10.23±1.51)h,对照组为(12.29±4.37)h和(13.46±2.67)h,差异有统计学意义(P<0.05)。研究组术后出现切口感染4例,腹盆腔脓肿2例,未出现术后出血及肠粘连,对照组术后出现切口感染6例、腹盆腔脓肿1例,并发症发生率差异无统计学意义(P>0.05)。研究组住院时间为(5.34±0.67)d,对照组为(7.46±1.60)d,差异有统计学意义(t=9.670,P<0.001);研究组住院费用(7012.41±246.28)元,对照组(9321.74±421.49)元,差异有统计学意义(t=36.085,P<0.001)。研究组满意度(92.06%)高于对照组(79.36%),差异有统计学意义(χ^2=-4.415,P=0.042)。结论加速康复外科理念联合腹腔镜治疗儿童穿孔性阑尾炎的疗效显著,具有促进早期进食,缩短住院时间,明显降低住院费用,提升患儿家长满意度等优点。

Objective To explore the application of enhanced recovery after surgery plus laparoscopic technique in children with perforated appendicitis.Methods Retrospective analyses were performed for 126 cases with perforated appendicitis from August 2015 to August 2018.According to preoperative preparation,anesthesia choice,laparoscopic appendectomy and postoperative treatment,they were divided into study group(n=63)and control group(n=63).Then operative duration,wound infection,abdominal&pelvic abscess formation,recovery of intestinal function,postoperative hospital stay,hospitalization expense and parental satisfaction were compared between two groups.Results The postoperative time of anal exhaust was(16.38±3.45)h in study group versus(22.45±5.32)h in control group.The difference was statistically significant(t=7.985,P<0.001).The recovery time of postoperative bowel sounds and oral feeding time were(9.84±3.48)h and(10.23±1.51)h versus(12.29±4.37)h and(13.46±2.67)h respectively.The differences were statistically significant(P<0.05).In study group,there were incision infection(n=4),abdominal&pelvic abscess(n=2)and no postoperative bleeding or intestinal adhesion;in control group,incision infection(n=6)and abdominal&pelvic abscess(n=1).No significant inter-group difference existed in the incidence of complications(P>0.05).The hospitalization time was(5.34±0.67)days in study group versus(7.46±1.60)days in control group.The difference was statistically significant(t=9.670,P<0.001);hospitalization expense was(7 012.41±246.28)yuan in study group versus(9 321.74±421.49)yuan in control group.The difference was statistically significant(t=36.085,P<0.001).The satisfaction rate of study group was significantly higher than that of control group(92.06%vs 79.36%).The difference was statistically significant(χ^2=-4.415,P=0.042).Conclusion The efficacy of enhanced recovery after surgery plus laparoscopic technique is remarkable for children with perforated appendicitis.It offers the advantages of promoting early ingestion,shorter hospitalization time,lower hospitalization expense and greater parental satisfaction.Wider popularization is recommended.