加速康复外科模式在腹腔镜经腹腹膜前腹股沟疝修补术中的应用

Application of enhanced recovery after surgery model in laparoscopic transabdominal preperitoneal inguinal hernia repair

目的探讨加速康复外科(ERAS)模式在腹腔镜经腹腹膜前腹股沟疝修补术(TAPP围手术期中的应用。方法选取2017年11月至2018年11月中山大学附属第六医院收治并行腹腔镜经腹腹膜TAPP术的240例患者为研究对象,按照随机分配原则分为ERAS模式组120例和传统模式组120例,记录并比较两组患者术后恶心呕吐发生率、切口疼痛发生率、尿潴留发生率、血清肿发生率、肛门排气时间、下床活动时间、正常进食时间、住院天数、住院总费用、患者满意度以及远期随访指标包括疝复发、慢性疼痛、补片感染等。结果 ERAS模式组患者术后恶心呕吐、切口疼痛、尿潴留的发生率分别为5.00%、3.33%、4.17%,低于传统模式组的15.00%、10.83%、11.67%,两者差异有统计学意义(χ^2=6.667、5.128、4.630,P=0.010、0.024、0.031);两组患者血清肿、疝复发、腹股沟区慢性疼痛、补片感染发生率比较,差异无统计学意义(χ^2=0.095、0.338、0.204、0.338,P=0.758、0.561、0.651、0.561)。ERAS模式组患者肛门排气时间(6.45±2.12)h、下床活动时间(8.12±2.62)h、正常饮食时间(8.38±2.64)h、住院天数(2.44±0.89)d、住院费用(1.58±0.26)万元均低于传统模式组的(7.28±2.34)h、(12.17±4.35)h、(10.12±2.23)h、(3.78±1.19)d、(1.67±0.25)万元,差异有统计学意义(t=2.880、8.737、5.516、9.878、2.733,均P<0.01)。ERAS组患者满意度(71.67%)高于传统模式组(47.50%),差异有统计学意义(z=4.427, P=0.002)。结论 ERAS应用于腹腔镜TAPP术中,患者恢复快、并发症少、住院费用低、满意度高,值得临床推广应用。

Objective To explore the application of enhanced recovery after surgery(ERAS model in perioperative period of laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP).Methods From November 2017 to November 2018, two hundred and forty patients with laparoscopic TAPP were enroled in the Department of Gastroenterogy, Hernia and Abdominal Wal Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University. The patients were divided into two groups according to the principle of random distribution, with 120 patients in the ERAS model group and 120 patients in the traditional model group. The incidence of postoperative nausea and vomiting, incisional pain, urinary retention, and seroma, the time of anal exhaust, off-bed, and eating, hospital stays, the total costs of hospitalization, patient satisfaction, and long-term follow-up indicators including recurrence, chronic pain, and patch infection were recorded and compared between the two groups. Results The incidence of postoperative nausea and vomiting, incisional pain, and urinary retention in the ERAS model group were 5.00%, 3.33%, and 4.17%,respectively, which were lower than the traditional model group of 15.00%, 10.83%, and 11.67%, with statistically significant differences(χ^2=6.667, 5.128, 4.630, P=0.010, 0.024, 0.031). There were no significant differences in the incidence of seroma, hernia recurrence, chronic pain in the inguinal region, and patch infection between the two groups(χ^2=0.095, 0.338, 0.204, 0.338, P=0.758, 0.561, 0.651, 0.561). In ERAS model group, anal exhaust time, off-bed time, normal diet time, hospital days, hospitalization costs were less than those of the traditional model group, the differences were statistically significant [(6.45±2.12) h vs(7.28±2.34) h,(8.12±2.62) h vs(12.17±4.35) h,(8.38±2.64) h vs(10.12±2.23) h,(2.44±0.89) d vs(3.78±1.19) d,(1.58±0.26) million yuan vs(1.67±0.25) million yuan, t=2.880, 8.737, 5.516, 9.878,2.733, all P<0.01]. The satisfaction rate in the ERAS model group was 71.67%, higher than that in the traditional model group(47.50%), and the difference was statistically significant(z=4.427, P=0.002).Conclusion ERAS applied to TAPP patients is benefit to quick recovery, fewer complications, lower hospitalization costs and higher satisfaction, which is worthy of clinical application.