加速康复外科理念在小儿幼儿期腹腔镜鞘状突高位结扎日间手术中的应用研究

Research on the application of the concept of enhanced recovery after surgery in the daytime operation of laparoscopic high ligation of processus vaginalis in early childhood

目的探讨加速康复外科理念(ERAS)在小儿幼儿期腹腔镜鞘状突高位结扎日间手术的临床疗效。方法选取湖北医药学院十堰市太和医院2018年1月至2019年12月收治的1~3岁无合并症的鞘膜积液患儿临床资料141例,其中完成腹腔镜鞘状突高位结扎术137例。根据是否采用ERAS日间手术模式分为日间组(n=80)与对照组(n=57),比较ERAS日间手术模式和传统住院模式两组患儿住院时间、住院费用、术前禁饮时间、术后首次进水、奶时间、手术时间、术后疼痛评分、术后并发症发生率、半年内复发率、当日手术取消率、术后患儿监护人满意度等方面的差异。结果日间组患儿的住院时间、住院费用、术前禁饮时间、术后首次进水、进奶时间均低于对照组,差异均有统计学意义(P<0.05)。日间组患儿术后VAS评分6、12 h均优于对照组,差异有统计学意义(P<0.05)。而两组患儿手术时间、部分术后并发症发生率、半年内复发率、当日手术取消率、术中隐匿性鞘状突未闭发生率比较,差异无统计学意义(P>0.05)。结论ERAS理念的日间手术模式下小儿幼儿期鞘膜积液安全可行,在减少患儿住院时间、住院费用,减轻患儿对陌生环境的恐惧、减轻患儿术后疼痛,同时不增加术后并发症,值得临床的推广与应用。

Objective To explore the clinical efficacy of the concept of enhanced recovery after surgery(ERAS)in the daytime operation of laparoscopic high ligation of processus vaginalis in early childhood.Methods A total of 141 cases of children with hydrocele of tunica vaginalis without complications aged 1-3 years from January 2018 to December 2019 were admitted to Taihe Hospital Affiliated to Hubei University of Medicine,among which 137 cases completed the operation of laparoscopic high ligation of processus vaginalis.The patients were divided into the daytime group(n=80)and the control group(n=57)according to whether or not to adopt ERAS daytime operation mode.The differences between ERAS daytime operation mode and conventional hospitalization mode in hospitalization time,hospitalization expenses,preoperative fasting time,first postoperative water intake and milk intake time,operation duration,postoperative pain score,incidence of postoperative complications,relapse rate within half a year,surgical cancellation rate on the same day,and postoperative guardian satisfaction were compared between the two groups of children.Results The hospitalization time,hospitalization expenses,preoperative fasting time,and the first postoperative water intake and milk intake time in the daytime group were all lower than those in the control group,with statistically significant differences(P<0.05).The VAS scores of children in the daytime group were superior to those in the control group after 6 h and 12 h of operation,with statistically significant differences(P<0.05).However,there were no statistically significant differences in operation duration,incidence of part postoperative complications,relapse rate within half a year,surgical cancellation rate on the same day and incidence of occult patent processus vaginalis during operation between the two groups of children(P>0.05).Conclusion It is safe and feasible for children with hydrocele of tunica vaginalis in early childhood under the daytime operation mode based on ERAS concept,which can reduce the hospitalization time and expenses of children,reduce their fear of unfamiliar environment and relieve their postoperative pain,without increasing postoperative complications,and is worthy of clinical promotion and application.