无功能性肾上腺肿瘤实施日间手术的可行性评估

Feasibility evaluation of day surgery for patients with nonfunctional adrenal tumors

目的探索对无功能肾上腺良性肿瘤患者实施日间手术的可行性、安全性及有效性。方法采用方便抽样的方法选取2018年11月至2019年11月瑞金医院日间病房实施手术的25例无功能肾上腺良性肿瘤患者作为实验组,并选取同期32例在瑞金医院泌尿外科实施常规住院手术的无功能肾上腺肿瘤患者作为对照组。实验组患者的术前检查、健康宣教、麻醉评估等医疗服务于门诊完成,在日间手术室行全麻下腹腔镜肾上腺肿瘤切除,术后进行常规护理,术后第2天8∶00在满足出院评估标准后出院。对照组患者的术前检查、健康宣教、麻醉评估等医疗工作按常规住院手术在入院后完成,在病房手术室行全麻下腹腔镜肾上腺肿瘤切除,术后进行常规护理,术后根据患者恢复情况经评估后出院。比较两组患者手术时间、住院时间、住院医疗费用、满意度等指标。结果实验组术前等待入院手术时间、住院时间、住院医疗费用均少于对照组,差异有统计学意义(P<0.05)。实验组患者出院后满意度(100%)高于对照组(93%)。两组均未发生明显的术后并发症。结论对于无功能肾上腺肿瘤患者开展日间手术和实施管理安全有效,且可大大提高医疗资源的利用率,是一种非常高效的手术医疗模式。

Objective To investigate the feasibility,safety and effectiveness of day surgery for patients with nonfunctional adrenal benign tumors.Methods Twenty-five patients with nonfunctional adrenal benign tumors who underwent laparoscopic adrenalectomy in the Day Surgery Center of Ruijin Hospital as experimental group,32 patients received the same procedure in the Urology Department of Ruijin Hospital were selected as the control group.In the experimental group,the preoperative examination,health education,anesthesia evaluation and other medical services of patients were completed in the outpatient department.Then the patients received laparoscopic adrenalectomy in the operating room and routine postoperative care.At 8:00 A.M on the second day after the operation,the patients were discharged if they meeting the discharge criteria.The control group adopted the management method of hospitalized operation,of which the preoperative examination,health education,anesthesia evaluation and other medical work were completed after admission to hospital.Laparoscopic adrenalectomy was performed in the operating room and conventional care was performed after operation.The patients were discharged after assessment according to the recovery of the patients.Results The surgery waiting time,hospitalization time and hospitalization costs of the experimental group were less than those of the control group(P<0.05).The satisfaction of the patients in the experimental group(100%)was higher than that in the control group(93%).No postoperative complications occurred in both groups.Conclusion It is feasible,safe and effective to carry out day surgery for patients with nonfunctional adrenal benign tumors,which can greatly improve the utilization rate of medical resources.It is a very efficient surgical medical mode.