日间手术管理模式在地区医院小儿经脐单孔腹腔镜疝手术中的应用

Application of day operation management model in pediatric transumbilical single-port laparoscopic hernia surgery in regional hospitals

目的探讨日间手术管理模式在地区医院小儿经脐单孔腹腔镜疝手术中的应用价值。方法选取萍乡市人民医院2020年6月至2021年11月行经脐单孔腹腔镜下内环高位结扎术的258例患儿作为研究对象,按照筛选流程,将其分为日间手术组和常规手术组,其中进入日间手术组患儿157例,常规手术组患儿101例。比较两组患儿的性别、年龄、单双侧组成、术后需要延长住院时间的并发症(包括腹腔副损伤、切口出血、感染、皮下气肿、医源性隐睾、会阴肿胀等)、出院后1周内发生的呼吸道或消化道感染等疑似院内感染情况、术后半年内出现的疝复发情况、住院时间、住院费用。结果两组患儿的性别、年龄及单双侧组成比较,差异无统计学意义(P>0.05),日间手术组的住院时间短于常规手术组,差异有统计学意义(P<0.05),日间手术组的住院费用低于常规手术组(人均下降762元),差异有统计学意义(P<0.05)。两组患儿术后发生需要延长住院时间的并发症情况比较,差异无统计学意义(P>0.05);两组患儿出院后1周内发生的呼吸道、消化道感染等疑似院内感染情况的比较,差异无统计学意义(P>0.05)。两组患儿的术后半年内疝复发率比较,差异无统计学意义(P>0.05)。结论地区医院小儿经脐单孔腹腔镜疝手术采用日间手术模式是一种安全有效的手术管理模式,可降低住院费用成本和时间成本,获取更大的社会效益,有利于推动同级或基层医院小儿腹股沟疝手术的规范化治疗和管理。

Objective To investigate the application value of day operation management mode in pediatric transumbilical single-port laparoscopic hernia surgery in regional hospitals.Methods A total of 258 children who underwent transumbilical single-port laparoscopic high internal ring ligation in Pingxiang People's Hospital from June 2020 to November 2021 were selected as research subjects.According to the screening process,the patients were divided into the day surgery group and the conventional surgery group,among which 157 children were admitted to the day surgery group and 101 children were admitted to the conventional surgery group.The gender,age,unilateral and bilateral composition,postoperative complications requiring extended hospital stay(including abdominal collateral injury,incision bleeding,infection,subcutaneous emema,iatrogenic cryptorchidism,perineal swelling,etc.),suspected nosocomial infections such as respiratory or digestive tract infections occurring within 1 week after discharge,recurrent hernia occurring within half a year after surgery,length of hospital stay and hospitalization cost in the two groups were compared.Results There were no significant differences in gender,age and unilateral and bilateral composition between the two groups(P>0.05).The length of hospital stay in the day surgery group was shorter than that in the conventional surgery group,with statistically significant difference(P<0.05).The hospitalization cost in the day surgery group was lower than that in the conventional surgery group(762 yuan decreased per capita),with statistically significant difference(P<0.05).There were no significant differences in postoperative complications requiring prolonged hospitalization between the two groups(P>0.05).There were no statistically significant differences in the suspected nosocomial infection of respiratory tract and digestive tract within 1 week after discharge between the two groups(P>0.05).There was no significant difference in the recurrence rate of hernia between the two groups within half a year after surgery (P>0.05). Conclusion The mode of day surgery is a safe and effective surgical management mode for pediatric transumbilical single-port laparoscopic hernia surgery in regional hospitals, which can reduce hospitalization cost and time cost, obtain greater social benefits. It will be beneficial to promote the standardized treatment and management of inguinal hernia operation in children at the same level or at the grassroots level hospital.