小兒腹股溝疝手術一日外科的安全性和效能研究

Study of the safety and efficacy of day surgery in pediatric hernia repair

目的探討小兒腹股溝疝手術一日外科的安全性、結果和效能。方法2003年1月~2013年6月在本院小兒外科,348例431個疝一日外科手術。對疝的類型,術前告知,化驗檢查和輔助檢查,術前準備,麻醉和手術,延長住院原因,術後併發症和費用觀察分析。計量數據用x±s表示,採用spss 10.0軟件包處理數據。結果患兒348例,431疝手術,年齡2m-14y(4.6y±2.1y),男284,女64,雙側83,其中復發疝6,均為腹股溝斜疝擇期手術。323例行腹腔鏡疝囊高位結紮術(92.8%),25例開放疝囊高位結紮術,其中4例加內環成形術,預約等待手術時間0d-21d(7d±2.4d),手術用時20min±8min.,住院1~2天,費用15364.78±8252.41澳門元。術後併發症有術後發熱>38.5℃共17例,陰囊水腫9例,血腫2例,術後嘔吐4例,復發1例(復發率0.23%),低氧血症0,排尿困難0,切口感染0,繼發隱睾或睾丸萎縮0,疝內容損傷0,全組無死亡病例。併發症發生率9.5%。結論小兒腹股溝疝一日外科,適合無併發症病例,術前告知是術前準備重要部份,减少醫療費用和家長護理時間,不增加手術併發症。

Objective To study the safety,efficacy and result of the day surgery in pediatric hernia repair.Methods 348 children with 431 inguinal hernias from January 2003 to June of 2013,who underwent laparoscopic hernia repair at the tertiary general hospital pediatric surgery department were selected.The types of hernia,pre-operation consent,tests and laboratory examinations,pre-operation preparations,anesthesia and procedures,prolonged hospitalization causes,complications and expense were documented and analyzed prospectively.Data expressed by x±s,statistical analysis performed with SPSS 10.0 software.Results 284 boys and 64 girls,the mean of age was 2m-14y(4.6y±2.1y);the children with bilateral hernias were 83,and 6 with recurrent hernia,and 323 cases of all underwent with elective laparoscopic hernia sac ligation,25 others underwent conventional procedure,including 4 internal ring repair.The average operating time was 20min±8 min,hospital stay 1-2 days,hospitalization cost 15364.78±8252.41 Pacatas.The complications included 17 children with fever>38.5℃,9 edema of scrotum,2 hematoma with drainage,4 vomiting,1 hernia recurrence(recurrent rate 0.23%),0 orchiatrophy.There was no death in the group.The complication rate was 9.5%.Conclusion Pediatric hernia repair day surgery was indicated for children without complicated inguinal hernias.It is important to communicate with parents before operation.It reduces the medical cost and shortens parents accompanying care time,and didn’t increase the operating complications.