SMILE intraoperative complications: incidence and management

AIM: To report the intraoperative complications associated with small incision lenticule extraction(SMILE) and their management. METHODS: This was a retrospective consecutive interventional clinical study, carried out on patients with myopia and myopic astigmatism, who underwent SMILE procedure. Type of intraoperative complications and their management were recorded. RESULTS: Our study comprised 282 eyes of 141 patients who were enrolled for SMILE surgeries. The intraoperative complications included lost vacuum(18 eyes, 6.38%), treatment decentration(6 eyes, 2.12%), wound bleeding(21 eyes, 7.45%), incomplete bubble separation(black islands)(3 eyes, 1.06%), the epithelial defects(15 eyes, 5.32%). Incision tear(27 eyes, 9.57%), lenticule adherence to the cap(6 eyes, 2.12%), and cap perforation occurred in 2 eyes(0.7%). CONCLUSION: Although SMILE is a promising technique for the correction of myopia and myopic astigmatism with predictable, efficient, safe refractive and visual outcomes, complications can occur. However, most of them are related to inexperience and are included in the learning curve of the technique. More studies with a bigger number of eyes are required to efficiently evaluate the intraoperative complications and standardize their management strategies.

Intraoperative laparoscopic complications for urological cancer procedures

AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery(radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery(radical prostatectomy and radical cystectomy).CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386;95%CI: 1.808-16.042;P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary

AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Intraoperative Periprosthetic Femoral Fractures Related to Austin Moore Hemiarthroplasty—A Retrospective Review of 365 Patients

Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasties ranging from 0% to 14%. The present study was designed to determine the prevalence and outcome after IPFF during non-cemented hemiarthroplasty. In addition, the surgical step at higher risk to produce these fractures was evaluated in an attempt to identify strategies that could minimize the prevalence of this complication. We performed an observational study of 365 consecutive patients undergoing and Austin-Moore hemiarthroplasty from 2005 to 2006 at our institution. The institutional IPFF rate was 6.8% (twenty-five out of 365). The moment at which the fracture was detected was collected: 1) intraoperatively and 2) in the postoperative radiological control. The surgical step in which the fracture occurred was collected: 1) neck osteotomy, 2) broaching, 3) prosthesis introduction, and 4) reduction. Results were compared to a control group according to blood transfusion rate, mortality rate and revision surgery rate. The fractures were detected during the surgery in twenty cases (80%);for the five remaining cases the fracture was only detected in the postoperative radiology. For those detected during the surgery, the two most common manouvers in which the fracture occurred was hip reduction (10 cases) and prosthesis introduction (7 cases). The blood transfusion rate, first-month mortality rate and revision surgery rate showed no statistical difference between the two groups (p = 0.3). In the present series, most of IPFF during Austin-Moore hemiarthroplasty implantation, occurred during arthroplasty reduction. Difficulties during this step should lead the surgeon to reconsider if technical mistakes are present and can be solved. However, if fracture occurs, adequate treatment of IPFF should provide satisfactory results without increasing blood transfusion needs, mortality or revision surgery.

How to Deal with an Intraoperative Thrombosis of Microvascular Anastomosis

Background: Intraoperative thrombosis during microvascular surgery is a nasty complication. Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. Methods: A search of the literature up to November 2020 was performed, using PubMed and Web of Science databases. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. Results: Comprehensive illustrations of intraoperative clinical patency testing include: pulsation pattern, flicker test and milking test. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. Conclusion: Decision making in surgical salvage techniques for microvascular thrombosis depends on localization of the thrombus and the surgeon’s experience and preference. In case of any doubt, it is better to reopen a few sutures and have a clear inspection of the anastomosis in order to prevent redo surgeries. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion.

Impact of intraoperative blood loss on survival after curative resection for gastric cancer

AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study.Patients were divided into 3groups according to the amount of IBL:group 1(<200mL),group 2(200-400 mL)and group 3(>400 mL).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The Log-rank test was used to assess statistical differences between the groups.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of IBL on survival in each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.Finally,we explored the possible factors associated with IBL and identified the independent risk factors for IBL≥200 mL.RESULTS:Overall survival was significantly influenced by the amount of IBL.The 5-year overall survival rates were 51.2%,39.4%and 23.4%for IBL less than 200mL,200 to 400 mL and more than 400 mL,respectively(<200 mL vs 200-400 mL,P<0.001;200-400 mL vs>400 mL,P=0.003).Age,tumor size,Borrmann type,extranodal metastasis,tumour-node-metastasis(TNM)stage,chemotherapy,extent of lymphadenectomy,IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis.Following stratified analysis,patients staged TNMⅠ-Ⅱand those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200mL,while patients staged TNMⅢ,whose IBL was less than 400 mL had better survival.Tumor location,tumor size,TNM stage,type of gastrectomy,combined organ resection,extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL,while tumor location,type of gastrectomy,combined organ resection and year of surgery were independently associated with IBL≥200 mL.CONCLUSION:IBL is an independent prognostic factor for gastric cancer after curative resection.Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.

Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intraoperative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.

Prediction of Intraoperative Trifecta Achievement during Laparoscopic Partial Nephrectomy

Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. Methods: We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. Results: The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. Conclusion: We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.

With two episodes of right retromandibular angle subcutaneous emphysema during right upper molar crown preparation:A case report

BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.

腹腔镜下子宫切除术与经腹子宫切除术治疗子宫肌瘤患者的疗效对比

目的探讨腹腔镜下子宫切除术与经腹子宫切除术治疗子宫肌瘤患者的疗效。方法80例子宫肌瘤患者,采用随机数字表法分为开腹组和腔镜组,每组40例。开腹组采用经腹子宫切除术完成疾病治疗,腔镜组采用腹腔镜下子宫切除术完成疾病治疗。对比两组的治疗效果、手术相关指标及并发症发生率。结果腔镜组子宫肌瘤患者治疗总有效率95.00%相较于开腹组的70.00%显著提升(P<0.05)。腔镜组子宫肌瘤患者术中出血量(60.25±5.23)ml相较于开腹组(160.19±3.11)ml显著减少,手术时间(90.25±2.25)min、术后拆线时间(5.22±1.36)d、住院时间(7.65±0.28)d、术后肛门排气时间(30.25±2.25)h相较于开腹组的(120.36±5.26)min、(7.25±1.49)d、(9.29±1.33)d、(45.69±5.29)h显著缩短(P<0.05)。腔镜组子宫肌瘤患者并发症总发生率7.50%相较于开腹组的25.00%显著降低(P<0.05)。结论经腹子宫切除术以及腹腔镜下子宫切除术治疗子宫肌瘤均获得广泛应用,同前者比较,后者的治疗优势明显,可显著提升子宫肌瘤患者总体预后。

阴道骶棘韧带悬吊术治疗盆腔脏器脱垂的临床效果及术后并发症观察

目的探讨阴道骶棘韧带悬吊术(SSLF)治疗盆腔器官脱垂(POP)的临床效果及术后并发症发生情况。方法选取2018年1月—2022年2月收治的POP患者68例,采用随机数字表法分为观察组34例和对照组34例,观察组采用阴道子宫切除联合SSLF治疗,对照组采用阴道子宫切除联合阴道前或后壁修补术治疗。比较2组手术时间、术中出血量、术后住院时间,手术前后盆底功能障碍问卷(PFDI-20)、盆底障碍影响简易问卷-7(PFIQ-7)评分,以及术后并发症发生率。结果观察组手术时间及术后住院时间均较对照组缩短,术中出血量也较对照组显著减少(P<0.01)。2组患者术前盆腔器官脱垂定量分度法(POP-Q)各指示点测量值均无显著差异(P>0.05);与术前POP-Q各指示点测量值相比,2组患者术后测量值均明显降低,其中观察组测量值更低(P<0.05)。术前PFDI-20、PFIQ-7评分2组患者均无显著差异(P>0.05);术后2组患者PFDI-20、PFIQ-7评分均明显下降,其中观察组下降更明显(P<0.05)。观察组术后并发症发生率为5.88%(2/34)低于对照组的26.47%(9/34),差异有统计学意义(P<0.05)。结论SSLF治疗POP临床效果显著,能显著改善患者盆底功能,且术后并发症发生率较低。

铒激光治疗对颌骨囊肿患者疗效、疼痛、舒适度、疼痛介质的影响

目的观察比较铒激光、传统方法对颌骨囊肿患者疗效、疼痛、舒适度、疼痛介质的影响。方法选取2018年10月—2022年10月收治的300例颌骨囊肿,根据手术方案分为铒激光组150例和传统组150例,分别采取铒激光治疗、传统刮治术治疗。统计2组围术期情况,治疗前后疼痛介质、口腔微生物群菌落数,以及术后舒适度、临床疗效、术后并发症。结果铒激光组术后24 h疼痛程度轻于传统组,术中出血量少于传统组,舒适度优于传统组(P<0.01);术后12 h铒激光组血清P物质、前列腺素E_(2)、神经肽Y水平低于传统组(P<0.05);术后3个月、6个月铒激光组双歧杆菌菌落数高于传统组,放线杆菌、牙龈卟啉单胞菌菌落数低于传统组(P<0.05);术后6个月2组治疗总有效率、术后并发症比较差异无统计学意义(P>0.05)。结论铒激光、传统方法在颌骨囊肿患者治疗中效果相当,铒激光治疗可减少患者术中出血量,缓解疼痛程度,维持口腔微生物群平衡,提高舒适度,减轻应激反应。

主动脉夹层围手术期神经系统并发症的危险因素与治疗策略

急性A型主动脉夹层(aTAAD)作为常见的主动脉疾病,病死率较高。因其常累及弓上分支,极易造成神经系统并发症。本文系统阐述aTAAD围手术期神经系统并发症及其相关危险因素,并总结常用的主动脉夹层手术中脑保护策略,以期指导临床干预和治疗。

食管癌术中喉返神经损伤因素的研究进展

食管癌患者淋巴结转移率高,其中双侧喉返神经旁淋巴结转移率高达19.8%~37.6%。在食管癌根治性淋巴结清扫过程中,喉返神经旁淋巴结的清扫可改善预后,同样也会增加喉返神经损伤风险,导致患者术后出现声音嘶哑及肺炎等并发症,降低术后生活质量。需要术者注重喉返神经的保护,完善术前检查,确定手术流程,合理使用术中仪器,提高术中操作水平。本文就术中神经检测、手术方式、淋巴结清扫范围、术者个人因素、喉返神经旁淋巴结的检查方式等对术中喉返神经损伤的影响展开综述。

两种不同入路行双平面假体隆乳术临床疗效对比研究

目的探讨不同入路行双平面假体隆乳术的效果。方法回顾性分析2020年1月—2023年1月新乡市中心医院收治的629例行双平面假体隆乳术患者的临床资料,按其手术入路的不同将其分为2组,其中经乳晕入路行手术的329例患者纳入对照组,经腋窝入路行手术的300例患者纳入观察组,术后均随访6个月。对比2组手术相关指标、乳房形态变化、隆胸效果、并发症。结果观察组切口愈合时间[(7.30±1.25)d]短于对照组[(9.21±1.69)d],并发症发生率(1.67%)低于对照组(4.86%),差异有统计学意义(P<0.05)。2组术中出血量、手术时间、住院时间、术后数字评分法(numeric rating scale,NRS)评分、隆胸效果相比,差异无统计学意义(P>0.05)。术前、术后2组乳头-乳房下皱襞的经皮距离(nipple to inframammaryfold,N-IMF)、胸骨切迹-乳头距离(sternal notch to nipple,S-N)、乳头-正中线距离(nipple to midline,N-M)、乳房总体积相比,差异无统计学意义(P>0.05)。结论经乳晕入路、经腋窝入路行双平面假体隆乳术均能够取得优良的隆胸效果,但经腋窝入路行手术更能够促进切口愈合,降低并发症发生率。文章的研究结果为临床后期选择双平面假体隆乳术的入路提供了借鉴内容,具有一定的运用价值。

镜疝修补术与开放式无张力疝修补术治疗腹股沟疝疗效对比研究

目的对比研究镜疝修补术治疗腹股沟疝的临床疗效。方法方便选取2019年6月—2023年10月启东市第二人民医院收治的123例腹股沟疝患者,采用密闭信封法分为对照组(n=61)、研究组(n=62)。对照组行开放式无张力疝修补术,研究组行镜疝修补术。比较两组围术期指标及并发症发生率。结果研究组手术时间长于对照组,其他指标优于对照组,差异有统计学意义(P均<0.05)。研究组并发症发生率(3.23%)低于对照组(14.75%),差异有统计学意义(χ^(2)=4.768,P<0.05)。结论镜疝修补术治疗腹股沟疝的效果优于传统术式,该手术方式具有微创性,对患者机体损伤较轻,同时,该种术式能够降低并发症风险,具有较高的安全性,有利于患者术后机体康复,从而改善患者预后。

腹腔镜下经胆囊管胆道取石术与胆总管切开取石术治疗胆囊结石合并胆管结石的效果对比

目的:比较腹腔镜下经胆囊管胆道取石术与胆总管切开取石术治疗胆囊结石合并胆管结石的效果。方法:选取2017年12月—2022年12月于常熟市第五人民医院行手术治疗的102例胆囊结石合并胆管结石患者,通过随机分组法分为试验组和常规组,各51例。常规组采取胆总管切开取石术治疗,试验组采用腹腔镜下经胆囊管胆道取石术治疗。比较两组围手术期指标、炎症指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)]及并发症发生率。结果:试验组术中出血量少于常规组,手术时间、住院时间短于常规组,差异有统计学意义(P<0.05)。术前,两组IL-6、CRP水平比较,差异无统计学意义(P>0.05);术后12 h,两组IL-6、CRP高于术前,但试验组均低于常规组,差异有统计学意义(P<0.05)。试验组并发症总发生率低于常规组,差异有统计学意义(P<0.05)。结论:与胆总管切开取石术相比,腹腔镜下经胆囊管胆道取石术治疗胆囊结石合并胆管结石患者可缩短手术时间、住院时间,加速术后康复。

腰椎后路手术髂内动脉损伤1例报告并文献复习

腹部血管损伤是腰椎椎间盘突出症手术罕见、严重的并发症,其发生率<1%[1]。尽管发生率低,一旦发生,极可能在短时间内发生失血性休克,危及患者生命。本研究回顾性分析了2021年3月4日本院紧急救治的1例后路腰椎椎间盘切除术中发生右侧髂内动脉损伤患者,予以一期紧急填塞止血、二期血管支架修复术,术后患者血管修复,救治成功。现将诊疗过程进行总结分析,以期为该并发症的诊治提供参考,现报告如下。

妇科腹腔镜手术中风险管理结合围术期心理支持对患者康复的影响

目的:探讨术中风险管理结合围手术期心理支持对妇科腹腔镜手术患者术后康复的影响。方法:纳入2022年1月-2023年12月本院收治、拟行妇科腹腔镜手术治疗的子宫肌瘤及卵巢囊肿患者102例,随机数字表法分为干预组、对照组各51例,两组均给予常规护理,干预组给予术中风险管理结合围术期心理支持,观察两组术后胃肠道功能恢复指标、并发症、术后疼痛量表评分(VAS)、汉密顿抑郁量表(HAMD)评分、广泛性焦虑自评量表(GAD-7)评分、自我护理能力测定表(ESCA)评分、健康促进生活方式评定量表-Ⅱ(HPLP-Ⅱ)评分,患者干预满意度。结果:干预组胃肠道功能恢复相关指标均短于对照组,术后并发症发生率(2.0%)低于对照组(13.7%),术后1d、4d、术后7d VAS评分(4.03±0.26分、1.35±0.32分、0.41±0.08分)均低于对照组(4.74±0.34分、2.01±0.29分、0.85±0.12分),干预后HAMD评分(11.52±1.85分)、GAD-7评分(10.06±1.85分)、ESCA评分(122.49±2.85分)、HPLP-Ⅱ评分(168.45±7.34分)均优于对照组(14.95±2.12分、12.35±2.05分、118.65±3.23分、142.35±8.45分),干预满意度各项评分均高于对照组(均P<0.05)。结论:术中风险管理结合围手术期心理支持可促进妇科腹腔镜手术患者术后胃肠道功能恢复,减少术后并发症,改善患者心理状态,提升患者自我护理能力及帮助患者养成健康行为,利于术后恢复,患者满意度高。