| 经皮内镜下腰椎间盘切除术的日间手术(8 h内)诊疗流程的建立、优化及应用效果 |
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| 引用本文： | 于凌佳,祝斌,张国强,谢学虎,刘宁,董华钧,李想,杨雍. 经皮内镜下腰椎间盘切除术的日间手术(8 h内)诊疗流程的建立、优化及应用效果[J]. 中华腔镜外科杂志(电子版), 2022, 15(4): 227-232. DOI: 10.3877/cma.j.issn.1674-6899.2022.04.008 |
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| 作者姓名： | 于凌佳 祝斌 张国强 谢学虎 刘宁 董华钧 李想 杨雍 |
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| 作者单位： | 1. 100050 北京，首都医科大学附属北京友谊医院骨科中心 |
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| 基金项目： | 北京友谊医院科研启动基金(yyqdktgl2021-4); 北京市医管局青苗计划基金(QML20200101) |
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| 摘 要： | 目的探讨在日间手术模式下经皮穿刺内镜下腰椎椎间盘切除术(percutaneous endoscopic lumbar discectomy，PELD)治疗腰椎间盘突出症(lumbar disc hernation，LDH)管理流程的建立、优化及应用效果。 方法借鉴笔者所在医院已经开展的日间手术管理经验，根据前期PELD日间手术流程遇到的问题，对日间管理流程进行改进，制定PELD日间手术治疗LDH的管理制度和诊疗流程，改进工作规范，于2021年7月起应用PELD日间手术治疗患者100例，对全部患者进行最少30 d的随访，对诊疗流程应用前后患者的手术时间、伤口感染发生率、并发症发生率、爽约率、当日取消率、未准点开台率、入院前的等待时间、30 d内再入院率、延迟出院率及患者满意度共计十项评价指标分别采用t检验、卡方检验或Fisher精确检验等进行统计分析。 结果自2021年3~12月在日间病房共完成PELD的200例。其中2021年3~6月期间日间病房收治的100例PELD患者为对照组；自2021年7~12月期间日间病房共收治100例PELD患者作为观察组。比较发现两组患者在年龄、性别、手术节段、突出类型及手术入路等基本信息方面差异无统计学意义(P>0.05)。在经过日间手术管理流程建立和优化后，患者在入院前的等待时间、并发症发生率、爽约率及未准点开台率方面均明显下降；观察组的患者满意度明显高于对照组；而手术时间、伤口感染、当日取消率、30 d内再入院率、延迟出院率方面差异无统计学意义(P>0.05)。 结论PELD日间手术开展初期，可以借鉴传统日间手术的模式，建立适合本院医疗结构的PELD日间手术流程，笔者建立的改进措施能够降低患者手术前院外等待时间、降低爽约率、提高准点开台率等，可供相关医疗单位借鉴和应用。
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| 关 键 词： | 经皮内镜 日间手术 腰椎间盘切除术 腰椎间盘突出 流程优化 |
| 收稿时间： | 2022-05-16 |
Establishment,optimization and application of day surgery (within 8 hours) process for percutaneous endoscopic lumbar discectomy |
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| Lingjia Yu,Bin Zhu,Guoqiang Zhang,Xuehu Xie,Ning Liu,Huajun Dong,Xiang Li,Yong Yang. Establishment,optimization and application of day surgery (within 8 hours) process for percutaneous endoscopic lumbar discectomy[J]. Chinese Journal of Laparoscopic Surgery ( Electronic Editon), 2022, 15(4): 227-232. DOI: 10.3877/cma.j.issn.1674-6899.2022.04.008 |
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| Authors: | Lingjia Yu Bin Zhu Guoqiang Zhang Xuehu Xie Ning Liu Huajun Dong Xiang Li Yong Yang |
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| Affiliation: | 1. Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China |
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| Abstract: | ObjectiveTo explore the establishment, optimization and application effect of PELD in the management of lumbar disc herniation under day surgery. MethodsTo improve the management process in the day surgery management process according to the management experience of day surgery in our hospital and also the problems of the PELD operation process. We try to formulate the management system and the treatment process of PELD day surgery for lumbar disc herniation and to improve the work norms. Since Jul. 2021, 100 patients in the day surgery were included in this study and followed up more than 30 days. We compared 10 indexes (operation time, wound infection rate, complication rate, stand up rate, day cancellation rate, unpunctuality rate, waiting time before admission, readmission rate within 30 days, delayed discharge rate and patient satisfaction) before and after the application of treatment process. Including. ResultsFrom Mar. to Dec. 2021, a total of 200 PELD surgeries were performed in the day surgery. 100 PELD patients admitted to the day surgery ward from Mar. to Jul. 2021 were the control group. From Jul. to Dec. 2021, another 100 PELD patients were admitted to the day surgery as the observation group. There were no significant differences in age, gender, surgical level, type of protrusion and surgical approach between two groups. After the day surgery management process was established and optimized, the waiting time before admission, complication rate, stand up rate and unpunctuality rate of patients were significantly decreased. The patient satisfaction of observation group was significantly higher than that of control group. However, no significant differences between operation time, wound infection, day cancellation rate, 30-day readmission rate and delayed discharge rate. ConclusionsIn the early stage of PELD day surgery, we can establish PELD day surgery procedures suitable for own hospital, referring to the traditional day surgery model. Our diagnosis and treatment process can reduce waiting time before admission, stand up rate and also increase punctuality rate. It can be used by relevant medical units. |
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| Keywords: | Percutaneous endoscopic Day surgery Lumbar discectomy Lumbar disc hernation Process optimization |
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