快速康复外科理念在腹腔镜胆囊切除术围术期护理中的应用效果

目的探讨快速康复外科(FTS)理念在腹腔镜胆囊切除术(LC)围术期护理中的应用效果。方法随机将行择期LC治疗的86例胆囊结石患者分为2组,各43例。对照组实施围术期常规康复护理,观察组给予围术期FTS理念护理。比较2组的护理效果。结果观察组患者的术后离床活动时间、恢复进食时间及住院时间均显著短于对照组患者,差异均具有统计学意义(P0.05)。结论围术期应用FTS理念对LC患者进行护理,有利于促进患者术后康复,缩短住院时间,降低医疗费用,效果满意。     

快速康复外科在老年腹腔镜胆囊切除术围术期护理中的应用

目的 探讨快速康复外科(FTS)应用于老年腹腔镜胆囊切除术(LC)围手术期护理的效果.方法 将行LC治疗的94例老年患者随机分为2组,各47例.对照组围术期予以常规护理,FTS组在常规护理的基础上实施FTS理念指导下的护理干预.比较2组患者术后胃肠功能恢复时间、离床活动时间、住院时间、并发症发生率,以及视觉模拟评分(V...     

快速康复外科在腹腔镜胆囊切除术围手术期护理中的应用

目的探讨快速康复外科（fast track surgery,FTS）在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）围手术期的应用效果。方法 2011年1～6月280例LC按入院日期单双号分为FTS组与传统组各140例,2组术前、术中、术后给予不同的处理,比较2组患者康复及术后并发症的发生情况。结果 FTS组恶心呕吐、切口疼痛、肺部感染、泌尿系感染的发生率明显低于传统组（P〈0.05）。FTS组术后住院时间（2.5±1.4）d显著短于传统组（5.1±1.7）d（t=-13.969,P=0.000）,输液时间（2.7±1.3）d显著短于传统组（4.9±2.0）d（t=-10.913,P=0.000）,治疗费用（6.9±1.8）千元显著少于传统组（10.0±1.6）千元（t=-15.230,P=0.000）。结论 LC围手术期中应用FTS,具有安全、经济、有效、可靠等优势。     

快速康复外科在腹腔镜胆囊切除术围手术期护理中的应用

目的：探讨快速康复外科（ fast track surgery ,FTS）在腹腔镜胆囊切除术（ laparoscopic cholecystectomy ,LC）围手术期护理中的应用效果。方法2012年1～12月将200例LC按住院号的单双号分为2组,每组100例,比较2组患者康复和并发症发生情况。结果 FTS组术后首次肛门排气时间（12．0±4．4）h ,明显短于对照组（24．9±5．4）h（t＝-18．519,P＝0．000）;术后出院时间（3．2±1．3）d明显短于对照组（4．2±2．1） d（t＝-4．049,P＝0．000）;术后5 d体重下降值（3．2±0．3） kg明显低于对照组（5．2±0．6）kg（t＝-29．814,P＝0．000）。结论 FTS应用于LC能加速患者术后康复。     

浅谈快速康复外科在腹腔镜胆囊切除术围手术期护理中的应用体会

正伴随临床外科的飞速发展及对疾病认识的不断深入,快速康复外科(fast track surgery,FTS)理念受到越来越多的关注与重视。FTS是围手术期的多模式优化方案,旨在通过减弱应激反应,维持患者的生理功能,减少器官功能障碍与并发症,以达到快速康复的目的~([1]),它是将麻醉学、疼痛控制及微创手术方式等新技术与传统护理方法进行改进结合,降低了术后应激反应及并发症发生率,缩短了住院时间,实现了     

围术期快速康复理念在全膝关节置换术中的研究进展

快速康复(FTS)强调术后早期锻炼,可减少住院时间并降低医疗费用,已成为骨科术后康复方式的发展趋势。FTS的关键在于围术期处理。术前调控涉及营养评估、体质指数(BMI)确定;镇痛管理中收肌管阻滞及鸡尾酒疗法得到较多认可,但镇痛药物仍需术者慎重选择,且镇痛模式已从单一模式向多模式转变;血液管理以多种方式和药物联合调控为主,氨甲环酸(TXA)的应用途径及用量日益多样化,闭式吸引引流(CSD)是否放置和如何进行放置亟待关注。该文就围术期FTS在全膝关节置换术中的研究进展作一综述。     

快速康复外科在胰十二指肠切除术围术期管理中的应用价值

背景与目的:近年来,快速康复外科(ERAS)理念已在许多外科领域推广应用,并取得了显著成效.然而ERAS在胰十二指肠切除术(PD)围术期的应用仍然有限.本研究通过前瞻性临床分析,探讨ERAS在PD围术期管理中的应用价值.方法:前瞻性连续收集2017年12月-2019年9月间中南大学湘雅医院胰腺外科收治的101例行PD患...     

快速康复外科护理模式在腹腔镜肝癌切除术围手术期的应用

目的探讨快速康复外科理念在腹腔镜肝癌切除术围手术期护理中的应用效果。方法回顾性收集温州医科大学附属第一医院2015年1月1日至2016年6月30日收治的拟行腹腔镜肝癌切除术的原发性肝癌患者80例,根据护理模式分对照组(予常规护理,n=40)和观察组(予快速康复外科护理,n=40)。比较两组患者基础资料、临床效果和术后并发症发生率。结果观察组与对照组比较,术后首次排气或排便时间[(19.12±10.43)h vs(36.66±13.05)h,P0.01]、下床活动时间[(22.58±6.52)h vs(39.31±7.19)h,P0.05]、住院时间[(199.45±43.34)h vs(386.90±89.33)h,P0.05]均显著缩短。观察组与对照组比较,术后并发症腹胀发生率[5%vs 17.5%,P0.05]、排便困难的发生率[2.5%vs 25%,P0.05]显著下降。结论在行腹腔镜肝癌切除术的围手术期应用快速康复外科护理理念能促进患者的康复,缩短住院时间,并且降低并发症发生率,是一种安全有效的护理模式,值得借鉴推广。     

快速康复外科理念在食管癌围术期护理中的应用

目的 探讨快速康复外科理念在食管癌围术期护理中的应用效果.方法 将156例同期住院的食管癌手术患者随机分为观察组(76例)和对照组(80例),对照组按食管癌手术常规护理;观察组遵循快速康复外科理念采用术前教育、手术准备、术后镇痛、体温保护、液体管理、引流管护理、术后饮食护理及早期活动等措施.结果 两组术后首次排气、排便时间,术后并发症发生率,住院总费用及住院时间比较,差异有统计学意义(P<0.05,P<0.01).结论 快速康复外科理念在围术期的灵活应用,可有效促进食管癌术后患者的康复,减少术后并发症发生率,缩短住院时间,降低住院费用.     

快速康复外科理念在乳腺癌根治术围术期护理中的应用体会

目的探讨快速康复外科理念在乳腺癌根治术围术期护理中应用效果。方法随机将90例乳腺癌根治患者分为观察组和对照组,各45例。观察组围术期采取快速康复外科理念进行护理,对照组围术期采取常规护理。对比分析2组护理效果。结果观察组的总有效率为97.78%,明显高于对照组的71.11%,不良反应发生率(28.89%)明显低于对照组(55.56%),差异均具有统计学意义(P0.05)。结论应用快速康复外科理念对乳腺癌根治术患者行围术期护理,可促进患者恢复,降低不良反应发生率,效果满意。     

Fast-track Rehabilitation Accelerates Recovery After Laparoscopic Colorectal Surgery

Background:

Fast-track (FT) rehabilitation protocols have been shown to be successful in reducing both hospital stay and postoperative complications, as well as enhancing overall postoperative patient recovery. We are reporting the outcomes of our first group of patients undergoing colorectal surgery following the FT protocol.

Patients and Methods:

We performed a prospective study of patients, between January 1, 2007 and January 31, 2010, who underwent laparoscopic colorectal resections in accordance with the guidelines of FT rehabilitation protocol. Recovery parameters including time to removal of naso-gastric tube and urinary catheter, time to bowel function and to resume diet, and length of hospital stay were evaluated. Postoperative outcomes, that is, postoperative complications and mortality, reoperations, and readmissions were also studied.

Results:

A total of 71 patients, 30 women and 41 men, underwent FT rehabilitation for laparoscopic colorectal surgery. The mean age of the patients was 60 ± 16 years. The most common surgical procedures were right hemicolectomy 30% and anterior resection 27%. Liquid and regular diet were initiated on postoperative day 1.2 ± 0.4 and 2.1 ± 0.4, respectively. Overall postoperative morbidity was 8.5%. The mean length of stay was 4.4 ± 1.7 days, with only 3 readmissions. Forty-five patients fulfilled the FT care plan and were discharged on postoperative day 3. No reoperations or mortality were observed.

Conclusions:

FT rehabilitation results in favorable postoperative outcomes. Our data provides evidence and suggests that FT protocols should be implemented as a reliable method of preparation and recovery for laparoscopic colorectal surgery.     

快速康复外科理论在高龄患者腹腔镜胆囊切除术中的应用——前瞻性随机对照研究

目的探讨快速康复外科(fast track surgery,FTS)理论在高龄患者腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)中的应用价值。方法 2008年3月～2011年3月30例80岁以上择期3孔法LC,随机分为FTS组及对照组,FTS组接受FTS方案治疗,对照组接受传统方法治疗。比较2组术后肠道排气时间、住院时间、术后并发症和住院总费用等。结果 FTS组术后排气时间(22.9±5.5)h显著短于对照组(36.1±8.1)h(t=-5.280,P=0.000),FTS组术后住院时间(2.8±2.1)d显著短于对照组(5.6±2.0)d(t=-3.725,P=0.000),FTS组术后住院总费用(9.9±1.8)千元显著少于对照组(12.2±2.1)千元(t=-3.231,P=0.000);2组并发症发生率无统计学差异(P=0.586)。结论对80岁以上患者择期LC应用FTS能缩短患者的住院时间,加速康复。     

全面护理在鼻综合整形术的围手术期患者中的应用效果

目的 探究全面护理在鼻综合整形术的围手术期患者中的应用效果。方法 选取2020年 6月-2022年6月于我院行鼻综合整形术的53例患者为研究对象,按照随机数字表法分为传统组（n=27）和 探究组（n=26）。传统组采用常规护理,探究组采用全面护理,比较两组护理满意度及并发症发生情况。 结果 探究组护理满意度各维度评分均高于对照组（P＜0.05）;探究组并发症发生率为3.85%,低于对照 组的29.63%（P＜0.05）。结论 全面护理在鼻综合整形术的围手术期患者中的应用效果确切,可预防、减 少相关并发症发生,能够提升患者多层面的满意度,值得临床应用。     

Laparoscopic Cholecystectomy in an Academic Hospital: Evaluation of Changes in Perioperative Outcomes

Objective:

Evaluate changes in perioperative outcomes over an 82-month period in patients undergoing laparoscopic cholecystectomy by a single attending surgeon in an academic hospital.

Methods:

A retrospective review of 1025 consecutive patients undergoing laparoscopic cholecystectomy from September 1992 to February 1997 was compared to the initial 600 patients from May 1990 to August 1992. Statistical analysis included Chi square with Yates correction and Fischer''s exact test.

Results:

Over the 82-month period there were no significant differences in the overall conversion rate to open cholecystectomy (p=0.26), intraoperative complications (p = 0.81), postoperative complications (p = 0.054) or mortality rates (p=0.66). There were 3 (0.5%) bile duct injuries in the initial 600 patients and only 1 (0.1%) in the group of 1025 patients (p=0.065). There was an increase (p<0.001) in laparoscopic cholecystectomies performed for acute cholecystitis and biliary dyskinesia and an increase (p<0.001) in the percentage of cases performed overall and for acute cholecystitis by the surgery residents over the last 54 months. Despite this, the conversion rates to open cholecystectomy in patients with acute cholecystitis decreased (p < 0.001) over the last 54 months. Additionally, more patients (p < 0.001) were discharged on the day of surgery in the most recent group.

Conclusion:

Laparoscopic cholecystectomy can be performed safely by surgery residents under the direct super-vision of an experienced laparoscopist without significant changes in perioperative outcomes. Despite an increased percentage of cases being performed for acute cholecystitis over the last 54 months, conversion rates to open cholecystectomy and biliary tract injury rates have decreased, and the perioperative morbidity has remained the same.     

Laparoscopic Splenectomy Coupled with Laparoscopic Cholecystectomy

Background and Objectives:

The aim of this study was to evaluate the results of laparoscopic surgery performed for coexisting spleen and gallbladder surgical diseases.

Methods:

Between May 2004 and October 2012, 12 patients underwent concomitant laparoscopic splenectomy and cholecystectomy. Indications for surgery included idiopathic thrombocytopenic purpura in 5 patients, hereditary spherocytosis in 4 patients, and thalassemia intermedia in 3 patients.

Results:

The mean operative time was 100 minutes (range, 80–160 minutes), and the blood loss ranged from 0 to 150 mL (mean, 50 mL). The mean longitudinal diameter of the spleen was 14 cm. One patient required conversion to open procedure. An accessory spleen was detected and removed in one case. The mean length of hospital stay was 5 days. No deaths or other major intraoperative and/or postoperative complications occurred.

Conclusion:

Provided that the technique is performed by an experienced surgical team, concomitant laparoscopic splenectomy and cholecystectomy is a safe and feasible procedure and may be considered for coexisting spleen and gallbladder diseases.     

快速康复外科理念在胆总管探查围手术期应用

目的探讨快速康复外科理念在胆总管探查围手术期的应用价值。方法将2008年5月至2011年5月我院腹腔镜应用中心收治的择期行胆总管探查病人105例按年龄、性别、体重、病程接近原则随机分成快速康复外科理念指导的围手术处理组(n=53)和传统的围手术处理组(n=52),比较两组术后排气排便时间、住院天数、住院费用及并发症发生率。结果快速康复外科理念指导的围手术处理组术后排气排便时间、住院天数、住院费用明显减少(P<0.05),并发症发生率无明显差异(P>0.05)。结论快速康复外科理念在胆总管探查围手术期的应用安全、有效。     

用加速康复外科理念治疗胃癌患者的临床应用探讨

目的探讨加速康复外科理念在胃癌患者围手术期治疗过程中的应用。方法将80例胃癌患者随机分为传统方法组(n=40)和加速康复组(n=40),比较2组患者术前1 d、术后第1、3天的外周血总淋巴细胞计数(TLC)、C反应蛋白(CRP)、IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平,记录2组患者术后发热持续时间、首次排气时间,住院时间以及术后并发症情况。结果加速康复组术后首次排气时间提前,术后发热持续时间及住院时间均较传统方法组短(P<0.05),2组患者术后并发症发生率差异无统计学意义(P>0.05);2组患者术后第1天TLC与术前1 d相比降低,而CRP与术前1 d相比增高,差异均有统计学意义(P<0.01)。术后第3天加速康复组CRP较传统方法组明显降低(P<0.05),IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平均比传统方法组升高(P<0.05)。结论胃癌患者行加速康复外科理念治疗是安全有效的,且能减轻手术创伤对患者免疫功能的打击,促进患者康复。     

Risk Factors for Perioperative Anxiety in Laparoscopic Surgery

Background and Objectives:

Our aim is to investigate the anxiety status of the patient before elective cholecystectomy and to analyze the relation between the level of anxiety for a given operation type (laparoscopic and open cholecystectomy) and the corresponding demographic and social data.

Methods:

A total of 333 patients undergoing cholecystectomy due to cholelithiasis were included in the study; 218 patients (66.1%) received laparoscopic cholecystectomy and 115 patients (33.9%) were treated with open cholecystectomy. The Beck Anxiety Inventory was given to all patients to be completed. We evaluated levels of anxiety in 3 groups as follows: 0 to 15, low to mild anxiety; 16 to 25, moderate anxiety; 26 to 63, severe anxiety. The following patient information remained confidential and was recorded: age and sex, associated disease, civil status, educational status, having open/laparoscopic cholecystectomy, previous knowledge of the operation, job status, economic status, health insurance, and having a child in need of care.

Results:

The following criteria were determined: the most determinant factors in differentiating between the score groups were having a low level of education, being of the female sex, being single, and having laparoscopic operation; the factors of being a homemaker and over the age of 25 years were determined to have significant effects.

Conclusions:

When analyzing the results that may appear during the intraoperative and postoperative period, understanding preoperative anxiety, analyzing the risk factors in depth, and taking the necessary precautions are all considerations that need to be the primary objectives of operators who are involved with laparoscopic, endoscopic, and robotic surgery.