快速康复外科理念在成人腹股沟疝日间手术的应用体会

目的探讨快速康复外科理念指导下的成人腹股沟疝日间手术的安全性及有效性。 方法采用前瞻性研究方法，将符合入选条件的67例患者分为试验组与对照组。试验组采用快速康复外科理念指导下的日间手术治疗成人腹股沟疝，麻醉方式为局部浸润麻醉；对照组为住院手术患者，常规采用椎管内麻醉。分析比较2组术后2 h疼痛评分、术后下床活动时间及术后进食或饮水时间、术后并发症发生情况及平均住院费用；记录试验组15 d内非计划再次入院率、日间手术延迟出院率。 结果试验组术后2 h疼痛评分（3.6±1.1）分、术后下床活动时间（3.2±1.1）h、术后进食或饮水时间（2.3±0.9）h及平均住院费用（4060.0±91.3）元与对照组（6.0±1.0）分、（7.2±1.1）h、（7.1±0.9）h、（5635.6±229.0）元比较，差异均有统计学意义（P<0.05）。2组术后并发症发生情况差异无统计学意义（P>0.05），术后随访4~16个月，均无复发。试验组无15 d内非计划再次入院及日间手术延迟出院患者。 结论快速康复外科理念指导下的成人腹股沟疝日间手术，安全有效。

Application of the concept of fast track surgery in ambulatory surgery of adult inguinal hernia

ObjectiveTo explore the safety and effectiveness of ambulatory surgery for adult inguinal hernia under the guidance of the concept of fast track surgery. MethodsA prospective study method was used, and 67 patients eligible for inclusion were divided into the treatment group and the control group. The treatment group was treated with ambulatory surgery under the guidance of the concept of fast track r surgery with local infiltration anesthesia. The patients in the control group were routine hospitalized patients with spinal anesthesia. The VAS pain score at 2-hours postoperatively, postoperative ambulation time, postoperative eating or drinking time, the incidence of postoperative complications and the average cost of hospitalization were analyzed and compared between the two groups. Meanwhile, the rate of unplanned readmission within 15 days and delayed discharge rate after ambulatory surgery in the treatment group were recorded. ResultsThe VAS pain score at 2-hours postoperatively (3.6±1.1 vs 6.0±1.0), postoperative ambulation time (3.2±1.1 h vs 7.2±1.1 h), postoperative eating or drinking time (2.3±0.9 h vs 7.1±0.9 h) and average hospitalization cost (4060.0±91.3 vs 5635.6±229.0 yuan) in the treatment group were significantly lower than those in the control group (P<0.05). There was no difference in the incidence of postoperative complications between the two groups (P>0.05). There was no recurrence after the follow-up of 4~16 months in both groups. There was no unplanned readmission within 15 days and delayed discharge of ambulatory surgery in the treatment group. ConclusionIt is safe and effective for adult patients with inguinal hernia to receive ambulatory surgery under the guidance of the concept of fast track surgery.