快速康复外科理念在小儿腹股沟疝日间手术中的应用

目的探讨影响小儿腹股沟疝术后快速康复的主要因素及处理措施。方法收集本院2013年10月至2015年10月收治的307例小儿腹股沟疝患儿临床资料,均按照日间手术模式行腹横纹小切口5 mm 30°腹腔镜经疝囊探查及隐性疝微创治疗。结果 307例中,双侧疝32侧,隐性疝33例,共有44例同时行腹腔镜下"穿针引线法"对侧疝囊高位结扎术,术后第1天出院285例;22例术后体温超过37.5℃,于3d内出院,无需拆线。获1年以上随访188例,3个月以上随访263例,无一例疝复发和术后发现对侧疝。结论精准微创的手术、优化的麻醉方法、有效的护理宣教和家长积极配合等多学科协作是影响小儿疝术后快速康复的主要因素,小儿腹股沟疝术后快速康复对医患双方均有益处,有临床推广价值。

Application of fast-track surgery for pediatric inguinal hernia

Objetive To explore the major factors and treatment options of pediatric inguinal herni-a. Methods The clinical data were collected and analyzed for 307 inguinal hernia patients during October 2013 to October 2015.Laparoscopic (5 mm,30°)exploration of hernial sac was performed through abdominal transverse cleavage line incision and mini-invasive treatment for latent hernia. Results Among 307 cases, there were bilateral hernia (n =32),latent hernia (n =33)and sewing with laparoscopic assistance and high ligation of contralateral hernial sac (n =44).And 285 cases had the same day discharge after operation while 22 cases of above 37.5 ℃ were discharged after 3 days.After operation,there was no need for removing ab-dominal stitches.And 188 cases were followed up for over 12 months and 263 cases for over 3 months.There was no recurrence of contralateral hernia. Conclusions Fast-track surgery of pediatric inguinal hernia is closely correlated with precise and mini-invasive operative procedures,optimized anesthesia method,systematic nursing education and active parental cooperation.With benefits for physicians and patients,it is worthy of wi-der clinical applications for fast-track surgery idea of pediatric inguinal hernia.