摘要
目的探讨日间手术理念的引入对腹腔镜胆囊切除术的影响。方法将2017年1～12月我科180例LC按照日间手术开展的时间顺序分为日间手术理念引入前(2017年1～4月)、日间腹腔镜胆囊切除术(ambulatory laparoscopic cholecystectomy,ALC)开展初期(2017年5～8月)、ALC开展成熟期(2017年9～12月),并相应分为A、B、C组,其中A组55例,B组65例,C组60例。比较3组术前等待时间、住院时间、术后并发症、日间手术完成率,并分析B、C 2组延迟出院的原因。结果 A、B、C组术前等待时间中位数分别为52 h(25～242 h)、7 h(3～53 h)、6. 5 h(3～60 h),有统计学差异(χ~2=101. 240,P=0. 000; P_(A-B)=0. 000,P_(A-C)=0. 000,P_(B-C)=1. 000);住院时间中位数分别为8 d(3～13 d)、3 d(1～9 d)、1 d(1～7 d),有统计学差异(χ~2=87. 005,P=0. 000; P_(A-B)=0. 000,P_(A-C)=0. 000,P_(B-C)=0. 002)。A、B、C组日间手术完成率分别为0. 0%(0/55)、33. 8%(22/65)、56. 7%(34/60),有统计学差异(χ~2=65. 546,P=0. 000); B、C组延迟出院率分别为66. 2%(43/65)、43. 3%(26/60),B组明显高于C组(χ~2=6. 570,P=0. 010),但因心理因素而延迟出院患者分别占延迟出院患者总数79. 1%(34/43)、80. 8%(21/26),无统计学差异(χ~2=0. 029,P=0. 865)。结论日间手术理念的引入可有效缩短术前等待时间、住院时间,提高日间手术完成率应注重患者心理因素的影响。
Objective To investigate the influence of ambulatory surgery concept on laparoscopic cholecystectomy (LC).Methods Clinical data of 180 patients who received LC from January 2017 to December 2017 in our hospital were collected.According to the time order,the patients were divided into 3 groups:before introduction of ambulatory LC (ALC)(group A,55 cases,January to April),early stage of ALC (group B,65 cases,May to August),mature stage of ALC (group C,60 cases,September to December).The preoperative waiting time,hospitalization time,postoperative complications,and day surgery completion rate were analyzed.Reasons for delayed discharge in B and C groups were analyzed.Results The median waiting time of group A,B,and C was 52 h (range,25-242 h),7 h (range,3-53 h),and 6.5 h (range,3-60 h),respectively,with statistical differences (χ^2 =101.240,P =0.000;P A-B =0.000,P A-C =0.000,P B-C =1.000);the median hospital stay was 8 d (range,3- 13 d),3 d (range,1-9 d),and 1 d (range,1-7 d),respectively,with statistical differences (χ^2 = 87.005,P =0.000;P A-B =0.000,P A-C =0.000,P B-C =0.002);the day surgery completion rate was 0.0%(0/55),33.8%(22/65),56.7%(34/60),respectively,with significant difference (χ^2 =65.546,P =0.000).The delayed discharge rate of the B and C groups was 66.2%(43/65) and 43.3%(26/60),respectively,with significant higher rate in the B group than that in the C group (χ^2 =6.570,P = 0.010).However,the number of patients delayed by psychological factors accounted for 79.1%(34/43) and 80.8%(21/26) of the total number of the B and C groups,without significant difference (χ^2 =0.029,P =0.865).Conclusions The introduction of ambulatory surgery concept can effectively shorten preoperative waiting time and hospital stay time.In order to further improve the completion rate of ALC,we should pay more attention to the psychological factors of patients.
作者
任海洋
周健
冯伟
张金梁
徐力善
翟博
Ren Haiyang;Zhou Jian;Feng Wei(Department of Oncological and Hepatobiliary Surgery,Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2019年第5期421-425,共5页
Chinese Journal of Minimally Invasive Surgery
基金
黑龙江省医学科学院科研计划资助项目(201815)
黑龙江省自然科学基金资助项目(H2018028)
哈尔滨医科大学附属第四医院星火计划任务书(HYDSYXH201904)
关键词
日间手术
腹腔镜胆囊切除术
延迟出院
Ambulatory surgery
Laparoscopic cholecystectomy
Delayed discharge
