摘要
目的:基于单中心临床实践,探讨日间腹腔镜阑尾切除术(DCLA)的推广模式,初步验证此模式的安全性与有效性。方法:前瞻性分析2022年2月22日至2022年9月30日连续收治的97例腹腔镜阑尾切除术患者的临床资料,不设置入选标准,患者均接受加速康复外科“五大核心要素”处理,并自动进入DCLA管理,依据术后恢复情况决定是否终止DCLA。结果:81例最终符合DCLA标准,占83.51%。术后通气时间平均(10.37±1.85)h,住院(1.42±0.50)d。术后30 d随访,发生切口感染1例(1.23%),无腹腔感染、再次住院、再次手术、严重并发症及死亡病例。结论:加速康复外科核心措施适于腹腔镜阑尾切除术,通过术前评估后施行的腹腔镜阑尾切除术可认为符合DCLA入选标准,将判定DCLA是否终止的依据放在术后结局方面,这一模式安全、可行,可减少外科医生行DCLA时的困扰,提高DCLA的执行率。
Objective:To discuss the promotion mode of day case laparoscopic appendectomy(DCLA),preliminarily validate the safety and effectiveness of the model based on clinical practice of single center.Methods:Prospective analysis was made on the clinical data of 97 consecutive patients who underwent laparoscopic appendectomy from Feb.22,2022 to Sep.30,2022.NO selection criteria was set,all patients received enhanced recovery after surgery core for the"big five"processing,and automatically entered the DCLA management.Whether to terminate DCLA was decided according to the postoperative recovery.Results:Eighty-one patients eventually met DCLA standards,accounting for 83.51%.The ventilation time was(10.37±1.85)h,and the hospital stay was(1.42±0.50)d.At the 30-day postoperative follow-up,there was 1 case of incision infection,accounting for 1.23%.There was no abdominal infection,hospital readmission,reoperation,severe complications and death.Conclusions:The"five core elements"of enhanced recovery a fter surgery are suitable for laparoscopic appendectomy.All the laparoscopic appendectomy performed after preoperative evaluation are identified as meeting DCLA inclusion criteria,and it is safe and feasible to judge whether to terminate DCLA on the basis of postoperative outcome,which may reduce the confusion of surgeons when implementing DCLA and improve the implementation rate of DCLA.
作者
潘华峰
成汇
董艳平
管俊杰
王海锋
龚冠闻
王刚
赵允召
江志伟
PAN Hua-feng;CHENG Hui;DONG Yan-ping(Department of General Surgery,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210002,China)
出处
《腹腔镜外科杂志》
2023年第6期444-448,453,共6页
Journal of Laparoscopic Surgery
基金
江苏省重点学科项目(JS2251)
江苏省中医院院管课题(Y2020CX63)。
