Lü Chengjie,Hu Shuqi,Chen Rui,et al.Clinical exploration of ambulatory surgery mode of infantile hypertrophic pyloric stenosis[J].Journal of Clinical Pediatric Surgery,2022,21(03):258-264.[doi:10.3760/cma.j.cn101785-202106073-011]
婴儿肥厚性幽门狭窄日间手术模式的临床探索
- Title:
- Clinical exploration of ambulatory surgery mode of infantile hypertrophic pyloric stenosis
- Keywords:
- Pyloric Stenosis; Hypertrophic/CN; Pyloric Stenosis; Hypertrophic/SU; Surgical Procedures; Operative/MT; Enhanced Recovery After Surgery; Ambulatory Surgery
- 摘要:
- 目的 探索加速康复外科（enhanced recovery after surgery，ERAS）理念应用于婴儿肥厚性幽门狭窄（infantile hypertrophic pyloric stenosis，IHPS）日间手术（ambulatory surgery，AS）的可行性。方法 回顾性分析2018年1月至2020年12月浙江大学医学院附属儿童医院收治的163例婴儿IHPS患儿的临床资料，2018年1月起IHPS围术期均采取ERAS管理模式，2019年9月起IHPS进入日间手术模式。2019年9月前收治的患儿纳入ERAS组，此后收治的患儿纳入ERAS+AS组。ERAS组中同时符合日间手术准入标准和术后15 h达到离院标准者纳入ERAS 1组，其余纳入ERAS 2组；ERAS+AS组中完成日间手术模式者纳入ERAS+AS 1组，其余纳入ERAS+AS 2组。分析患儿住院期间与治疗相关的临床指标以及住院费用，探讨IHPS日间手术准入标准及日间手术模式的可行性。结果 163例患儿均顺利完成经脐单部位腹腔镜幽门环肌切开术，无一例中转开腹手术，无一例出现幽门穿孔等严重并发症。ERAS+AS 1组和ERAS+AS 2组比较，手术时日龄[（43.77±15.16） d比（36.93±22.42） d]、入院前病程[（15.59±12.73） d比（14.00±12.76） d]、术后1周呕吐次数[（2.18±0.50）次比（2.49±0.59）次]差异均无统计学意义（P>0.05）；术前住院时间[（11.64±8.40） h比（52.07±31.40） h]、术后住院时间[（18.16±3.86） h比（77.81±42.28） h]、住院费用[（8 474.16±537.73）元比（12 413.61±3 341.96）元]，差异均有统计学意义（P<0.05）。ERAS+AS 1组和ERAS 1组比较，术后1周呕吐次数[（2.18±0.50）次比（2.29±0.60）次]差异无统计学意义（P>0.05）；术前住院时间[（11.64±8.40） h比（42.00±16.85） h]、术后住院时间[（18.16±3.86） h比（74.66±14.02） h]、住院费用[（8 474.16±537.73）元比（12 891.76±3 181.31）元]差异均有统计学意义（P<0.05）。结论 在掌握好日间手术准入标准的前提下，ERAS理念应用于婴儿IHPS日间手术是安全可行的，值得进一步研究和探索。
- Abstract:
- Objective To explore the mode and feasibility of ambulatory surgery (AS) for infantile hypertrophic pyloric stenosis (IHPS) during enhanced recovery after surgery (ERAS).Methods Retrospective analysis was performed for clinical data of 163 children hospitalized with infantile hypertrophic pyloric stenosis from January 2018 to December 2020.ERAS management model was adopted during perioperative period of IHPS since January 2018 and AS for IHPS since September 2019.Children admitted before September 2019 were designated as ERAS group and those after as ERAS+AS group.And children in ERAS group fulfilling the ambulatory surgery admission and discharge standards simultaneously at 15h post-operation were recorded as ERAS1 group and the remainders as ERAS2 group; Children in ERAS+AS group not completing ambulatory surgery mode were recorded as ERAS+AS 1 group while those not completing ambulatory surgery mode as ERAS+AS 2 group.The treatment-related clinical parameters and hospitalization expenses were recorded for exploring the feasibility of IHPS ambulatory surgery admission standards and models.Results All of them successfully completed transumbilical single-site laparoscopic pyloric myotomy.There was no conversion into laparotomy.Pyloric duct perforation was absent.Comparison of ERAS+AS 1 group and ERAS+AS 2 group, operative age[(43.77±15.16) vs.(36.93±22.42) days], pre-admission course of disease[(15.59±12.73) vs.(14.00±12.76) days] and frequency of vomiting within 1 week post-operation[(2.18±0.50) vs.(2.49±0.59)].There was no significant inter-group difference (P>0.05); preoperative length of hospital stay[(11.64±8.40) vs.(52.07±31.40) hours], postoperative hospital stay[(18.16±3.86) vs.(77.81±42.28) hours] and hospitalization expense[(8 474.16±537.73) vs.(12 413.61±3 341.96) yuan].The inter-group differences were statistically significant(P<0.05); length of stay and hospitalization expense in day-to-day surgery group were significantly lower than those in incomplete group.Comparing ERAS+AS 1 and ERAS 1 groups, frequency of vomiting within 1 week post-operation was[(2.18±0.50) vs.(2.29±0.60)].There was no significant inter-group difference (P>0.05); preoperative length of hospitalization[(11.64±8.40) vs.(42.00±16.85) hours], postoperative hospital stay[(18.16±3.86) vs.(74.66±14.02) hours] and hospitalization expense[(8 474.16±537.73) vs.(12 891.76±3 181.31) yuan].And inter-group difference was statistically significant (P<0.05).Conclusion Under the premise of mastering the admission standards of ambulatory surgery, AS for IHPS is both feasible and safe.It is worthy of further researches and explorations.
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备注/Memo
收稿日期:2021-06-29。
基金项目:国家中心自主设计项目（R22G0014）
通讯作者:黄寿奖,Email:huangshoujiang@zju.edu.cn