Ming Gedong,Zhu Hongxi,Chen Chen,et al.Application of fast-tract surgery in laparoscopic treatment of children with complicated appendicitis[J].Journal of Clinical Pediatric Surgery,2019,18(07):600-605.[doi:10.3969/j.issn.1671-6353.2019.07.016]
加速康复外科在腹腔镜治疗儿童复杂性阑尾炎中的应用
- Title:
- Application of fast-tract surgery in laparoscopic treatment of children with complicated appendicitis
- 分类号:
- R656.8;R616.5;R762
- 摘要:
- 目的 探讨加速康复外科（enhanced recovery after surgery，ERAS）理念应用于腹腔镜治疗儿童复杂性阑尾炎中的有效性及安全性。方法 回顾性分析江苏省盐城市妇幼保健院和淮安市妇幼保健院2017年3月至2018年4月收治的58例儿童复杂性阑尾炎患儿临床资料，根据患儿病情和家长意愿分为ERAS组（n=29）和对照组（n=29）。两组均在腹腔镜下行阑尾切除术，ERAS组围术期采用加速康复外科处理方案，对照组则采用传统处理方案，比较两组术后首次进食时间、肛门排气时间、术后下床活动时间、住院时间、手术并发症发生率、住院费用、疼痛评估及满意度等指标。结果 58例复杂性阑尾炎均痊愈出院。ERAS组术后首次进食时间（12.11±2.23）h，肛门排气时间（26.61±12.30）h，术后下床活动时间（9.17±1.35）h，住院时间（4.23±1.18）d，住院费用（9 948.12±105.36）元，疼痛评分（2.35±0.26）分，满意度为96.55%。对照组术后首次进食时间（24.62±3.28）h，肛门排气时间（44.63±17.28）h，术后下床活动时间（24.75±2.85）h，住院时间（6.15±1.49）d，平均住院费用（12 131.65±132.29）元，疼痛评分（5.48±0.79）分，满意度为75.86%。两组患儿术后首次进食时间、肛门排气时间、下床活动时间、住院时间、住院费用、疼痛评分及满意度等指标比较，差异均有统计学意义（P<0.05）。ERAS组术后1例并发腹壁切口感染（3.44%），对照组2例并发腹壁切口感染（6.88%），差异无统计学意义（P>0.05）。所有患儿术后随访3个月，均恢复良好，无切口感染、阑尾残株炎及粘连性肠梗阻等并发症发生。结论 在腹腔镜治疗儿童复杂性阑尾炎围手术期，应用ERAS能够加速术后康复，缩短住院时间，提升就诊满意度，且不增加额外经济负担，因此安全有效，值得临床推广。
- Abstract:
- Objective To explore the effectiveness and safety of ERAS in laparoscopic treatment of children with complicated appendicitis.Methods Respective analysis was performed for 58 hospitalized children with complicated appendicitis from March 2017 to April 2018.Based upon the condition of children and parental wishes,they were randomly divided into ERAS and controlled groups (n=29 each).Laparoscopy was performed in both groups.The group of ERAS adopted ERAS while controlled group adopted traditional program.Two groups were compared with regards to initial feeding time,anus exhausting time,postoperative activity time,hospital stay,incidence of surgical complications,hospitalization expense and patient satisfaction.Results All children recovered and discharged.The initial feeding time of ERAS group was less than that of controlled group[(12.11±2.23) vs (24.62±3.28) h]; the anus exhausting time of ERAS group was earlier than that of controlled group[(26.61±12.30) vs (44.63±17.28) h]; the postoperative activity time of ERAS group was less than that of controlled group[(9.17±1.35) vs (24.75±2.85) h]; the hospital stay of ERAS group was shorter than that of controlled group[(4.23±1.18) vs (6.15±1.49) days]; the hospitalization expense of ERAS group was lower than that of controlled group[(9948.12±105.36) vs (12131.65±132.29) yuan]; the patient score of ERAS group was lower than that of controlled group[(2.35±0.26) vs (5.48±0.79)]; the patient satisfaction of ERAS group was much higher than that of controlled group (96.55% vs 75.86%).Laparoscopic appendectomy resulted in lower complications rate and shorter postoperative hospital stay than open appendectomy.All comparisons had significant differences.One case of ERAS group had complications after surgery (3.44%) while two cases of controlled group had complications (6.90%).There was no statistically significant difference.During a follow-up period of 3 months,there was no occurrence of such severe complications as infection of incisional wound,appendix stump inflammation or adhesive ileus,etc.Conclusion The application of ERAS in laparoscopic treatment of children with complicated appendicitis can enhance postoperative recovery,shorten hospital stay,improve patient satisfaction and add no extra financial burden.Both safe and effective,this procedure may be further popularized.
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备注/Memo
收稿日期:2018-6-11。
基金项目:江苏省盐城市医学科技发展计划项目（编号：YK2017045）；江苏省妇幼健康科研项目（编号：F201854）
通讯作者:朱鸿喜,Email:401485@qq.com