日间手术与次日出院的腹腔镜胆囊切除术回顾性病例对照研究
A retrospective case-control study on fast tract laparoscopic cholecystectomy: ambulatory surgery versus over-night surgery
郭伟 1周晓娜 1刘军 1金岚 1李建设 1张忠涛1
作者信息
- 1. 100050 首都医科大学附属北京友谊医院普外科
- 折叠
摘要
目的 探讨日间腹腔镜胆囊切除术(ALC)的手术指征.方法 收集首都医科大学附属北京友谊医院普外科2016年1月-2018年9月接受腹腔镜胆囊切除术2277例患者的病历资料,其中行ALC术患者1072例(ALC组),次日出院的腹腔镜胆囊切除术(OLC)患者835例(OLC组),比较两组患者在手术指征指标(年龄、诊断、伴随疾病、ASA评分)和手术结局指标(手术时间、术后镇痛、非计划再入院、医疗费用)方面的差异.采用SPSS 22.0进行统计分析.结果 两组患者在手术指征指标,如年龄段分布、主要诊断、伴随疾病和ASA评分方面的差异明显;在手术结局指标,如手术时间[(42.6±12.4) min比(48.7±20.3) min,P=0.326)]、非计划再入院(6/1072比3/835,P=0.526)方面差异无统计学意义.平均检查费和平均住院费相比,ALC组的均低于OLC组[(1667.10±461.69)元比(3156.44±884.90)元)];(8881.69±1954.34)元比(12149.79±3476.59)元,差异有显著统计学意义(P＜0.01).结论 伴随疾病较多不是ALC的绝对排除标准,如果能够完善门诊检查流程,充分评估麻醉和手术风险,排除手术禁忌证,更多的患者可以采用ALC治疗.
Abstract
Objective To evaluate the optimal indications for the ambulatory laparoscopic cholecystectomy (ALC).Methods From Jan.2016 to Sep.2018,2277 case who underwent laparoscopic cholecystectomies were performed in Beijing Friendship Hospital,Capital Medical University,including 1072 cases of ALC (ALC group) and 835 cases of overnight laparoscopic cholecystectomy (OLC group).Indications including age,diagnosis,comorbidity and ASA score,and outcomes including operative time,analgesic,unplanned readmission and hospital cost were compared between ALC group and OLC group.Statistical analysis was conducted by the software of SPSS 20.0.Results There were no differences in the operative time [(42.6 ± 12.4) min vs.(48.7 ±20.3) min,P =0.326] and unplanned readmission (6/1072 vs.3/835,P =0.526).The examination cost [(1 667.10 ± 461.69) vs (3 156.44 ± 884.90)] and hospital cost (8 881.69 ± 1 954.34 vs.12 149.79 ± 3 476.59) was significant lower in ALC group,and the differences were statistically significant (P ＜ 0.01).Conclusions The comorbidities were not absolute exclusion criterion for ALC.More patients could be treated by ALC if the preoperative assessment streamlining in outpatient clinic was more improved.
关键词
胆囊切除术,腹腔镜/病例对照研究/住院病人/手术指征/日间手术Key words
Cholecystectomy, laparoscopic/Case-control studies/Surgical indication/Ambulatory surgery引用本文复制引用
基金项目
首都临床特色应用研究(Z161100000516082)
北京市属医院科研培育计划项目(PX2016001)
首都卫生发展科研专项重点攻关项目(2016-1-1111)
出版年
2018
NETL
NSTL
维普
万方数据