摘要
目的:总结分析成人腹股沟疝日间手术开展的相关情况，系统探讨日间手术诊疗模式中存在的问题，为进一步优化成人腹股沟疝日间手术提供经验和参考。方法:回顾分析2019年9月至2023年9月，华中科技大学同济医学院附属武汉市中心医院疝与腹壁外科日间手术中心收治的成人腹股沟疝患者的病历资料，其中常规日间手术管理模式患者共1443例，精细化管理模式患者共1346例，采用便利抽样法选取不同日间诊疗管理模式下患者各1000例，分为观察组（采用精细化日间诊疗管理模式）与对照组（采用常规日间腹股沟疝手术模式）。比较2组患者手术相关指标，切口愈合及并发症发生情况。并分层观察不同术式下2组患者的手术时间、住院费用、24 h延迟出院率、患者满意度及术后疼痛恢复情况。结果:观察组24h延迟出院率（0.6%）明显低于对照组（3.7%）（P<0.05）。2组患者术后均发生不同类型和程度的并发症，其中术后切口脂肪液化、血清肿、局部瘀斑及慢性疼痛的发生率，观察组明显低于对照组（P<0.05），其中亲密关系为孤独关系的患者慢性疼痛发生率最高，予以改善睡眠、抗焦虑及抑郁后可有效缓解慢性疼痛。术后发热、切口感染、切口出血及疝复发情况比较，差异无统计学意义（P>0.05）。进一步分层分析，发现TEP术式下出院后3个月满意度，观察组明显高于对照组；Lichtenstein术及开放腹膜前修补手术下，24 h延迟出院率观察组明显低于对照组；Lichtenstein及TEP术式下，并发症发生率观察组更低，差异均有统计学意义。而3种术式下2组患者的手术时间、住院费用、出院时患者满意度比较，差异均无统计学意义。结论:精细化、规范化及个体化的诊疗模式，可有效保证日间手术的安全、顺利开展和推广，避免和降低术后相关并发症的发生，从而提高患者日间手术的感受性和满意度。日间手术术前准确评估患者心理状态及围手术期注重控制患者心因性疼痛因素，有利于日间腹股沟疝手术规模化开展，可进一步提高患者就医体验。
Abstract
Objective:To summarize and analyze the implementation of adult inguinal hernia day surgery, systematically explore the issues within this surgical model, and provide experience and references for further optimization.Methods:A retrospective analysis was conducted on the medical records of adult inguinal hernia patients treated from September 2019 to September 2023 at the day surgery Center of Hernia and Abdominal Wall Surgery, Wuhan Central Hospital,Tongji Medical College, Huazhong University of Science and Technology. The study involved 1443 patients under the regular day surgery management model and 1346 patients under the refined management model. Using convenience sampling, 1000 patients from each management model were selected and divided into an observation group (refined daytime management model) and a control group (regular daytime inguinal hernia surgery model). Surgical indices, wound healing, and complication rates were compared between the two groups. Stratified observation was conducted on surgical duration, hospitalization costs, 24-hour delayed discharge rates, patient satisfaction, and postoperative pain recovery under different surgical techniques.Results:The observation group had a significantly lower 24-hour delayed discharge rate (0.6%) compared to the control group (3.7%) (P<0.05). Both groups experienced various types and degrees of complications. The incidence of postoperative wound fat liquefaction, seroma, local ecchymosis, and chronic pain was significantly lower in the observation group (P<0.05), with the highest chronic pain incidence in patients with solitary relationships, which could be effectively alleviated with improved sleep and anti-anxiety and anti-depression treatment. No significant difference was observed in postoperative fever, wound infection, hemorrhage, or hernia recurrence (P>0.05). Further stratified analysis revealed that patient satisfaction 3 months post-discharge was significantly higher in the observation group under the TEP technique, while the 24-hour delayed discharge rate was significantly lower in the observation group for both Lichtenstein and open preperitoneal repair surgery; the incidence of complications was also lower in the observation group under both Lichtenstein and TEP techniques, with statistically significant differences. However, there was no significant difference in surgical duration, hospitalization costs, and patient satisfaction at discharge between the two groups.Conclusion:A refined, standardized, and individualized treatment model can effectively ensure the safety and smooth implementation of day surgery, avoiding and reducing the occurrence of postoperative complications, and thereby enhancing patient receptivity and satisfaction. Preoperatively accurate assessment of patients' psychological states and a focus on controlling psychogenic pain factors during the perioperative period are beneficial for the standardized implementation of daytime inguinal hernia surgery, further enhancing the patient's medical experience.
基金项目
湖北省卫生健康委联合基金立项项目青年重点项目(WJ2019H382)
武汉市卫生健康委员会医学科研项目青年重点项目(WX19Q35)
万方数据