加速康复外科在腹腔镜先天性肥厚性幽门狭窄手术中的应用

摘要

Objective To investigate the safety and effectiveness of fast track surgery (FTS) in laparoscopic surgery for congenital hypertrophic pyloric stenosis (CHPS).Methods From Feb.2014 to Feb.2016,29 infants with CHPS,aged (37.0 ± 13.7) days and weighed (3.4 ± 0.6) kg were grouped as FTS and treated with laparoscopic surgery.Another group of infants with overall clinical features similar to the FTS group were given traditional clinical treatment.The changes in feeding regimen due to vomiting,the total feeding time after operation and the total cost of treatment were compared.Results The total feeding time after operation in the FTS group and the control group was 21.0 ± 8.8 and 38.3 ± 8.3 h respectively;the hospitalization time was 6.8 ± 1.7 and 10.8 ± 2.5 days respectively;the total cost of the treatment was 7 223.5 ± 991.6 and 9 082.5 ± 823.3 RMB respectively.The differences were statistically significant (P＜0.05).Conclusions The FTS could accelerate postoperative recovery of congenital hypertrophic pyloric stenosis,shorten the length of hospital stay,reduce the hospital cost,and decrease the incidence of postoperative complications.It is safe and effective,worthy of being popularized in clinical practice.%目的 探讨应用加速康复外科(fast track surgery,FTS)理念在腹腔镜治疗先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,CHPS)的安全性和有效性.方法 收集盐城市妇幼保健院2014年2月至2016年2月应用加速康复理念治疗的CHPS患儿29例,日龄(37.0±20.3)d,体重(3.7±1.1)kg,为FTS组;选取2012年2月至2014年2月采取传统处理方法且与FTS组条件相同、总体临床特点类似的CHPS患儿32例,日龄(30.3±13.7)d,体重(3.4±0.6)kg,作为对照组.全部病例均行腹腔镜下幽门环肌切开术,对两组病例术后呕吐致喂养方案改变、术后达全量喂养时间、住院时间和治疗费用等方面进行比较.结果 FTS组与对照组术后达全量喂养时间分别是(21.0±8.8)h和(38.3±8.3)h,住院时间分别是(6.8±1.7)d和(10.8±2.5)d,治疗费用分别是(7 223.5±991.6)元和(9 082.5±823.3)元,差异均有统计学意义(均P＜0.05).两组术后均未出现并发症,呕吐致喂养方案改变的发生率差异无统计学意义(P＞0.05).结论 FTS理念可加速术后康复,缩短住院时间,节省住院费用,并不增加术后并发症,安全有效,值得临床推广应用.