Application and Evaluation of Day Care Laparoscopic Cholecystectomy
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摘要:
目的 基于云南曲靖地区胆囊切除患者手术情况，分析和讨论日间腹腔镜胆囊切除术（ambulatory laparoscopic cholecystectomy，ALC）的安全性和可行性。 方法 回顾性选择曲靖市第一人民医院2019年9月至2020年10月收治的行腹腔镜胆囊切除术患者77例作为研究对象，按照手术管理流程的不同，将77例患者分为ALC组（n = 38）和传统腹腔镜胆囊切除术（traditional laparoscopic cholecystectomy，TLC）组（n = 39），比较2组患者术前一般情况，手术安全性、卫生经济学、满意度指标。 结果 2组患者在病例特点、性别、年龄、手术时间、术中出血、术后并发症、术后满意度的差异均无统计学意义（P > 0.05），2组患者术前等待时间、住院时长和住院费用的差异有统计学意义（P < 0.05），其中ALC组在术前等待时间、住院时间较TLC组明显减少，ALC组在手术费用方面较TLC组明显下降。 结论 精准微创外科操作下配合延续性护理服务、多模式镇痛理念、快速康复理念的围术期管理，能显著缩短术前及住院时长、降低住院费用、并且无术后并发症的增加，故ALC是可实践，安全有效，有益患者、地区医疗资源的。可结合各地实际情况开展。 Abstract:Objective To analyze and discuss the safety and feasibility of ambulatory laparoscopic cholecystectomy （ALC） based on the surgical situation of gallbladder resection patients in Qujing, Yunnan. Methods A retrospective analysis was conducted on 77 patients who underwent laparoscopic cholecystectomy at the First People's Hospital of Qujing City from September 2019 to October 2020. Based on the different treatment methods, the 77 patients were divided into the ALC group （n = 38） and the traditional laparoscopic cholecystectomy （TLC） group （n = 39）, and comparisons were made on the general preoperative conditions, surgical safety, health economics, and satisfaction indicators of the two groups. Results There were no statistically significant differences between the two groups of patients in terms of medical history, gender, age, surgery time, intraoperative bleeding, postoperative complications, and postoperative satisfaction （P > 0.05）. The differences in preoperative waiting time, length of hospital stay, and hospital costs were statistically significant between the two groups （P < 0.05）, with the ALC group showing a significant reduction in preoperative waiting time and hospital stay compared to the TLC group, and a significant decrease in surgical costs compared to the TLC group. Conclusion Precise minimally invasive surgical procedures combined with continuous postoperative care services, multi-modal pain management concepts, and fast recovery concepts in perioperative management can significantly shorten the preoperative and hospital stay duration, reduce hospital costs, and avoid an increase in postoperative complications. Therefore, ALC is practical, safe, effective, and beneficial to patients and regional medical resources. It can be implemented in combination with the actual situation in different regions. -
Key words:
- Day surgery /
- Laparoscopic cholecystectomy /
- Curative effect /
- Implementation
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图 1 2组患者出院1月后满意度调查的独立样本Kruskal-Wallis检验
Figure 1. Kruskal-Wallis test of independent samples of the satisfaction survey of the two groups of patients 1 month after discharge
表 1 2组患者术前观察指标的分析比较[$\bar x \pm s $/n（%）]
Table 1. Analysis and comparison of preoperative observation indexes between the two groups[$\bar x \pm s $/n（%）]
项目 观察组（ALC）
n=38对照组（TLC）
n=39t/χ2 P 年龄（岁） 43.16±11.61 42.69±12.55 0.169 0.866 性别 男 8（21.1） 10（25.6） 0.226 0.634 女 30（78.9） 29（74.4） 疾病类型 胆囊结石 34（89.5） 34（87.2） 0.098 0.754 胆囊息肉 4（10.5） 5（12.8） 
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表 2 2组患者手术相关指标的分析比较（$\bar x \pm s $）
Table 2. Analysis and comparison of operation-related indicators between the two groups（$\bar x \pm s $）
项目 观察组（ALC）n=38 对照组（TLC）n=39 t P 术前等待时间（h） 34.97±4.83 41.79±4.56 6.378 <0.001* 手术时间（min） 46.03±8.98 45.08±7.94 0.492 0.624 术中出血量（mL） 12.50±5.90 11.54±4.61 3.054 0.085 住院时间（h） 18.16±2.76 93.28±13.13 34.948 <0.001* 住院费用（元） 7823.67 ±405.5710183.80 ±810.8216.216 <0.001* *P < 0.05。
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表 3 2组患者术后并发症分析比较[n（%）]
Table 3. Analysis and comparison of postoperative complications between the two groups [n（%）]
项目 观察组（ALC）
n=38对照组（TLC）
n=39χ2 P 有并发症 3（8.1） 4（10.3） 0.105 0.746 无并发症 35（91.9） 35（89.7）
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表 4 2组患者出院1月后满意度调查的非参数检验[n（%）]
Table 4. Nonparametric test of satisfaction survey of two groups of patients after one month of discharge[n（%）]
项目 观察组（ALC）
n=38对照组（TLC）
n=39H P 非常满意 20（52.6） 23（59.0） 0.187 0.665 满意 12（31.6） 10（25.6） 一般 4（10.5） 3（7.7） 不满意 2（5.3） 3（7.7）
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