论著

低浓度布比卡因联合全身麻醉对腹腔镜下直肠癌根治术患者体征及苏醒质量的影响

Clinical study on the effect of low concentration bupivacaine combined with general anesthesia on the physical signs and recovery quality of patients undergoing laparoscopic radical resection of rectal cancer

:295-299
 
目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组(P<0.05);术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组(P>0.05);但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组(P<0.05);联合组的麻醉相关不良反应发生率略高于全麻组(P>0.05);随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组(P<0.05)。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。
Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects.The patients were divided into groups by drawing lots.Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group.Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation.The changes of physical signs and the quality of recovery were compared between the two groups.Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group(P<0.05).After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group(P>0.05).However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group(P<0.05).The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group(P>0.05).During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group(P<0.05). Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe.
论著

快速康复理念联合腹腔镜手术治疗对小儿腹股沟疝疗效观察

Observation on the therapeutic effect of rapid rehabilitation concept combined with laparoscopic surgery for inguinal hernia in children

:781-785
 
目的 探讨快速康复理念联合腹腔镜手术治疗对小儿腹股沟疝疗效观察。方法 选取焦作市妇幼保健院2021年1月—2023年1月收治的86例腹股沟疝患儿进行分析与研究,应用随机数字表法将其分为观察组与对照组,各组均为43例。所有患儿均采取腹腔镜手术治疗,对照组采取常规护理,观察组采取快速康复理念护理。对比两组围术期恢复情况,术后4、12、24、48 h疼痛程度,并发症及护理满意度情况。结果 观察组首次下床时间、首次肛门排气时间、进食时间、住院时间短于对照组(P<0.05);两组患儿术后4、12、24、48 h视觉模拟量表(VAS)评分逐渐降低,观察组低于对照组(P<0.05);两组恶心呕吐、尿潴留、腹胀腹痛、感染并发症发生率对比差异无统计学意义(P>0.05);观察组患儿及家长健康教育、住院环境、专科护理、检查指导、病情观察相关护理满意度评分高于对照组(P<0.05)。结论 快速康复理念联合腹腔镜手术治疗小儿腹股沟疝效果显著,可进一步促进患儿早日康复,缩短住院时间,术后疼痛水平低,同时可提升患儿及家长护理满意度。
Objective To explore the therapeutic effect of rapid rehabilitation concept combined with laparoscopic surgery on pediatric inguinal hernia.Methods A total of 86 children with inguinal hernia admitted to Jiaozuo Maternal and Child Health Care Hospital from January 2021 to January 2023 were selected for analysis and study,and divided into observation group and control group by random number table method,with 43 cases in each group.All patients were treated with laparoscopic surgery,while the control group received routine care,while the observation group received rapid recovery concept care.The perioperative recovery,pain level,complications,and nursing satisfaction at 4,12,24,and 48 hours after surgery were compared.Results The first discharge time,first anal exhaust time,feeding time,and hospitalization time were shorter than the control group(P<0.05).The VAS scores decreased after 4 h,12 h,24 h and 48 h,and the observation group was lower than the control group(P<0.05).The incidences of nausea and vomiting,urinary retention,abdominal distension,abdominal pain and infectious complications between the two groups were significantly insignificant(P>0.05).The health education,inpatient environment,specialized care,nursing examination guidance and condition observation were significantly higher than that of the observation group(P<0.05).Conclusions The combination of rapid recovery concept and laparoscopic surgery for the treatment of inguinal hernia in children has a significant effect,which can further promote early recovery,shorten hospital stay,lower postoperative pain levels.At the same time,it can improve the nursing satisfaction of children and parents.
论著

成人全麻腹腔镜下疝修补日间手术可行性和安全性分析

Feasibility and safety analysis of laparoscopic inguinal hernia repair ambulatory surgery under general anesthesia in adults

:1357-1362
 
目的 探讨成人全身麻醉(全麻)腹腔镜下腹股沟疝修补日间手术的可行性及安全性。方法 回顾性分析2021年1月—2023年12月广州市第一人民医院收治的进行全麻腹腔镜下疝修补手术治疗的成人患者病历资料,根据患者住院手术模式分为日间手术组、传统手术组。日间手术组采用日间手术模式下全麻腹腔镜腹股沟疝修补术,传统手术组采用传统入院模式下择期全麻腹腔镜下腹股沟疝修补术,对比分析两组可行性(住院时间、住院费用、患者满意度)、安全性(手术时间、手术的出血量、手术并发症的发生率)等。结果 最终纳入199例病例,日间手术组52例(26.1%),传统手术组147例(73.9%)。与传统手术组相比较,日间手术组住院时间、术前住院时间、术后住院时间缩短,满意度评分升高,差异具有统计学意义(P<0.05)。在手术费用、住院总费用、术后24 h疼痛评分、手术时间、手术的出血量、手术并发症的发生率方面,组间比较差异均无统计学意义(P>0.05)。结论 成人全麻腹腔镜下腹股沟疝修补日间手术,能够缩短患者的住院时间,提高患者的住院满意程度,不增加手术风险和并发症发生率,是安全、有效的。
Objective To explore and analyze the feasibility and safety of laparoscopic inguinal hernia repair surgery under general anesthesia in adults.Methods A retrospective analysis was conducted on the medical records of patients admitted to a hospital from January 2021 to December 2023 who underwent laparoscopic hernia repair surgery under general anesthesia.The patients were divided into day surgery group and traditional surgery group based on their hospitalization surgery mode.The daytime surgery group underwent laparoscopic inguinal hernia repair under general anesthesia in the daytime surgery mode,while the traditional surgery group underwent elective laparoscopic inguinal hernia repair under general anesthesia in the traditional admission mode.The feasibility(hospitalization duration,hospitalization cost,patient satisfaction)and safety(surgery duration,surgical bleeding volume,incidence of surgical complications)of the two groups were compared and analyzed.Results A total of 199 cases were enrolled,with 52 cases(26.1%)in the day surgery group and 147 cases(73.9%)in the traditional surgery group.Compared with the traditional surgery group,the daytime surgery group showed a decrease in length of hospital stay,preoperative hospital stay,and postoperative hospital stay,while the satisfaction score increased,and the difference was statistically significant(P<0.05).There was no difference(P>0.05)between the two groups in terms of surgical costs,total hospitalization costs,postoperative 24-hour pain scores,surgical time,surgical bleeding volume,and incidence of surgical complications.Conclusion sLaparoscopic inguinal hernia repair under general anesthesia during the day for adults is safe and effective.
论著

胆囊结石患者经单孔腹腔镜胆囊切除术治疗的回顾性分析

Retrospective analysis of patients with cholecystolithiasis treated by single-incision laparoscopic cholecystectomy

:1319-1324
 
目的 探究单孔腹腔镜胆囊切除术(LC)治疗胆囊结石(GD)患者的效果。方法 回顾性收集2021年1月—2023年9月郑州大学附属郑州中心医院收治的96例GD患者病例资料,按手术方案不同分两组。以接受单孔LC治疗的48例患者列为A组,以接受三孔LC治疗的48例患者列为B组。对比两组围术期指标、手术前后胃肠激素指标[胃泌素(GAS)、胃动素(MTL)]、肝功能指标[天门冬氨酸转氨酶(AST)、丙氨酸氨基转移酶(ALT)]、疼痛介质指标[前列腺素E2(PGE-2)、5-羟色胺(5-HT)]水平、术后并发症发生率。结果 A组手术用时(71.56±6.29)min更长于B组(62.37±5.85)min,术后排气时间(15.37±2.26)h、住院用时(5.30±1.24)d、切口总长度(1.84±0.27)cm短于B组(17.49±3.55)h、(7.64±1.35)d、(4.13±0.35)cm,术中失血量(41.28±4.36)mL低于B组(58.31±6.52)mL更低(均P<0.001);术后1 d A组GAS(113.34±13.47)pg/mL、MTL(202.78±24.68)pg/mL水平高于B组(102.65±11.08)pg/mL、(164.34±20.76)pg/mL(均P<0.001);术后1d A组AST(31.82±3.62)U/L、ALT(40.36±4.74)U/L水平低于B组(38.78±4.03)U/L、(51.60±5.42)U/L(均P<0.001);术后1 d A组SP(55.84±5.90)ng/L、5-HT(132.17±9.16)ng/mL、PGE-2(25.45±4.27)ng/mL水平低于B组(73.27±7.51)ng/L、(173.54±13.32)ng/mL、(31.71±5.24)ng/mL(均P<0.001);A组并发症发生率2.08%(1/48)低于B组16.67%(8/48)更低。结论 与三孔LC治疗GD患者相比,经单孔LC治疗会略微延长手术用时,但能进一步减少术中失血量,降低术后并发症风险,缩短切口长度及患者康复进程,且对机体胃肠功能、肝功能影响更小,对机体造成疼痛应激更轻微,更符合微创特征。
Objective To explore the effect of single-incision laparoscopic cholecystectomy(LC)in the treatment of patients with gallstone disease(GD).Methods Retrospective data of 96 GD patients in Zhengzhou Central Hospital Affiliated to Zhengzhou University(January 2021—September 2023)were collected and divided into two groups according to different surgical protocols.Forty-eight patients receiving single-incision LC were classified as group A,and 48 patients receiving three-port LC were classified as group B.The perioperative indexes,gastrointestinal hormone indexes[gastrin(GAS),motilin(MTL)],liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT)],pain mediator indexes[prostaglandin E2(PGE-2),5-hydroxytryptamine(5-HT)] before and after operation,and the incidence of postoperative complications were compared between the two groups.Results The operation time in group A was(71.56±6.29)min,which was longer than that in group B(62.37±5.85)min.In group A,the postoperative exhaust time was(15.37±2.26)h,hospitalization time was(5.30±1.24)d,and the total length of incision was(1.84±0.27)cm,which were shorter than those in group B[(17.49±3.55)h,(7.64±1.35)d,and(4.13±0.35)cm].The intraoperative blood loss was(41.28±4.36)mL,which were lower than(58.31±6.52)mL in group B(all P<0.001).The levels of GAS[(113.34±13.47)pg/mL] and MTL[(202.78±24.68)pg/mL] in group A were higher than those in group B[(102.65±11.08)pg/mL and(164.34±20.76)pg/mL](all P<0.001).The levels of AST[(31.82±3.62)U/L] and ALT[(40.36±4.74)U/L] in group A were lower than those in group B[(38.78±4.03)U/L and(51.60±5.42)U/L](all P<0.001).The levels of SP[(55.84±5.90)ng/L],5-HT[(132.17±9.16)ng/mL],pge-2[(25.45±4.27)ng/mL] in group A were lower than those in group B[(73.27±7.51)ng/L,(173.54±13.32)ng/mL and (31.71±5.24)ng/mL](all P<0.001).The incidence of complications in group A was 2.08%(1/48),which was lower than that in group B[16.67%(8/48)](χ2=4.414,P=0.036).Conclusion sCompared with three-port LC for GD patients,single-incision LC can slightly prolong the operation time,but it can further reduce the intraoperative blood loss,reduce the risk of postoperative complications,shorten the incision length and the rehabilitation process of patients,and has less impact on the gastrointestinal function and liver function,causing less pain stress to the body,which is more in line with the characteristics of minimally invasive.
论著

新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响

Effect of neostigmine antagonizing timing of cisatracurium on residual muscle relaxation and early lung function after laparoscopic radical resection of colorectal cancer

:70-74
 
目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激(TOF)比值将试验组患者分为试验组A(TOF≤0.1)、试验组B(0.10.8)。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组(P<0.01),空白对照组患者TOF比值高于其他组(P<0.01);空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义(P>0.01);试验组A患者肌松恢复指数低于其他组(P<0.01),空白对照组患者肌松恢复指数高于其他组(P<0.01)。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC比较差异无统计学意义(P>0.05)。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。
Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer.Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects.The patients were randomly divided into a blank control group and an experimental group using a random number table method.Then,combined with the train-of-four(TOF)ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A(TOF≤0.1),experimental group B(0.10.8).The residual muscle relaxation and lung function between groups were compared.Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups(P<0.01),while the TOF ratio of patients in the blank control group was higher than that of other groups(P<0.01).There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit(P>0.01).The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups(P<0.01),while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups(P<0.01).There were no significant differences in force expiratory volume in one second(FEV1),forced Vital capacity(FVC)and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation(P>0.05).Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels.
论著

儿童结直肠息肉98例的临床特征及腹腔镜联合结肠镜下手术治疗效果

Clinical characteristics of 98 cases of colorectal polyps in children and the efficacy of laparoscopic surgery combined with colonoscopy

:63-67
 
目的 调查与分析儿童结直肠息肉的临床特征及腹腔镜联合结肠镜下手术对其的治疗效果。方法 选择2019年2月—2021年10月在郑州大学附属儿童医院诊治的98例结直肠息肉患儿,记录患儿的临床特征,根据患儿的手术方法分为腹腔镜组(腹腔镜联合结肠镜下手术治疗,n=40)与结肠镜组(采用结肠镜手术治疗,n=58),对比不同手术方法的治疗效果、并发症发生率、疼痛视觉模拟评分法(VAS)评分、息肉复发与再手术率。结果 98例患儿中,息肉部位为直肠44例、横直肠38例、其他16例;息肉最大直径(1.65±0.24)cm;息肉单发83例、多发15例。腹腔镜组的围手术期指标比结肠镜组改善(P<0.05)。腹腔镜组术后7 d的感染、出血、肠穿孔、肠梗阻等并发症发生率为5.00%,低于结肠镜组的17.24%(P<0.05)。腹腔镜组术后1个月的总有效率为97.50%,高于结肠镜组的82.76%(P<0.05)。腹腔镜组术后1、3、7 d的疼痛VAS评分低于结肠镜组(P<0.05)。所有患儿术后随访1年,联合的息肉复发率与再次手术率为5.00%、2.50%,均低于结肠镜组的18.97%、13.79%(P<0.05)。结论 儿童结直肠息肉主要位于直肠、横直肠,多为单发,腹腔镜联合结肠镜下手术治疗能促进患儿康复,提高总体治疗效果,也能缓解患儿疼痛,减少并发症的发生,降低随访息肉复发率与再次手术率。
Objective To investigate and analyze the clinical features of children with colorectal polyps and the efficacy of laparoscopic surgery combined with colonoscopy. Methods A total of 98 children with colorectal polyps diagnosed and treated in our hospital from February 2019 to October 2021 were selected as subjects of this study. The clinical characteristics of all children were recorded,and they were divided into the laparoscopic group(laparoscopic surgery combined with colonoscopy,n=40)and the colonoscopy group(colonoscopy,n=58)according to the differences in surgical methods. The therapeutic effect,complication rate,VAS pain score,polyp recurrence and reoperation rate of different surgical methods were compared. Results Among the 98 children,the polyps of 44 cases were in rectum,38 cases in transverse rectum and 16 cases in other sites. The maximum diameter of polyp was(1. 65±0. 24)cm. Polyps were solitary in 83 cases and multiple in 15 cases. The perioperative indexes in the laparoscopic group were significantly improved compared with those in the colonoscopy group(P<0. 05). The incidence of postoperative complications such as infection,bleeding,intestinal perforation and intestinal obstruction was 5. 00% in the laparoscopy group,which was significantly lower than 17. 24% in the colonoscopy group(P<0. 05). The total effective rate of laparoscopic group was 97. 50% one month after operation,which was significantly higher than that of colonoscopy group(82. 76%,P<0. 05). The VAS pain score of the laparoscopic surgery group was significantly lower than that of the colonoscopy group at 1,3 and 7 days after surgery(P<0. 05). After 1 year of follow-up,the combined polyp recurrence rate and reoperation rate were 5. 00% and 2. 50%,which were significantly reduced compared with 18. 97% and 13. 79% in colonoscopy group(P<0. 05). Conclusions The main sites of colorectal polyps in children are rectum and transverse rectum,and most of them are solitary. Laparoscopic and colonoscopic surgery for colorectal polyps in children can promote the recovery of children,improve the overall treatment effect of patients,relieve the pain of children,reduce the occurrence of complications,and reduce the recurrence rate and reoperation rate of follow-up polyps in children.
论著

术前超声在预测困难的腹腔镜胆囊切除术中的价值

The value of preoperative ultrasound in predicting difficult laparoscopic cholecystectomy

:95-99
 
目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ2检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm2、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。
Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ2 test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm2, gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.
临床诊疗

曲普瑞林联合腹腔镜下卵巢囊肿剥除术对卵巢子宫内膜异位囊肿患者术后血清性激素水平及妊娠率的影响

Effect of triprirelin combined with laparoscopic ovarian cyst stripping on serum sex hormone levels and pregnancy rate in patients with ovarian endometriosis cyst after operation

:140-143
 
目的 分析曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗卵巢子宫内膜异位囊肿(OEC)患者的效果。方法 选取我院2019年1月—2020年5月期间收治的OEC患者108例,采用随机抽签法分成研究组与对照组,各54例。对照组行腹腔镜下卵巢囊肿剥除术治疗,研究组基于对照组加用曲普瑞林治疗,统计对比2组疗效、妊娠率以及术前、术后6个月、1年血清性激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、抗苗勒管激素(AMH)]、血清高迁移率组蛋白B1(HMGB1)、视黄醇结合蛋白4(RBP4)、糖类抗原125(CA125)水平。结果 研究组治疗总有效率92.59%高于对照组75.93%(P<0.05);术后6个月、1年研究组LH、FSH低于对照组,AMH高于对照组(P<0.05);术后6个月、1年研究组CA125、RBP4、HMGB1低于对照组(P<0.05);研究组妊娠率59.26%高于对照组29.63%(P<0.05)。结论 曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗OEC患者时,可改善性激素水平,提高妊娠率,降低血清CA125、RBP4、HMGB1水平。
论著

腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况回顾性分析

Retrospective analysis of the perioperative application of antibacterial drugs during laparoscopic myomectomy

:51-55
 
目的 对腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况进行回顾性分析,并分析腹腔镜子宫肌瘤切除术围手术期感染的影响因素。方法 选择2018年5月—2021年5月在我院行腹腔镜子宫肌瘤切除术的患者72例进行回顾性分析。收集患者一般资料及抗生素使用情况,根据有无术后感染将患者分为2组,比较2组患者上述各资料,并采用多因素分析法判断各因素对腹腔镜子宫肌瘤切除术后感染的综合作用。结果 本次纳入的72例腹腔镜子宫肌瘤切除术患者共有16例出现术后感染,术后感染率为22.22%。多因素Logistic回归分析结果显示:年龄≥50岁、手术时间≥60 min、合并糖尿病为腹腔镜子宫肌瘤切除术围手术期感染的危险因素,预防性使用抗生素、术前≤2 h抗生素使用、术后抗生素使用≤48 h为保护性因素(P<0.05)。结论 腔镜子宫肌瘤切除术患者术后感染率为22.22%,抗菌药物使用时机及使用时间对腹腔镜子宫肌瘤切除术患者术后感染有重要的影响,此外患者年龄、手术时间、合并糖尿病情况也与患者术后感染有关。
Objective To retrospectively analyze the perioperative application of antibacterial drugs during laparoscopic myomectomy, and to analyze the influencing factors of infection during the perioperative period of laparoscopic myomectomy. Methods Seventy-two patients who underwent laparoscopic myomectomy in our hospital from May 2018 to May 2021 were selected for retrospective analysis. The patients were divided into two groups according to postoperative infection status. The above data were compared between the two groups, and the comprehensive effects of various factors on postoperative infection after laparoscopic myomectomy were determined by multivariate analysis. Results There were 16 cases of 72 patients underwent laparoscopic myomectomy had postoperative infection, and the postoperative infection rate was 22.22%. Multivariate Logistic regression analysis showed that age over 50, operation time over 60 minutes, and with diabetes mellitus were the risk factors of perioperative infection in laparoscopic myomectomy. Prophylactic use of antibiotics, preoperative use of antibiotics in less than 2 hours and postoperative use of antibiotics in less than 48 hours were protective factors (P<0.05). Conclusions The infection rate of patients underwent laparoscopic myomectomy was 22.22%. The time and length of antibiotics use had important influence on postoperative infection of patients underwent laparoscopic myomectomy. In addition, age, operation time and complicated with diabetes mellitus were also related to postoperative infection.
临床诊疗

化脓性阑尾炎抗生素治疗后不同时机腹腔镜阑尾切除术的疗效及预后

:138-141
 
目的 探究与分析化脓性阑尾炎抗生素治疗后不同时机腹腔镜阑尾切除术的疗效及预后。方法 研究于2019年1月—2021年1月进行,我院收治的96例化脓性阑尾炎患者为此研究的参与对象,接受抗生素治疗≤72 h后手术的患者为观察组(n=38),>72 h的患者为对照组(n=38)。对比2组患者的指标。结果 2组的手术时间等相较均无差异(P>0.05);观察组的住院时间及住院费用均短于或少于对照组(P<0.05)。观察组术前中性粒细胞比例及白细胞计数高于对照组(P<0.05);术后2组患者组间无差异(P>0.05)。观察组的腹腔渗液阳性率低于对照组(P<0.05)。2组并发症发生率比较,组间无差异(P<0.05)。结论 化脓性阑尾炎患者经抗生素治疗后续尽早接受手术治疗。
出版者信息








《广州医药》公众号