日间手术室输尿管软镜治疗上尿路结石的可行性及安全性研究
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摘要
目的探讨输尿管软镜碎石取石术日间手术模式的安全性及可行性。方法回顾性分析2016年1月至2017年7月于我中心采用输尿管软镜碎石取石术治疗上尿路结石的297例患者的临床资料,分为日间手术组141例,住院手术组156例。比较两组的术后住院时间、结石清除率、术后并发症和住院费用等指标。结果两组性别、平均年龄、结石直径、体质量指数、术前置管、结石部位和肾下盏结石比例等指标差异无统计学意义。两组结石清除率差异无统计学意义(85.1%vs 85.9%,P=0.847)。两组术后并发症发生率差异无统计学意义(2.1%vs 5.1%,P=0.172)。日间手术组术后住院时间明显少于住院手术组[(13±4) h vs (44±25) h,P<0.001],日间手术组人均费用明显低于住院组费用[(14 946±2 302)元vs (15 568±2 364)元,P=0.022]。结论输尿管软镜碎石取石术日间手术安全有效,显著缩短术后住院时间,降低治疗费用,有利于患者术后康复,并加快医院床位周转,提高医疗资源利用效率,值得推广。
Objective To explore the safety and feasibility of flexible ureteroscopy in day surgery for patients with upper urinary calculus. Methods The records of 297 consecutive patient underwent flexible ureteroscopic procedures for upper urinary calculus from January 2016 to July 2017 at our institution were analyzed retrospectively. There were 141 cases for day surgery group and 156 cases for inpatient surgery group. Hospital stay, stone free rate, postoperative complications and overall costs were analyzed in each group. Results No significant differences were found in sex, age, stone diameter, body mass index, preoperation catheterization, and stone location between the day surgery group and the inpatient surgery group. The stone free rate was not different between the day surgery group and the inpatient surgery group(85.1% vs 85.9%, P=0.847). The complication rate of the day surgery group was lower than the inpatient surgery group(2.1% vs 5.1%), but the differences between the two groups weren't statistically significant(P>0.05). Shorter hospital stay was needed by day surgery group than inpatient surgery group. The day surgery group also benefited in overall costs [(14 946±2 302) RMB vs(15 568±2 364) RMB, P=0.022]. Conclusions Day surgery of flexible ureteroscopy is a safe and feasible procedure with advantages of shorter hospital length of stay, less need of overall costs, return more quickly to daily life, improving the utilization efficiency of medical resources, less risk of nosocomial and cross infection and better medical experience.
Objective To explore the safety and feasibility of flexible ureteroscopy in day surgery for patients with upper urinary calculus. Methods The records of 297 consecutive patient underwent flexible ureteroscopic procedures for upper urinary calculus from January 2016 to July 2017 at our institution were analyzed retrospectively. There were 141 cases for day surgery group and 156 cases for inpatient surgery group. Hospital stay, stone free rate, postoperative complications and overall costs were analyzed in each group. Results No significant differences were found in sex, age, stone diameter, body mass index, preoperation catheterization, and stone location between the day surgery group and the inpatient surgery group. The stone free rate was not different between the day surgery group and the inpatient surgery group(85.1% vs 85.9%, P=0.847). The complication rate of the day surgery group was lower than the inpatient surgery group(2.1% vs 5.1%), but the differences between the two groups weren't statistically significant(P>0.05). Shorter hospital stay was needed by day surgery group than inpatient surgery group. The day surgery group also benefited in overall costs [(14 946±2 302) RMB vs(15 568±2 364) RMB, P=0.022]. Conclusions Day surgery of flexible ureteroscopy is a safe and feasible procedure with advantages of shorter hospital length of stay, less need of overall costs, return more quickly to daily life, improving the utilization efficiency of medical resources, less risk of nosocomial and cross infection and better medical experience.
引文
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[15]Zhong W,Leto G,Wang L,et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.
[2]Roberts L.Day surgery-National and international:From the past to the future[J].Ambulatory Sur,2006,12(3):143-145.
[3]Cassinotti E,Colombo EM,Di Giuseppe M,et al.Current indications for laparoscopy in day-case surgery[J].Int J Surg,2008,6 Suppl 1:S93-S96.
[4]曹剑涛,李志建,马进.基于门诊患者流量优化医院床位数量:理论模型及政策含义[J].中国卫生政策研究,2012,5(11):42-47.
[5]曾国华,麦赞林,夏术阶,等.中国成年人群尿石症患病率横断面调查[J].中华泌尿外科杂志,2015,36(7):528-532.
[6]Resorlu B,Unsal A,Ziypak T,et al.Comparison of retrograde intrarenal surgery,shockwave lithotripsy,and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones[J].World J Urol,2013,31(6):1581-1586.
[7]Landman J,Lee DI,Lee C,et al.Evaluation of overall costs of currently available small flexible ureteroscopes[J].Urology,2003,62(2):218-222.
[8]Suhonen RA,Iivonen MK,V?lim?ki MA.Day-case surgery patients'health-related quality of life[J].Int J Nurs Pract,2007,15(6):454-455.
[9]白雪,马洪升,罗利.中外日间手术发展对比研究及展望[J].中国医院管理,2014,34(5):35-37.
[10]Paez A,Redondo E,Linares A,et al.Adverse events and readmissions after day-case urological surgery[J].Int Braz J Urol,2007,33(3):330-338.
[11]Doksr?d S,L?fgren B,Nordhammer A,et al.Reinforced laryngeal mask airway compared with endotracheal tube for adenotonsillectomies[J].Eur J Anaesthesiol,2010,27(11):941-946.
[12]Moore JG,Ross SM,Williams BA.Regional anesthesia and ambulatory surgery[J].Curr Opin Anaesthesiol,2013,26(6):652-660.
[13]Salinas FV,Joseph RS.Peripheral nerve blocks for ambulatory surgery[J].Anesthesiol Clin,2014,32(2):341-355.
[14]Breebaart M B,TeuneA,Sermeus L A,et al.Intrathecal chloroprocaine vs.lidocaine in day-case surgery:recovery,discharge and effect of pre-hydration on micturition[J].Acta Anaesthesiol Scand,2014,58(2):206-213.
[15]Zhong W,Leto G,Wang L,et al.Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.