日间手术模式下内镜辅助低温等离子腺样体消融术的临床探讨

Clinical analysis of endoscope-assisted cryogenic plasma adenoidectomy in ambulatory surgery mode

摘要:

目的 探讨日间手术模式下内镜辅助低温等离子腺样体消融术的可行性和安全性。方法 回顾分析2018年1—12月佛山市第一人民医院耳鼻咽喉头颈外科收治的108例腺样体肥大患者的临床资料，根据住院流程分为日间组65例和住院组43例。日间组于门诊完成各项检查，24 h内完成入院、手术、出院。比较两组患者手术情况（手术时间、出血量）、围手术期并发症（术后疼痛、发热、出血）和住院相关指标（术前等待时间、住院时间、住院总费用、西药费）。结果 日间组65例患者均顺利完成手术，日间组和住院组的手术时间分别为（6.9±2.3） min和（7.5±2.8） min，出血量分别为（5.2±3.6） mL和（5.5±2.4） mL，组间比较差异无统计学意义（P>0.05）。日间组3例出现术后发热、无术后出血、平均疼痛指数评分为（1.6±0.5）分；住院组6例出现术后发热、无术后出血、平均疼痛指数评分为（2.1±1.1）分，组间比较差异无统计学意义（P>0.05）。日间组和住院组临床疗效分别是96.9%（63/65）和95.3%（41/43），两组差异无统计学意义（P=0.935）。日间组术前等待时间和住院时间分别为（1.2±0.6） h和（10.5±2.8） h，较住院组术前等待时间（21.5±5.8） h和住院时间（76.2±12.5） h均明显缩短（P<0.001）。日间组住院总费用和西药费分别是（9 629.1±206.8）元和（650.4±54.3）元，亦较住院组住院总费用（11 672.7±1 016.2）元和西药费（779.5±103.9）元明显减少，差异具有统计学意义（P<0.05）。结论 日间手术模式下开展内镜辅助低温等离子腺样体消融术是安全、有效的，与住院手术相比可大大缩短术前等待时间和住院时间，降低住院费用，有助于减少医疗资源的消耗，加快病房运行效率。

关键词:腺样体肥大;日间手术;低温等离子;内镜

Abstract:

Objective To evaluate the feasibility and safety of endoscope-assisted low-temperature plasma adenoidectomy in ambulatory surgery mode.Methods It was retrospectively analyzed for the clinical data of 108 patients with adenoid hypertrophy admitted to the Department of Otolaryngology, Head and Neck Surgery, Foshan First People's Hospital from January 2018 to December 2018. A11 patients were divided into two groups[ambulatory surgery group (n=65) and inpatient surgery group(n=43)]based on their wishes. In ambulatory surgery group, the admission, operation and discharge were completed within 24 hours. It was compared for clinical data about surgery(duration time, bleeding volume), complications(pain, fever, bleeding) and inpatient quality indicators(duration before surgery, inpatient duration, total hospitalization costs and medicine costs) between two groups.Results All 65 patients in the ambulatory surgery group underwent surgery successfully. The operative time of the ambulatory surgery group and the inpatient group were (6.9±2.3) min and (7.5±2.8) min respectively, and the bleeding volume of the ambulatory surgery group and the inpatient group was (5.2±3.6) mL and (5.5±2.4) mL respectively, but there were not statistical significance for the data between the two groups(P>0.05). In the ambulatory surgery group, 3 patients without postoperative bleeding showed postoperative fever, and the average pain index score was (1.6±0.5) points, while in the inpatient group,6 patients without postoperative bleeding showed postoperative fever, and the average pain index score was (2.1±1.1) points, and there was no significant difference for the data between the two groups (P>0.05). The clinical efficacy was 96.9% (63/65) in the ambulatory surgery group and 95.3% (41/43) in the inpatient group respectively, and there was no significant difference for between the two groups (P=0.935). The preoperative waiting time and hospital stay in the ambulatory surgery group were (1.2±0.6) h and (10.5±2.8) h, respectively, which were significantly shorter than those in the inpatient group (21.5±5.8) h and (76.2±12.5) h (P<0.001); In ambulatory surgery group, the total hospitalization costs and medicine costs were(9 629.1±206.8) Yuan and (650.4±54.3) Yuan, which were significantly lower than that in inpatient surgery group(P<0.05).Conclusions In the ambulatory surgery mode, it is safe and effective to perform endoscopy assisted low-temperature plasma adenoidectomy. Compared with inpatient surgery, it can greatly shorten the preoperative waiting time and hospitalization time, reduce the hospitalization cost. It helps to reduce the consumption of medical resources and speed up the operation.

Key words:Adenoid hypertrophy;Ambulatory surgery;Low temperature plasma;Endoscopy