Kingsnorth A N, Bowley D M G, Porter C
Department of Surgery, Plymouth Postgraduate Medical School, Derriford Hospital, Plymouth, UK.
Ann R Coll Surg Engl. 2003 Jan;85(1):18-22. doi: 10.1308/003588403321001363.
A hernia service within a general hospital was prospectively evaluated to establish whether evidence-based protocols could deliver results comparable to those reported from specialist hernia clinics.
Protocols were devised according to established models. With the support of a nurse specialist, 1015 patients with inguinal hernia were treated. Quality-of-life analysis was undertaken using the Short Form 36.
Patients ranged in age from 16-98 years (median, 56 years). Ambulatory day-case surgery was achieved in 820 patients (81%), with local anaesthesia in 891 (88%). Wound infection occurred in 10 patients (0.98%). Wound haematoma requiring surgical intervention occurred in three patients. Two patients formed wound seromas that settled spontaneously. One patient developed ischaemic orchitis resulting in testicular atrophy. At 5 days after operation, 91% of patients had returned to normal activity. At 1 year, 7 patients (0.7%) had pain sufficient to limit normal activity or employment. There were 8 recurrences (0.78%) at a median follow-up of 2.5 years. Quality-of-life was enhanced at 1 year postoperatively.
A protocol-driven hernia service within a general hospital can provide patient outcomes comparable to specialist hernia clinics.
对一家综合医院的疝气治疗服务进行前瞻性评估,以确定循证方案是否能取得与专科疝气诊所报告的结果相当的成效。
根据既定模式制定方案。在一名专科护士的支持下,对1015例腹股沟疝患者进行了治疗。使用简短健康调查问卷36项版本进行生活质量分析。
患者年龄在16至98岁之间(中位数为56岁)。820例患者(81%)实现了日间门诊手术,891例(88%)采用了局部麻醉。10例患者(0.98%)发生伤口感染。3例患者出现需要手术干预的伤口血肿。2例患者形成了可自行消退的伤口血清肿。1例患者发生缺血性睾丸炎,导致睾丸萎缩。术后5天,91%的患者恢复了正常活动。1年时,7例患者(0.7%)疼痛严重,足以限制正常活动或工作。在中位随访2.5年时出现8例复发(0.78%)。术后1年生活质量得到改善。
综合医院中由方案驱动的疝气治疗服务能够提供与专科疝气诊所相当的患者治疗结果。