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[腹腔镜检查:门诊及短期住院手术中的潜力与局限]

[Laparoscopy: potential and limitations in outpatient and short-term inpatient surgery].

作者信息

Feussner H

机构信息

Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich.

出版信息

Chirurg. 2004 Mar;75(3):248-56. doi: 10.1007/s00104-003-0806-4.

Abstract

Many laparoscopic operations can usually be performed on an outpatient or at least short-term inpatient basis. Since the postoperative risk is easily estimated and can be determined on the 1st or 2nd postoperative day, it quickly becomes clear whether the healing process will be undisturbed or complications will occur. Prerequisites are comprehensive information to the patient as well as his cooperation and that of his social setting. From a medical standpoint, suitable administrative and infrastructural conditions must be arranged that enable safe, efficient preop preparation and guarantee reliable postoperative care of the patient. The newly begun shift in the German health care delivery system toward outpatient and short-term inpatient treatment must be introduced carefully and step by step, since the resultant reduction in postoperative inpatient care goes hand in hand with reduced patient comfort and without question places a greater burden on the patient's social setting.Clearly, optimal collaboration with local doctors is necessary to accompany this nationwide reduction in hospital stay, and the distribution of responsibility among the various physicians must be clarified. However, independently these elements, the success of outpatient and short-term inpatient laparoscopy still can be guaranteed only by surgeons' high experience and minimal complications.

摘要

许多腹腔镜手术通常可在门诊进行,或至少在短期住院的基础上进行。由于术后风险易于评估,且可在术后第1天或第2天确定,因此很快就能明确愈合过程是否会受到干扰或是否会出现并发症。前提条件是要向患者及其社会环境提供全面信息,以及患者及其社会环境的配合。从医学角度来看,必须安排合适的行政和基础设施条件,以确保安全、高效的术前准备,并保证对患者进行可靠的术后护理。德国医疗保健系统新开始的向门诊和短期住院治疗的转变必须谨慎、逐步地推行,因为术后住院护理的减少会导致患者舒适度降低,而且无疑会给患者的社会环境带来更大负担。显然,要配合全国范围内住院时间的缩短,与当地医生进行最佳协作是必要的,而且必须明确各医生之间的责任分配。然而,抛开这些因素不谈,门诊和短期住院腹腔镜手术的成功仍只能通过外科医生的丰富经验和最少并发症来保证。

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