Laparoskopik nefrektomide spesmen çıkarma yönteminin hasta memnuniyetine etkisi

Yıl 2020, Cilt: 12 Sayı: 2, 122 - 128, 23.07.2020

Serkan Doğan , Bülent Çelik Mehmet Yılmaz

Öz

Amaç: Bu çalışma laparoskopik nefrektomi sonrası spersmen çıkan bölgedeki ağrı, yaşam kalitesi ve hasta memnuniyeti değerlendirildi.

Gereç ve Yöntemler: Kliniğimizde 2016-2017 yılları arasında laparoskopik nefrektomi yapılan 52 hasta çalışmaya dahil edildi. Hastaların demografik ve cerrahi özellikleri kaydedildi. Hastalar spesmen çıkarımında kullanılan insizyona göre üç grupta değerlendirildi: port yeri genişletilenler (n= 26), Gibson (n = 10) ve Pfannenstiel (n = 16) insizyonları. Gruplar görsel analog skala ile ölçülen postoperatif ağrı skorları, komplikasyonlar ve yaşam kalitesi skalasına göre ölçülen hasta memnuniyeti açısından karşılaştırıldı.

Bulgular: EPS, Gibson ve Pfannenstiel gruplarında 3. saat VAS ortalaması sırasıyla 2.46 ± 2.06, 4.70 ± 2.90 ve 2.50 ± 2.47 idi. EPS, Gibson ve Pfannenstiel gruplarının ortalama 9. saat VAS ortalamaları sırasıyla 2.53 ± 2.06, 2.80 ± 2.97 ve 2.50 ± 2.12 idi. EPS, Gibson ve Pfannenstiel grupları için 72 saatlik VAS ortalamaları sırasıyla 0.53 ± 0.76, 1.60 ± 1.95 ve 1.18 ± 1.51 idi. 3, 9, 24 ve 72. saatlerde ortalama toplam VAS sırasıyla 2.90 ± 2.40, 2.57 ± 2.23, 1.94 ± 2.13 ve 0.94 ± 1.34 idi. Cerrahi örnek çıkarım yöntemleri arasında ağrı ve hasta memnuniyeti açısından anlamlı fark yoktu (p> 0.05). Kullanılan CO2 hacmi veya insizyon uzunluğu (145.5 ± 84.7, 124.3 ± 47.6, 135.7 ± 75.2L) (3.2 ± 1.72, 7.3 ± 2.49, 7.78 ± 1.26cm) gibi ameliyatla ilgili sonuçlara göre yöntemler arasında anlamlı bir fark yoktu. (p> 0.05). Hastanede yatış süresinde anlamlı fark yoktu (4.0 ± 2.26, 6.2 ± 4.34, 4.12 ± 1.62days) (p> 0.05). Pearson korelasyon testine göre, ameliyat sonrası ağrıyı etkileyen tek önemli faktör uzamış operasyon idi (p = 0.039).

Sonuç: Farklı örnek çıkarım yöntemleri morbiditeyi değiştirmez. Spesmen çıkarım yönteminden bağımsız olarak hasta memnuniyeti yüksektir.

Anahtar Kelimeler

Laparoskopi, nefrektomi, ağrı

The effect of specimen extraction site on patient satisfaction in laparoscopic nephrectomy

Öz

Introduction: This study aimed to evaluate the patient satisfaction and postoperative pain in location of specimen extraction as well as quality of life following surgery.

Material and Methods:A total of 52 patients who underwent laparoscopic nephrectomy in our clinic between 2016 and 2017 were included in the study.Demographic and surgical characteristics were documented.Patients were evaluated in three groups according to incision used for specimen extraction:expanded port site(n=26),Gibson(n=10) and Pfannenstiel(n=16) incisions;patients were analyzed in terms of postoperative pain scores measured by visual analogue scale, complications and patient satisfaction measured by quality of life scale.

Results: The mean of the 3rd hour VAS for EPS, Gibson and Pfannenstiel groups were 2.46±2.06, 4.70±2.90 and 2.50±2.47,respectively. The mean 9th hour VAS averages for EPS, Gibson and Pfannenstiel groups were 2.53±2.06, 2.80±2.97 and 2.50±2.12, respectively. For EPS, Gibson and Pfannenstiel groups, 72-hour VAS averages were 0.53±0.76, 1.60±1.95 and 1.18±1.51, respectively. The mean total VAS at the 3rd, 9th, 24th and 72th hours were 2.90±2.40, 2.57±2.23, 1.94±2.13 and 0.94±1.34,respectively. There was no significant difference in surgical specimen extraction in terms of pain and patient satisfaction(p>0.05). There was no significant difference between the methods according to surgery-related results such as used CO2 volume or incision length(145.5±84.7, 124.3±47.6, 135.7±75.2L) (3.2±1.72, 7.3±2.49, 7.78±1.26cm)(p>0.05). There was no significant difference in hospitalization time(4.0±2.26, 6.2±4.34, 4.12±1.62days)(p>0.05). According to the Pearson correlation test, prolonged operation was the only important factor affecting post-operative pain(p=0.039).

Conclusion: Different specimen extraction methods do not alter morbidity. Patient satisfaction is high, independent from specimen extraction method.

Anahtar Kelimeler

Laparoscopy, nephrectomy, pain

Kaynakça

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