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胆囊切除术与或没有手术内胆道血管学和常见导管损伤风险之间的关联

Kristin M Sheffield¹, Taylor S Riall, Yimei Han

¹Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, USA.

|August 29, 2013

概括

在胆囊切除术期间的手术内胆道图 (IOC) 并不能显著预防常见管道损伤. 先进的分析表明,IOC不是减少这些手术并发症的有效策略.

科学领域:

胃肠病学胃肠病学
外科手术的结果
医疗设备的有效性医疗设备的有效性

背景情况:

在胆囊切除术期间常规使用手术内胆道图 (IOC) 对于其在预防常见管道损伤方面的有效性进行了辩论.
常见管道损伤是胆囊切除术后的重大并发症,需要进一步调查预防措施.

研究的目的:

为了评估手术内胆道图 (IOC) 使用与胆囊切除术期间常见管道损伤的发生率之间的关联.
为了确定IOC是否在这个手术过程中作为有效的预防策略,防止共同通道受伤.

主要方法:

使用德克萨斯州医疗保险索赔数据 (2000-2009) 对66岁以上接受胆囊切除术的患者进行回顾性队列研究.
采用多级逻辑回归和仪器变量分析来评估IOC和常见通道损伤之间的关系,控制患者,外科医生和医院因素.

主要成果:

在92,932例胆囊切除术中,有40.4%包括IOC,整体常管损伤率为0.30%.
最初的后勤回归显示,没有IOC的伤害几率更高 (OR,1.79),但对混因子进行控制的仪器变量分析没有发现显著的关联 (OR,1.26;P = .31).

结论:

在使用仪器变量分析控制混变量后,手术内胆道图 (IOC) 没有显示出与减少常见管损伤的统计学意义上的关联.
这些发现表明,IOC可能不是在胆囊切除术期间预防常见管道损伤的有效策略.

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