在急性穿孔椎炎中进行 laparoscopic lavage 和初级切除: SCANDIV 随机临床试验
Johannes Kurt Schultz1, Sheraz Yaqub2, Conny Wallon3
1Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway2Faculty of Medicine, University of Oslo, Oslo, Norway.
JAMA
|October 7, 2015
概括
与结肠切除相比,对穿孔性膜炎进行 laparoscopic 冲洗并没有减少严重的并发症. 这种方法导致重复手术和错过诊断的比率提高, 质疑其在紧急手术中的使用.
科学领域:
- 胃肠病学
- 外科创新
- 临床试验
背景情况:
- 穿孔性结肠膜炎通常需要手术切除,
- laparoscopic 洗已被提议作为一种不那么侵入性的替代方案,
研究的目的:
- 为了比较腹腔镜冲洗与初级结肠切除治疗穿孔膜炎的疗效和安全性.
主要方法:
- 这是一项多中心随机临床试验,涉及199名疑似穿孔性膜炎的患者.
- 参与者被分配到腹腔镜腹膜洗或结肠切除.
- 主要结局是在90天内出现严重的术后并发症 (Clavien- Dindo分数> IIIa).
主要成果:
- 在腹腔镜洗 (30. 7%) 和结肠切除 (26. 0%) 之间,严重的术后并发症没有显著差异.
- 在没有便周周炎的患者中, laparoscopic 洗显示了显著更高的重复手术率 (20. 3% vs 5. 7%).
- 在腹腔镜洗组中,没有发现四种西格瘤.
结论:
- laparoscopic 洗并没有减少穿孔膜炎的严重术后并发症.
- 这种手术与更糟糕的二次结果和错过的恶性瘤有关.
- 结果不支持腹腔镜洗作为穿孔膜炎的首要治疗方法.
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