与微创性结肠直肠手术相关的延长手术时间的影响:手术护理结果评估计划的报告
Kenley R Unruh1, Amir L Bastawrous2, Shalini Kanneganti3
1Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington.
Diseases of the colon and rectum
|October 25, 2023
概括
在结直肠外科手术中,延长的手术时间与更长的住院时间和更多的并发症有关. 然而,微创方法可以减轻这些负面影响,改善患者的治疗结果.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 最少侵入性的手术
背景情况:
- 在结直肠外科手术中,增加的手术时间与较差的结果相关.
- laparoscopic 和机器人方法显示,尽管操作时间更长,但结果有所改善.
- 对于长时间的操作时间缺乏一致的定义.
研究的目的:
- 在各种结肠直肠手术和外科手术方法中建立长期手术时间的定义.
- 调查延长的手术时间对住院时间和短期患者结果的影响.
主要方法:
- 从2011年到2019年,由42家医院的23098名成年患者参与的回顾性队列研究.
- 分析了六项常见的选择性结肠直肠手术:右侧切除术,左侧/双面切除术,全切除术,前侧下切除术,IPAA和腹腔关切除术.
- 延长的手术时间被定义为每个程序和方法的第75个百分位;结果包括停留时间,出院目的地和并发症,并使用调整的模型.
主要成果:
- 延长的手术时间与更长的中位数停留时间 (5-7天 vs. 3-5天) 和更高的并发症率 (13-42% vs. 17-28%) 在开放式,腹腔镜和机器人方法中有关.
- 在所有方法 (93-96%) 中,在所有操作时间层中,排放家庭费率保持相似.
- 超过中位数的每一个额外的手术时间增加了1.07-1.08的较长停留时间的相对风险,在最小侵入性手术中效果降低.
结论:
- 长时间的手术时间始终与停留时间的延长和结直肠手术中的并发症有关.
- 最少侵入性方法 (腹腔镜和机器人) 似乎可以减少长时间手术对结果的负面影响.
- 由于研究的局限性,包括其回顾性质,潜在的选择偏差和混因素,需要进一步的研究.
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