之前开放腹部手术对开放腹部大动脉修复的影响:来自NSQIP数据库的研究
Laurence Bertrand1, Carlota Fernandez Prendes1, Ryan Melo1
1Department of Vascular Surgery, Ludwig Maximillian University Hospitals, München, Germany.
Annals of vascular surgery
|November 1, 2023
概括
以前的开放腹部手术 (PAS) 并没有显著增加腹部大动脉动脉瘤 (AAA) 开放手术修复 (OSR) 的死亡率或并发症. 然而,PAS与更长的操作时间和缺血性结肠炎率的增加有关.
科学领域:
- 血管外科 血管外科
- 外科手术的结果
- 腹腔大动脉动脉瘤修复 腹腔大动脉动脉瘤修复
背景情况:
- 开放式手术修复 (OSR) 仍然是腹腔大动脉动脉瘤 (AAA) 的关键治疗方法.
- 之前经历过腹部手术 (PAS) 的患者是一个越来越多的亚群,正在接受AAA的OSR.
- PAS对OSR结果的影响还没有得到很好的定义.
研究的目的:
- 为了调查前腹部手术 (PAS) 和接受腹部大动脉动脉瘤 (AAA) 开放性手术修复 (OSR) 的患者的结果之间的关联.
主要方法:
- 使用美国外科医生学院国家外科质量改进计划数据库 (2011-2017) 进行的回顾性队列研究.
- 前腹部手术的患者 (PAS) 和没有 (非PAS) 患者之间的比较结果,接受了AAA的选择性OSR.
- 主要结局:手术后30天死亡率. 二次结果:手术时间,缺血性结肠炎,并发症,停留时间.
主要成果:
- 在2034名患者中,27%的人患有PAS. 在30天死亡率 (4.0%对4.1%) 或整体并发症 (33%对29%) 中没有显著差异.
- PAS与更长的操作时间 (P=0.032) 相关,并使缺血性结肠炎的发病率增加了一倍 (4.7%对2.6%,P=0.02).
- 多变量分析表明,PAS不是死亡率,缺血性结肠炎或更长的操作时间的重要独立风险因素.
结论:
- 前腹部手术 (PAS) 对腹部大动脉动脉瘤 (AAA) 的开放性手术修复 (OSR) 存在一些缺点,包括更长的手术时间和更高的缺血性结肠炎率.
- 尽管有这些趋势,PAS并不是30天死亡率的统计学上显著的独立风险因素.
- 患有PAS史的患者不应排除考虑开放性大动脉腹动脉瘤修复的可能性.
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