结肠癌的短暂左侧大肠切除术:这是安全的吗?
Angelos Papanikolaou1, Sophia Y Chen, Shannon N Radomski
1From the Colorectal Research Unit, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Journal of the American College of Surgeons
|November 8, 2023
概括
短暂停留左侧切除术 (≤24小时住院) 是安全的选择结肠癌患者在美国. 这种方法虽然未得到充分利用,但当患者经过仔细选择时,其结果与长期住院结果相似.
科学领域:
- 手术瘤学手术瘤学
- 胃肠道手术 胃肠道手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 手术的进步已经减少了手术后住院时间 (LOS).
- 美国结肠癌患者短期 (≤24小时) 左侧切除术的安全性仍在调查中.
研究的目的:
- 确定结肠癌患者短期左侧大肠切除术的安全性和可行性.
- 为了比较短暂停留大肠切除术与更长时间住院的结果.
主要方法:
- 从美国外科医生学院NSQIP数据库 (2012-2021) 分析了接受选择性左侧切除术的成年结肠癌患者.
- 患者被分为四个LOS组:≤24小时,2-4天,5-6天和≥7天.
- 主要结局:30日术后整体和严重发病率. 二次结果:30天死亡率和再接收. 使用多变量逻辑回归.
主要成果:
- 总共有15,745名患者被分析;1.87% (294) 短暂停留 (≤24小时).
- 短期住院患者更年轻,更健康,30天整体发病率明显降低 (3.74%vs7.38%至37.64%,p<0.001).
- 经过调整后的分析显示,短期住宿和2-4天LOS组之间的整体或严重发病率没有显著差异. 死亡率和再接收率也是可比的.
结论:
- 短暂停留左侧小肠切除术是美国精心挑选的结肠癌患者的安全选择.
- 目前的利用率很低,这表明需要改进患者选择和临床途径优化.
- 进一步的研究和完善的协议可能会增加短期切除术的可行性.
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