在社区环境中对10年的开放式,腹腔镜和机器人直肠手术进行分析
Laura E Cooper1, Lena Morant2, Maribeth Anderson2
1Department of Surgery, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, United States of America.
Surgery open science
|November 29, 2023
概括
最少侵入性直肠手术,特别是机器人手术,为患者提供更好的短期和长期结果,并且比开放式手术更具成本效益. 这些发现支持在社区医院扩大机器人结直肠手术.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术瘤学手术瘤学
- 最少侵入性的手术
背景情况:
- 结肠直肠癌是美国普遍存在的恶性瘤,往往需要手术干预.
- 虽然微创性结直肠手术在学术中心得到了充分的记录,但其在社区医院的有效性仍未得到充分研究.
- 这项研究探讨了社区环境中微创技术的性能.
研究的目的:
- 评估在社区医院环境中进行的微创手术 (腹腔镜和机器人手术) 与开放性直肠手术的结果.
- 为了比较关键指标,包括血液损失,输血率,恢复时间,瘤结果,停留时间,存活率和成本.
- 评估先进的外科手术技术在非学术中心的可行性和好处.
主要方法:
- 从2010年到2020年,在一所大学附属社区中心接受直肠手术的122名患者的回顾性审查.
- 数据来自该机构的癌症登记数据库.
- 结果的分析包括估计的血液损失 (EBL),输血,首次排便的时间,瘤切除 (R0),淋巴结检索,全腹腔切除 (TME),停留时间 (LOS),存活率和成本.
主要成果:
- 微创手术显示EBL显著降低,输血减少,肠功能恢复更快 (p < 0.003).
- 瘤切除的充分性 (R0,淋巴结检索,TME) 在所有手术方法中都是可比的 (p > 0.48).
- 至少侵入性手术的停留时间要短得多 (4.35天而不是开放式手术的8.48天),腹腔镜手术的平均存活时间最长 (7.19年). 机器人手术是最具成本效益的.
结论:
- 最少侵入性直肠手术,特别是机器人手术,与开放式手术相比,在短期和长期内产生更好的结果.
- 这些技术实现了相当于瘤切除,并提供了更高的成本效益.
- 这些发现支持在社区医院环境中继续采用和扩展机器人结直肠外科手术.
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