第三次是神奇的? 重复重复IPAA的指示和结果
Marianna Maspero1, Olga Lavryk, Stefan D Holubar
1Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Diseases of the colon and rectum
|February 16, 2024
概括
第二次重复膜囊-门解剖 (IPAA) 程序可以为选择的,高动机的患者提供可接受的结果,这些患者寻求保持肠道连续性,尽管失败率为30%,主要是由于败血症.
科学领域:
- 外科胃肠道外科手术
- 炎症性肠道疾病管理管理
- 骨盆重建手术 骨盆重建手术
背景情况:
- 囊-门解剖手术 (IPAA) 的失败率很高,高达40%的病例导致囊失败.
- 为了保持肠道连续性,提供第二次重复IPAA的决定是有争议的,因为结果不确定.
研究的目的:
- 评估第二次重复IPAA程序的机构经验和结果.
- 为了比较患者报告的结果和第一个和第二个重复IPAA程序之间的囊存活率.
主要方法:
- 在2004年至2021年期间,在第三级转诊中心对接受第二次重复IPAA的患者进行了回顾性审查.
- 倾向性得分匹配用于比较经过第一和第二次重复手术的患者之间的结果.
- 包存活率和患者报告的结果 (克利夫兰全球生活质量调查) 是主要的终点.
主要成果:
- 23名患者接受了第二次重复IPAA;35%最终被诊断为克罗恩病.
- 囊中失效发生在30%的病例中,主要是由于败血症并发症,囊中3年生存率为76%.
- 在第一次和第二次重复手术之间,生活质量和功能结果是可比的,第二个重复手术组的失禁率更高.
结论:
- 第二次重复IPAA程序可以提供给精心挑选的,高度动机的患者,可接受的结果.
- 败血症并发症是第二次重复IPAA中袋子失效的主要驱动因素.
- 虽然总体结果是可比的,但在第二次重复IPAA的决策过程中,应考虑增加的失禁.
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