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对于性结肠炎的 laparoscopic 修复性结肠直肠切除术的影响:系统性审查和元分析
Motoi Uchino1, Hiroki Ikeuchi1, Yuki Horio1
1Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan.
对于性结肠炎 (UC) 的 laparoscopic ileal pouch anal anastomosis (LAP-IPAA) 显示了与开放手术相似的并发症率. 虽然手术需要更长的时间,但LAP-IPAA提供了诸如更快的口服术后摄入等好处.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- 结肠直肠手术 结肠直肠手术
背景情况:
- 腹腔镜手术 (LAP) 是大肠直肠手术的标准.
- 带有阴道袋门解剖术 (IPAA) 的整体直肠切除术是性结肠炎 (UC) 的标准.
- LAP-IPAA可能是复杂的,需要有效性评估.
研究的目的:
- 系统地审查和元分析LAP-IPAA对UC的疗效.
- 评估LAP-IPAA与开放外科手术相比的优缺点.
主要方法:
- 对PubMed/MEDLINE,Cochrane图书馆和日本中央医药局数据库的系统文献审查,直到2023年1月.
- 手术结果的元分析,包括发病率和手术过程.
- 包括9项观察性研究和1项随机对照研究,共707名参与者 (341名LAP,366名OPEN).
主要成果:
- 在LAP和OPEN手术之间,总并发症几率比率 (OR) 没有显著差异 (OR=1.12,p=0.74).
- 死亡率或LAP的死亡率没有显著差异 (OR=0.38,p=0.24).
- LAP-IPAA显示显著更长的操作持续时间 (MD 118.74分钟,p<0.01),但缩短了口服时间 (MD -2.10天,p=0.004).
结论:
- 针对UC的LAP-IPAA显示,患病率与开放性手术相当.
- 在LAP-IPAA中,延长的操作时间被改善的外科视觉和更快的口服摄入等好处所抵消.
- LAP-IPAA为UC治疗提供了一个可行的,潜在的优势,最少侵入性的选择.
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