确定肠道阻塞紧急手术中的多学科内科手术策略及其对结果的影响
Mai-Britt Tolstrup1, Anders Peter Skovsen2, Ismail Gögenur3
1Department of Gastrointestinal Surgery, Copenhagen University Hospital Hilleroed, Dyrehavevej 29, 3400, Hillerød, Denmark. mai-britt.tolstrup@regionh.dk.
Langenbeck's archives of surgery
|April 3, 2024
概括
一个新的跨学科团队 (MDT) 模式用于肠道阻塞手术,通过支持最终的手术和降低静脉形成率,显著降低了30天的死亡率. 腹腔镜手术也增加了,改善了患者的治疗结果.
科学领域:
- 胃肠道手术 胃肠道手术
- 手术瘤学手术瘤学
- 紧急医疗 紧急医疗
背景情况:
- 肠道阻塞是紧急腹腔切除术的常见迹象,往往导致高发病率和死亡率.
- 目前的外科手术方法缺乏标准化,影响患者的治疗结果和资源利用.
- 优化手术内决策对于改善肠道阻塞的外科治疗至关重要.
研究的目的:
- 评估基于多学科团队 (MDT) 的标准化肠道阻塞手术手术模式.
- 为了比较死亡率,腹腔镜干预率和口腔形成率与历史队列.
- 评估是否有可能偏好使用解剖切除而不是造口腔的最终手术.
主要方法:
- 追溯队列研究,包括369名因肠道阻塞而接受紧急手术的患者 (2019年和2021年).
- 实施30分钟和60分钟的MDT休息时间,以指导外科手术策略 (最终,息,伤害控制).
- 与历史队列 (2009-2013) 的结局 (腹腔镜检查,静脉瘤率,30天死亡率) 的比较.
主要成果:
- 77.0%的患者采用了最终的手术策略,30天死亡率为4.6%.
- 息性手术 (22.5%) 的30天死亡率明显高 (21.7%).
- 与历史队列相比,腹腔镜手术从5.0%增加到26.4%,口腔形成从12.0%降至6.1%,30天死亡率从12.9%降至4.6%.
结论:
- 基于MDT的内科手术策略有效指导肠道阻塞的手术干预.
- 这种方法有助于偏好解剖切除而不是口腔形成,改善患者的治疗结果.
- 该模型有助于量身定制术后护理途径,特别是用于息病例.
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