laparoscopic ileal pouch-anal anastomosis的演变:增强的恢复计划,药物变化和分阶段方法对结果的影响
Tommaso Violante1, Davide Ferrari2, Ibrahim A Gomaa3
1Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States; School of General Surgery, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
概括
增强的恢复计划 (ERP) 减少了囊-门缩 (IPAA) 手术的停留时间,但三阶段的方法显著降低了并发症. 手术前使用类固醇与并发症增加有关.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 最少侵入性的手术
背景情况:
- laparoscopic ileal pouch-anal anastomosis (IPAA) 是恢复性直肠切除术的标准. 这是一个非常好的方法.
- 对于IPAA的外科手术技术的发展是有限的.
- 术后护理已经有显著的进步,包括增强的恢复计划 (ERP),修改的类固醇使用,以及向三阶段方法的转变.
研究的目的:
- 为了评估不断变化的术后护理对腹腔镜IPAA中术后结果的影响.
- 为了比较早期队列 (历史组) 和近期队列 (现代组) 的IPAA患者之间的结果.
主要方法:
- 一个潜在的IPAA数据库的回顾性分析.
- 第100个腹腔镜IPAA病例 (历史) 与最近100个病例 (现代) 的比较.
- 评估操作时间,停留时间 (LOS),30天的发病率和再接收率.
主要成果:
- 现代群体使用三阶段方法的频率更高 (86%),而不是历史群体 (8%).
- 历史组的手术前类固醇 (67%) 和免疫调节剂 (31%) 使用率更高.
- 现代组显示了较短的手术时间 (233.8分钟与335.5分钟) 和LOS (4.2天与5.4天),较低的30天发病率 (20%与33%) 和再入院率 (9%与21%).
- 手术前使用类固醇增加了并发症 (OR,3.4),而三阶段IPAA方法减少了它们 (OR,0.3). 预计ERP预测LOS的时间更短.
结论:
- 增强的恢复计划 (ERP) 减少了停留时间,但并没有减少IPAA手术中的并发症.
- 一个三阶段的IPAA方法与降低的发病率有关.
- 手术前使用类固醇是IPAA后并发症增加的重要危险因素.
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