三阶段与性结肠炎修改的两阶段手术:以患者为中心的治疗权衡研究
Mei Lucy Yang1, Mantaj S Brar1, Erin Kennedy1
1Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
概括
经过阴道囊-门解剖的患者接受了5%更高的解剖口腔泄漏或囊失败的风险,以避免暂时转移阴道口腔. 这种偏好影响了治疗性结肠炎的手术方法决定.
科学领域:
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
- 患者报告的结果
背景情况:
- 关于在囊-门解剖 (IPAA) 施工过程中需要暂时转移 (结节) 的必要性存在争议.
- 结节切除术可能会降低门泄漏 (AL) 的风险,但会引发并发症,急救诊所访问和再入院.
- 了解患者的偏好对于平衡AL/囊功能衰竭 (PF) 风险与结节切开术并发症至关重要.
研究的目的:
- 量化患者接受增加AL和PF风险的意愿,以避免转向性骨干切开.
- 评估患者对IPAA手术策略的偏好 (修改的两阶段与传统的三阶段).
- 在IPAA手术中为临床决策提供信息.
主要方法:
- 在52名性结肠炎患者中,采用了治疗权衡值技术.
- 通过标准化采访和匿名在线调查,收集了患者的人口统计数据和风险承受能力.
- 这项研究测量了AL和PF患者接受放弃转向性结节切开术的绝对增加风险.
主要成果:
- 患者接受AL风险绝对增加5% (IQR为4.5%-15%) 以避免转向性骨干切开.
- 患者还接受了PF风险的绝对增加5% (IQR2.5%-10%),以避免转向性结肠切除术.
- 较年轻的患者 (21-29岁) 对PF的耐受性较低,与老年患者相比只接受了2%的增加 (P=0.01).
结论:
- 患者优先考虑避免暂时的结节切开,接受5%更高的AL或PF风险.
- 这些患者驱动的风险公差应指导在修改的两阶段和传统的三阶段IPAA程序之间做出选择.
- 纳入患者偏好可以提高IPAA性结肠炎手术的共享决策.
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