开放式与微创性脏切除术:来自广泛的国家人口数据库的当代分析
Antonio Franco1,2, Francesco Ditonno1,3, Celeste Manfredi1,4
1Department of Urology, Rush University Medical Center, Chicago, IL, USA.
Annals of surgical oncology
|June 15, 2024
概括
至少侵入性脏切除术 (MINU) 的采用量显著增加,取代了开放性脏切除术 (ONU). MINU与手术后并发症的减少有关,这表明人们正在转向更安全的手术实践.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 微创性脏切除术 (MINU),特别是机器人辅助腹腔镜,在医疗保健中越来越多地被采用.
- 开放性脏切除术 (ONU) 是这种手术的传统方法.
研究的目的:
- 调查美国采用MINU与ONU的当代趋势.
- 为了比较术后并发症率,并分析影响结果的因素,包括健康的社会决定因素 (SDOH).
主要方法:
- 在2011-2021年期间使用全付款人保险索赔数据库对15240名接受ONU或MINU的患者进行了回顾性分析.
- 使用国际疾病分类代码来识别程序,患者特征,SDOH和并发症.
- 使用多变量回归模型来比较结果.
主要成果:
- 在研究期间,MINU的使用率从29%上升到72%,而ONU则下降 (p=0.01).
- 与ONU (23%) 相比,MINU (19%) 的60天术后并发症率较低 (p<0.001).
- ONU与术后并发症的显著更高风险相关 (OR 1.33).
结论:
- 已经证实了国家对联合国取代联合国的MINU的重大转变.
- 最少侵入性的方法与手术并发症的风险降低有关.
- 在这项研究中,健康的社会决定因素 (SDOH) 并没有显著影响管切除术的结果.
相关概念视频
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
842
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
842
01:30Urinary Tract Calculi III: Medical Management
400
The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
400
01:25Urinary Tract Calculi VI: Surgical Management
1.0K
Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
1.0K
01:26Kidney Transplant II: Surgical Procedure
926
Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
926
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
3.5K
IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
3.5K