在TME后针对直肠癌的定制的胃口政策:TASTY方法
Lara Boissieras1, Deena Harji2, Bertrand Celerier1
1Colorectal Surgery, CHU Bordeaux, Bordeaux, France.
概括
在直肠癌手术后转移口腔的量身定制方法是可行的和安全的. 这种选择性策略通过根据个体患者口泄漏风险来个性化口腔使用来减少并发症.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 在瘤学瘤学.
- 手术创新 在外科创新.
背景情况:
- 对于直肠癌,转向性口腔是全腹腔切除术 (TME) 后的标准,以防止静脉口腔泄漏 (AL).
- 常规使用口腔支架具有其自身的风险,并且可能不对所有患者都是必要的.
- 一个个性化的,基于风险的方法来使用口腔支架可以优化结果.
研究的目的:
- 设计和试验定制的胃口政策 (TASTY) 方法,用于选择性胃口在下直肠癌手术中的使用.
- 为了验证风险分层的解剖器失败观察风险得分 (AFORS).
- 为了确定最佳的C-反应蛋白 (CRP) 值,用于早期闭口.
主要方法:
- 使用80名接受TME的患者队列对AFORS得分的外部验证.
- 计算尤登指数以确定AL预测的CRP切断值.
- 对122名因直肠癌而接受TME的患者进行TASTY方法的前性试点研究.
主要成果:
- AFORS评分显示预测和观察到的AL率 (17.5%观察到AL) 之间存在正相关性.
- 术后第二天的CRP截止值为115mg/L预测了AL,敏感度为86%,预测值为96%负.
- 在TASTY方法中,患者被分为低风险 (10%的AL) 和高风险 (23%的AL) 组,在没有胃口的队列中具有相应的发病率和较低的主要前部切除综合征 (LARS).
结论:
- "TASTY"方法证明了在直肠癌手术中选择性静脉口腔使用的可行性和安全性.
- 使用AFORS和CRP进行个性化风险评估可以指导口腔管道的管理.
- 选择性静脉口腔使用可能会降低低风险患者LARS发病率.
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