从开放性转向全面的安全过渡 癌症的最小侵入性食道切除术利用过程管理方法学
Milos Bjelovic1,2, Dragan Gunjic1, Tamara Babic3
1Euromedic General Hospital, Bulevar umetnosti 29, 11070 Belgrade, Serbia.
Journal of clinical medicine
|August 10, 2024
概括
对于食道癌,过渡到全身微创食道切除术 (tMIE) 是安全的. 使用混合的最小侵入性食道切除术 (hMIE) 作为中间步骤,可以实现与开放性食道切除术 (OE) 相似的结果,而不会影响患者的安全.
科学领域:
- 手术瘤学手术瘤学
- 最少侵入性的手术
- 医疗保健中的流程管理
背景情况:
- 全球转向对食道癌的微创食道切除术 (MIE).
- 从混合MIE (hMIE) 过渡到总MIE (tMIE) 存在挑战,包括对泄漏和淋巴结产量的担忧.
- 过程管理方法可以促进从开放性食道切除术 (OE) 到tMIE的安全过渡.
研究的目的:
- 为了证明从开放性食道切除术 (OE) 过渡到全身微创食道切除术 (tMIE) 对食道癌的安全性和可行性.
- 评估混合微创食道切除术 (hMIE) 作为这一过渡过程中的中间步骤的有效性.
- 应用流程管理方法,以确保tMIE的安全学习曲线.
主要方法:
- 单中心病例对照研究,涉及150名因癌症接受艾弗·易斯食道切除术的患者.
- 三组:开放性食道切除术 (OE,n=50),混合性MIE (hMIE,n=50) 和总MIE (tMIE,n=50). 这三组的治疗方法是:
- 在过渡阶段实施了预先培训和治疗结果的持续监测.
主要成果:
- 与OE和hMIE相比,tMIE组在操作持续时间,整体并发症,静脉泄漏,30天死亡率和瘤结果 (R状态,2年生存期) 方面没有显著差异.
- tMIE在减少重大术后肺部并发症和重症监护室 (ICU) 停留时间方面表现出卓越的结果.
- 使用hMIE作为中间体的过渡过程被证明是安全和有效的.
结论:
- 从OE过渡到tMIE,以hMIE作为中间步骤,是安全的和可行的.
- 管理方法和外科实践有助于顺利过渡,而不会影响患者的结果.
- 这种方法支持在食道癌症治疗中采用tMIE.
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