在内镜手术后的Stepfer I和II十二指肠穿孔:手术延迟如何影响结果
Quentin Chenevas-Paule1, Anaïs Palen1, Marc Giovannini2
1Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France.
Surgical endoscopy
|September 16, 2024
概括
对于后内镜十二指甲孔穿孔的及时治疗至关重要. 延迟侵袭性手术超过24小时会增加并发症和死亡率,强调在严重病例中需要及时干预.
科学领域:
- 胃肠病学 胃肠病学
- 外科手术的结果
- 医疗器械安全 医疗器械安全
背景情况:
- 后内镜十二指甲孔穿孔是一种罕见但严重的并发症.
- 与此事件相关的高发病率和死亡率.
- 缺乏明确的管理准则带来了挑战.
研究的目的:
- 调查治疗时间对患者治疗结果的影响.
- 分析与十二指甲孔穿孔治疗时间相关的发病率和死亡率.
- 评估早期干预与延迟干预的有效性.
主要方法:
- 在20年内对78名患者进行了回顾性分析.
- 根据治疗方法对患者进行分类:非手术,早期侵入性或延迟侵入性手术.
- 早期 (<24小时) 和延迟 (>24小时) 侵入性手术之间的并发症率 (Clavien-Dindo ≥3) 和死亡率的比较.
主要成果:
- 61名患者需要进行侵入性手术;40名患者接受了立即干预.
- 延迟的手术 (>24小时) 与更严重的并发症有关 (Clavien-Dindo ≥3).
- 延迟干预导致中位数更高的综合并发症指数和死亡率增加 (14.3%与早期组未指定的).
结论:
- 延迟决策显著复杂化后内镜十二指甲孔穿孔的管理.
- 对于患有不良条件的患者,建议在诊断后24小时内进行迅速的侵入性手术.
- 及时干预对于减少发病率和死亡率至关重要.
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