在手术室以外的尿路支架:挑战和机遇
Patrick Gordon1,2, Daryl Thompson1,2, Oneel Patel3
1Department of Surgery, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
BJU international
|October 9, 2024
概括
床边泌尿器支架插入是安全有效的,成功率高,并发症低. 与手术室干预相比,这种基于办公室的程序可以大幅节省成本.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 最少侵入性手术的方法
- 卫生经济学 卫生经济学
背景情况:
- 尿道支架插入是一种常见的泌尿器科手术.
- 传统的安置通常发生在手术室 (OT),造成更高的成本和资源利用.
- 评估替代性,不那么侵入性设置对于优化患者护理和医疗保健效率至关重要.
研究的目的:
- 系统地评估在床边或办公室环境中进行尿路支架插入的安全性,有效性,耐受性和成本效益.
- 将这些结果与传统的手术室程序进行比较.
主要方法:
- 一个系统的审查,遵守PRISMA-P和AMSTAR 2指南.
- 从1978年到2023年4月,在主要数据库 (PubMed,EMBASE,Google Scholar,CENTRAL) 进行了全面的文献搜索.
- 包括专注于在手术室之外放置初级泌尿器支架的研究.
主要成果:
- 分析了15项涉及2072个支架的研究.
- 床边/办公室插入的成功率从60%到95.8%不等 (大多数≥80%).
- 报告了低的并发症率 (例如,出血,发烧) 和可控的疼痛水平,患者愿意在局部麻醉下重复手术. 在非OT设置中观察到显著的成本降低 (高达四倍).
结论:
- 床边或办公室的尿路支架插入是OT手术的安全,有效和经济高效的替代方案.
- 这种方法提供了高的成功率和低的发病率,特别有利于资源有限的环境.
- 建议进一步研究标准化疼痛评估和随机试验,以支持更广泛的采用.
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