在右侧结肠切除后何时指示转移?
Richard Sassun1, David W Larson1, Katherine A Bews2
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.
一个新的风险评分有助于识别在右侧切除术后需要结节术的患者. 大多数患者具有低解剖漏 (AL) 风险,这表明转移应该保留给特定的高风险病例.
科学领域:
- 结肠直肠外科手术是什么意思
- 手术成果研究的研究结果.
背景情况:
- 胆管结肠瘤有较低的管泄漏 (AL) 风险,因此对转向循环结肠瘤的决定具有挑战性.
- 鉴定右侧胆管切除术后受益于胆管切除术的患者是困难的,因为AL的发病率很低.
研究的目的:
- 开发和验证对接受选择性右侧切除术的患者进行解剖漏洞 (AL) 风险评分.
- 帮助临床医生决定何时在右侧切除术后考虑转向循环结节术.
主要方法:
- 利用美国外科医生学院国家外科质量改进计划的多中心数据库 (2012-2020年).
- 开发了一个AL风险评分,使用多变量逻辑回归来识别风险因素.
- 评估了对视觉对应和内部有效性的开发得分.
主要成果:
- 分析了42,176名没有转移的右侧切除患者;AL发病率为2.4%.
- 开发的风险计算器显示出出色的校准和公平的歧视.
- 预测和实际的AL率在大多数风险评分分数中显示出强烈的视觉对应.
结论:
- 成功开发了一种内部验证的AL风险评分,用于选择性大眼切除.
- 大多数患者属于AL的低风险类别.
- 转向环结节切除术应保留在选择性右侧切除术后的高风险病例中.
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