彻底囊切除术前的肠道疗法:对现代队列的分析
Rishabh K Simhal1,2, Connor McPartland1,3, Kerith R Wang1
1Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
概括
在急性囊切除术 (RC) 之前的手术前肠道治疗方案可能会改善接受新膀转移的患者的结果. 目前的ERAS协议不推这些疗法,但这项研究表明,对特定的患者群体有潜在的益处.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 手术后增强恢复 (ERAS) 协议目前不建议在激进囊切除术 (RC) 之前进行手术前的肠道治疗方案 (BR).
- 之前的研究表明,BRs会恶化结果,但经常使用过时的数据,比如微创性RC等手术进步之前.
- 基于尿路转移类型的BRs的影响尚未得到充分研究.
研究的目的:
- 在接受RC的患者中确定手术前BR的结果.
- 根据尿路转移的类型 (状管与新膀) 来分析这些结果.
- 利用现代患者队列来评估当前的外科实践.
主要方法:
- 来自美国外科医生学院国家外科质量改进计划 (NSQIP) 数据库 (2019-2020) 的2054个RC的回顾性分析.
- 根据BR类型对患者进行分类:没有BR,只有机械肠道制备 (MBP),只有口服抗生素BR (OABR),或两者兼而有之.
- 倾向性得分匹配用于控制混因素,比较基线人口统计,30天并发症率和停留时间 (LOS).
主要成果:
- 在2054个RC中,71%没有接受BR,21.3%仅接受MBP,2.4%仅接受OABR,5.3%接受两者.
- 对于状管转移,OABR与增加的LOS有关.
- 对于新膀转移,BRs与更糟糕的结果无关,并且与减少的LOS有关.
结论:
- 手术前的BRs,特别是OABR,可能与接受新膀转移RC的患者的改善结果有关.
- 这些发现表明BR在特定患者群体中的潜在益处,挑战目前的ERAS准则.
- 需要进一步的研究来证实这些关联,并完善术后护理策略.
相关概念视频
Inflammatory Bowel Disease V: Surgical Management
116
Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Here are some common surgical interventions for IBD:
116
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
48
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
48
Appendicitis-II: Diagnostic Studies and Management
64
Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
64
Assessment of the Rectum and Anus
150
Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
150
Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
315
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
315
Endoscopic Procedures II: Colonoscopy
56
The colon, or large intestine, is the final segment of the digestive system. Its primary functions include absorbing water and vitamins produced by gut bacteria and transforming waste from liquid to solid to form stool. In adults, the large intestine is approximately 5 feet long and consists of four main sections:
56


