结肠直肠患者下肢区间综合征:危险因素和建议的指导方针
Reena S Suresh1, Miloslawa Stem, Ama J Winland
1From the Colorectal Research Unit, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
Journal of the American College of Surgeons
|March 21, 2025
概括
在石切位的结直肠手术中,延长的手术时间增加了下肢隔间综合征 (LLCS) 的风险,这是一个严重的并发症. 外科医生应谨慎使用较长的手术,特别是在年轻的患者中,以防止带切除.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术并发症 手术并发症
- 整形外科手术 整形外科手术
背景情况:
- 下肢区综合征 (LLCS) 是一种罕见但严重的并发症,与结直肠外科手术中长期的石切位定位有关.
- 潜在的机制涉及对肌肉部分的持续压力,导致血液流量减少和随后的再注射损伤.
研究的目的:
- 为了确定结直肠手术后LLCS的发生率.
- 确定与LLCS相关的风险因素,以指导预防策略.
主要方法:
- 从美国外科医生学院NSQIP数据库 (2006-2022) 分析了接受结直肠手术的成年患者.
- 主要结局是手术后隔间综合征,需要带切除;排除包括并发的血管手术或栓塞诊断.
- 使用多变量逻辑回归来评估手术时间和带切除术之间的关联.
主要成果:
- 在773,981名患者中,35人需要在结直肠手术后2天内进行带切割.
- 与非纤维切除组 (162 分钟) 相比,纤维切除组 (388 分钟) 的中位数手术时间明显更长.
- 观察到一个时间-反应关系:超过3-5小时的手术时间增加了3.5倍的断层切割几率,持续时间更长的进一步增加. 年龄较小 (<50岁),ASA类IV-V,以及手术前输血也与断层切除有关.
结论:
- 在结直肠外科手术期间,长时间的手术时间 (>3-5小时) 在断层切割位置是LLCS和随后的断层切割的重要风险因素,特别是在年轻患者中.
- 提高意识和制定常规的手术内下肢评估指南对于早期识别和预防LLCS至关重要.
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