紧急与选择性手术修复大副食道:一个匹配的病例对照研究
Enrique Biel1, Carlos Manterola2, Sofia Jaume-Bottcher3
1Section of Gastrointestinal Surgery, Department of Surgery, Hospital del Mar, Hospital del Mar Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Section of Gastrointestinal Surgery, Department of Surgery, Universidad de Concepción, Concepción, Chile.
概括
与急性胃卷发 (AGV) 相关的大型副食道 (PEH) 的紧急修复导致术后并发症比选择性手术更多. 然而,在紧急和可选PEH修复之间,30天死亡率和再入院率仍然相似.
科学领域:
- 胃肠病学 胃肠病学
- 手术创新 在外科创新.
- Hernia 修复 椎间板裂的修复
背景情况:
- 大型III/IV型食管 (PEH) 修复复杂,特别是急性胃卷发 (AGV).
- 对于这些情况,紧急的手术修复与选择性修复需要仔细考虑结果.
研究的目的:
- 为了比较大型III/IV型PEH的紧急和选择性修复之间的术后并发症 (POC) 和30天死亡率.
- 评估紧急手术干预对患者结果的影响.
主要方法:
- 在2007年至2024年期间,对74名接受PEH修复的患者进行了匹配的病例控制研究 (1:1).
- 案例:需要紧急/半选择性维修的AGV. 控制:计划进行可选维修的III/IV型PEH.
- 主要结局:术后并发症 (POC).
主要成果:
- 紧急PEH修复病例的手术持续时间更长,住院时间增加,开放或转换手术的比例更高 (OR,8.4;P=.008).
- 紧急手术独立预测了更高的POC (OR,7.4;P=.0001).
- 重复手术率,90天再入院率和复发率相似;死亡率低且可比.
结论:
- 复杂PEH的紧急修复,特别是AGV,与选择性手术相比,与术后并发症的增加有关.
- 尽管并发症率较高,但紧急PEH修复的30天死亡率和再入院率与选择性手术相似.
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