结肠癌手术的最小侵入性方法对功能限制患者的结果的影响
Mario Schootman1,2, Jun Ying3, Chenghui Li2,4
1Institute for Community Health and Innovation, Department of Internal Medicine, College of Medicine, The University of Arkansas for Medical Sciences, Springdale, AR, USA.
在功能依赖的结肠癌患者中,微创手术显著降低了30天的死亡率. 在这个弱势群体中优化MIS使用对于改善手术结果和降低死亡率至关重要.
科学领域:
- 大肠直肠手术
- 外科瘤学
- 医疗服务研究
背景情况:
- 与独立患者相比,功能依赖患者在结肠癌手术后的结果更差.
- 至少侵入性手术 (MIS) 越来越多地用于结肠癌切除,但它对功能依赖患者的影响需要进一步调查.
研究的目的:
- 评估微创手术 (MIS) 与开放手术对接受结肠癌切除的功能依赖患者的结果的影响.
- 评估外科手术对出院目的地,30天再入院和30天死亡率的影响.
主要方法:
- 美国外科医生学院2012-2020年国家外科质量改进计划数据的分析.
- 根据功能依赖 (独立或部分/完全依赖) 分类,包括因结肠癌而经过切除术的患者.
- 后勤回归和反事实建模来比较MIS和开放手术方法之间的结果.
主要成果:
- 功能依赖患者 (115897人中有2. 7%) 与整体队列患者 (64. 5%) 相比,接受MIS的可能性较低.
- 在功能依赖患者中,MIS和开放手术之间没有观察到释放目的地或再入院率的显著差异.
- 与功能依赖患者的开放手术相比,反事实分析预测MIS的30天死亡率相对降低了27. 3%.
结论:
- 对于接受结肠癌切除的功能依赖患者来说,轻微侵入性手术 (MIS) 具有显著的生存益处.
- 为改善结肠癌手术的结果,优先考虑功能受限患者的MIS.
- 进一步的研究应侧重于在弱势患者群体中增加MIS的策略.
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