皮质类固醇对手术后后果的影响肝胆瘤手术后的后果
Abdullah Altaf1, Selamawit Woldesenbet1, Kathleen Tong1
1Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
Surgery
|December 3, 2025
概括
在外科手术期间使用的皮质类固醇并没有改善肝胆瘤手术患者的结果. 现实数据显示,当天使用皮质类固醇与更糟糕的术后结果有关,包括并发症和死亡率.
科学领域:
- 手术瘤学手术瘤学
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
背景情况:
- 第三阶段试验表明,外科手术期间使用的皮质类固醇可以通过调节炎症反应来改善手术结果.
- 需要现实世界的证据来确认皮质类固醇在主要腹部手术中的有效性.
研究的目的:
- 为了研究外科手术期间使用皮质类固醇对接受肝胆细胞外科手术的患者术后结果的实际有效性.
主要方法:
- 通过使用Epic Cosmos数据库对125,269名接受肝胆瘤手术 (2016-2024) 的患者进行了回顾性分析.
- 暴露:单日使用皮质类固醇 (甲基普雷迪尼索隆或皮质).
- 治疗权重的稳定反向概率 (IPTW) 用于分析与术后并发症,停留时间和90天死亡率的关联.
主要成果:
- 在IPTW调整后,皮质类固醇的使用 (2.2%的患者) 与术后并发症 (OR: 2.16),延长停留时间 (OR: 1.56) 和90天死亡率 (OR: 1.26) 的几率明显增加.
- 亚组分析显示,肝胆道手术后的胆汁泄漏 (OR: 1.15) 或胰腺手术后的胰腺囊 (OR: 1.11) 没有影响.
- 接受皮质类固醇治疗的患者年轻,并发病率较高,并且在非恶性指标下更经常接受开放性肝脏手术.
结论:
- 现实数据表明,当天使用皮质类固醇并没有与肝胆瘤手术后的改善结果相关.
- 在这种情况下,外科手术期间使用皮质类固醇对术后结果产生不利影响.
- 不建议在外科手术前期定期使用皮质类固醇,用于肝胆瘤手术.
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