在跨内内显微手术期间腹膜开口:术前定位评估可以改善手术期间的管理吗?
Alberto Arezzo1, Carlo Alberto Ammirati2, Giovanni Distefano2
1Department of Surgical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy. alberto.arezzo@unito.it.
Surgical endoscopy
|February 4, 2026
概括
经内显微手术 (TEM) 期间的腹膜开口 (PO) 不常见,但与增加腹部转换和更长的住院时间有关. 仔细的手术规划,考虑到病变的特征和患者的位置,可以减轻风险.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 最少侵入性手术的方法
- 手术并发症 手术并发症
背景情况:
- 经内显微手术 (TEM) 期间的腹膜开口 (PO) 可能导致肺直肠崩和手术并发症.
- 由于TEM越来越多地用于更大,更接近直肠病变,了解PO至关重要.
研究的目的:
- 确定经内显微手术 (TEM) 期间腹开口 (PO) 的频率,预测因素和后果.
- 评估患者定位对PO和相关结果的影响.
主要方法:
- 对1077个TEM/TEO切除术的前性维护的单中心数据库的分析.
- 多变量后勤回归用于识别PO的预测因素,包括损伤距离,直径,切割平面和位置.
- 在PO和没有PO的患者之间比较结果 (腹部转换,并发症,停留时间),并分析位置效应.
主要成果:
- 在7.5%的TEM/TEO切除中发生了腹开口 (PO).
- 预测PO的因素包括从门边缘更远的距离,更大的病变直径,全厚切除和周围位置;后部位置是保护性的.
- PO与增加的腹部转换率 (6.2%与0.1%) 和更长的停留时间 (5与4天) 相关,但并发症并没有显著增加.
- 卧卧的PO更常见 (11.1%) 与卧卧的PO相比 (3.7%),但卧卧的PO组内的转换率更高.
结论:
- 在TEM/TEO期间腹膜开口 (PO) 是不常见的,主要是由解剖学因素驱动的.
- 安全的内膜修复通常是有效的管理PO.
- 优化手术规划 (损伤特征,位置) 可以降低PO风险而不会增加短期发病率.
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