逐步实施机器人技术和经过认证的增强恢复计划显著改善了肝脏手术部门的多个结果指标
Florian Primavesi1, Iveta Urban2, Daniela Rappold3
1Department of General and Visceral Surgery, Ordensklinikum Linz, Linz, Austria; Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum Vöcklabruck, Austria.
概括
最少侵入性手术 (MIS) 和手术后增强恢复 (ERAS®) 计划显著改善了肝癌手术的结果. 结合实施减少并发症,停留时间,并改善患者的康复.
科学领域:
- 肝胆道手术 肝胆道手术
- 手术瘤学手术瘤学
- 最少侵入性的技术
背景情况:
- 众所周知,微创手术 (MIS) 和手术后增强恢复 (ERAS®) 计划可以改善癌症患者的治疗结果.
- MIS和ERAS®对肝脏手术队伍的综合影响尚未得到充分证实.
研究的目的:
- 评估机器人辅助手术 (RAS) 和ERAS®认证逐步实施对肝脏手术结果的影响.
- 为了比较三个时期的结果:RAS前/ERAS®前,RAS/ERAS®类似,RAS/ERAS®.
主要方法:
- 一个单一中心的队列研究,涉及225名肝脏手术患者.
- 在三个17个月期间收集的数据,比较了MIS和ERAS®实施的不同阶段.
- 关键结局包括停留时间 (LOS),重症监护室LOS (ICU-LOS),90天的发病率和死亡率,肝切除术后的肝功能衰竭 (PHLF),出血 (PHH),胆汁泄漏 (BL),以及肝脏手术后的教科书结局 (TOLS).
主要成果:
- 在不同时期,MIS (包括RAS) 的采用率显著增加 (31.1%至77.3%).
- 转换为开放手术的病例减少,中位数的血液损失显著减少 (400毫升至200毫升).
- 中位数LOS/ICU-LOS下降 (9/3天降至5/1天),90天发病率降低 (54.1%至35.2%). PHLF从13.1%下降到5.7%,TOLS的利率从37.9%提高到70.8%.
结论:
- 在肝脏外科手术中逐步实施MIS/RAS和ERAS®可显著减少血液损失,LOS,发病率和PHLF.
- 这种综合方法在瘤性肝脏手术指示中大幅增加了TOLS率.
- MIS被确定为较低发病率和LOS的独立预测因素.
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