在食道外科手术中平衡创新和风险:从混合艾沃尔-易斯技术中吸取教训
Giovanni Maria Garbarino1,2, Andrea Pansa2, Lorenzo Giorgi2
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
概括
最少侵入性食道切除术的采用需要平衡创新与患者安全. 逐步整合和监测结果是伦理,以患者为中心的外科进展的关键.
科学领域:
- 手术创新 在外科创新.
- 食道手术 食道手术
- 患者安全 患者安全
背景情况:
- 最少侵入性食道切除术 (MIE) 的采用正在增加,原因是降低并发症等好处.
- 解剖学泄漏率和试验终点的变化引发了人们对MIE过渡期间患者安全的担忧.
- 大批量中心通过开放式或混合式方法取得了优异的结果,促使人们反思MIE采用速度.
研究的目的:
- 讨论过渡到完全MIE的伦理和临床考虑.
- 通过修改的混合Ivor-Lewis技术来分享机构的经验.
- 提出一个框架,以安全地采用外科创新.
主要方法:
- 以后回顾修改的混合艾佛-易斯技术的机构经验.
- 在逐步整合微创手术步骤时对结果的分析.
- 讨论影响创新采用的伦理和临床因素.
主要成果:
- 逐步整合MIE技术可以在学习曲线期间保持术后的结果.
- 机构的表现和主要的临床结果 (解剖体完整性,并发症) 对于指导创新至关重要.
- 结构化的学习途径对于以患者为中心的外科进展至关重要.
结论:
- 采用新手术技术的速度和方法应该以现实世界的结果为指导.
- 在过渡到完全MIE期间,优先考虑患者安全和重大临床影响至关重要.
- 伦理和以患者为中心的考虑必须推动食道手术的进步.
相关概念视频
Esophageal Strictures-II: Clinical Features and Management
804
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
804
Barrett Esophagus-II: Clinical Manifestations and Management
1.3K
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
1.3K
Esophageal Varices-II: Clinical Features and Management
700
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
700
Esophageal Perforation-II: Clinical Manifestations and Management
865
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Clinical Manifestations:
865
Esophageal Varices-I: Introduction
1.8K
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
1.8K
Esophageal Perforation-I: Introduction
687
Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
687


