Division of General Surgery, Minimally Invasive Surgery Research Group, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Dis Colon Rectum. 2009 Oct;52(10):1746-52. doi: 10.1007/DCR.0b013e3181b55616.
The purpose was to determine if the perioperative benefits associated with laparoscopic colectomies are maintained as operative time increases.
A retrospective review was performed of a database that was prospectively collected from April 1991 to May 2005. Since operative time distributions were different, patients were divided into three groups: laparoscopic right colectomy or ileocecal resection, sigmoid resection, and total abdominal colectomy. The following outcomes were assessed: intraoperative and postoperative complications, days to surgical diet, length of stay, 30-day mortality, and the presence of a learning curve.
Following exclusions, there were 231 right colon and ileocecal resections, 210 sigmoid colectomies, and 46 total abdominal colectomies. With increasing operative time in both right/ileocecal and sigmoid resections, logistic regression demonstrated no significant association between intraoperative and postoperative complications, days to surgical diet, or length of stay. Weight was significantly correlated with increasing operative time in the right/ileocecal and sigmoid resection groups. In the total abdominal colectomy group, significant relationships between increased operative time and postoperative complications (P = 0.04), days to surgical diet (P = 0.02), and hospital stay (P = 0.03) were found. An operative time cut-point was determined in the total abdominal colectomy group. Patients with operative times >270 minutes were more likely to have postoperative complications (P = 0.024), longer ileus (five vs. three median days to surgical diet, P = 0.003), and longer length of stay (seven vs. five days, P = 0.04). This increased risk remained significant after adjusting for weight and diagnosis. No significant learning curve was identified.
Increasing operative time does not appear to adversely affect perioperative outcomes in segmental colectomies. Total abdominal colectomies lasting more than 270 minutes were associated with increased postoperative complications, days to surgical diet, and length of stay.
本研究旨在确定腹腔镜结肠切除术的围手术期获益是否会随着手术时间的延长而持续存在。
对 1991 年 4 月至 2005 年 5 月前瞻性收集的数据库进行回顾性分析。由于手术时间分布不同，患者被分为三组：腹腔镜右半结肠切除术或回盲部切除术、乙状结肠切除术和全腹结肠切除术。评估以下结果：术中及术后并发症、术后开始进普通饮食时间、住院时间、30 天死亡率以及是否存在学习曲线。
排除后，右半结肠和回盲部切除术 231 例，乙状结肠切除术 210 例，全腹结肠切除术 46 例。在右半结肠和乙状结肠切除术的手术时间延长中，logistic 回归显示术中及术后并发症、术后开始进普通饮食时间和住院时间与手术时间无显著相关性。体重与右半结肠和乙状结肠切除术组手术时间的延长显著相关。在全腹结肠切除术组，随着手术时间的增加，术后并发症（P = 0.04）、术后开始进普通饮食时间（P = 0.02）和住院时间（P = 0.03）与手术时间之间存在显著的相关性。在全腹结肠切除术组确定了手术时间的截断点。手术时间>270 分钟的患者术后并发症发生率更高（P = 0.024），肠麻痹时间更长（术后开始进普通饮食时间中位数分别为 5 天和 3 天，P = 0.003），住院时间更长（分别为 7 天和 5 天，P = 0.04）。在调整体重和诊断后，这种风险仍然显著。未发现明显的学习曲线。
在节段性结肠切除术，手术时间的延长似乎不会对围手术期结果产生不利影响。全腹结肠切除术持续时间超过 270 分钟与术后并发症、术后开始进普通饮食时间和住院时间延长有关。
