预测消化系统手术后吻合口漏及其预后。
Prediction of anastomotic leak and its prognosis in digestive surgery.
机构信息
Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto, 8600008, Japan.
出版信息
World J Surg. 2011 Apr;35(4):716-22. doi: 10.1007/s00268-010-0922-5.
BACKGROUND
Anastomotic leak (AL) is a dangerous postoperative complication in gastrointestinal surgery. The present study focuses on whether our prediction scoring system, "Estimation of Physiologic Ability and Surgical Stress" (E-PASS), could predict occurrence of AL and its prognosis in various kinds of gastrointestinal surgical procedures.
METHODS
We prospectively investigated parameters of E-PASS, absence or presence of AL, and in-hospital mortality in 6,005 patients who underwent elective digestive surgery with alimentary tract reconstruction in 45 acute care hospitals in Japan between 1 April 2002 and 31 March 2007.
RESULTS
Incidences of AL were 19.6% for esophagectomy via right thoracotomy and laparotomy, 11.7% for pancreaticoduodenectomy, 7.4% for low anterior resection, 4.0% for total gastrectomy, 1.8% for open distal gastrectomy, 1.3% for open colectomy, for an overall incidence of 4.1%. The incidence in each procedure significantly correlated with median value of surgical stress score of the E-PASS (R = 0.78, n = 11, p = 0.0048). The incidences of AL increased when Total Risk Points (TRP) of the E-PASS increased; 1.1% at the TRP range of <500, 2.8% at 500 to <1,000, 4.8% at 1,000 to <1,500, and 13.6% at ≥ 1,500 (p < 0.0001). In patients who suffered from AL, an in-hospital mortality rate at TRP < 1,000 was significantly lower than that at TRP of ≥ 1,000 (1.1 vs. 15.9%; p = 0.00019).
CONCLUSIONS
The E-PASS, requiring only nine variables, may be useful in predicting AL and its prognosis.
背景
吻合口漏（AL）是胃肠外科术后一种危险的并发症。本研究旨在探讨我们的预测评分系统“生理能力和手术应激估计（E-PASS）”是否可用于预测各种胃肠外科手术中 AL 的发生及其预后。
方法
我们前瞻性调查了日本 45 家急性护理医院的 6005 例行择期消化道手术并重建消化道的患者的 E-PASS 参数、AL 有无及院内死亡率，研究时间为 2002 年 4 月 1 日至 2007 年 3 月 31 日。
结果
右胸和剖腹食管切除术、胰十二指肠切除术、低位前切除术、全胃切除术、开腹远端胃切除术、开腹结肠切除术的 AL 发生率分别为 19.6%、11.7%、7.4%、4.0%、1.8%、1.3%，总体发生率为 4.1%。各手术的 AL 发生率与 E-PASS 手术应激评分的中位数显著相关（R = 0.78，n = 11，p = 0.0048）。当 E-PASS 的总风险点数（TRP）增加时，AL 的发生率也随之增加；TRP 范围 <500 时发生率为 1.1%，500-1000 时为 2.8%，1000-1500 时为 4.8%，≥1500 时为 13.6%（p < 0.0001）。在发生 AL 的患者中，TRP <1000 的院内死亡率明显低于 TRP ≥1000 的患者（1.1% vs. 15.9%；p = 0.00019）。
结论
E-PASS 仅需 9 个变量，可用于预测 AL 及其预后。
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