General Surgery Residency Program, University Hospitals Case Medical Center, Cleveland, Ohio 44106-5047, USA.
Dis Colon Rectum. 2011 Jun;54(6):743-6. doi: 10.1007/DCR.0b013e318217ed17.
Alvimopan, a peripherally acting μ-opioid receptor antagonist, was recently approved for the reduction of postoperative ileus after open colectomy. No data are available regarding the use of alvimopan following laparoscopic segmental colectomy.
This study was designed to evaluate the effectiveness of alvimopan in patients undergoing laparoscopic segmental colectomy.
A retrospective review of segmental laparoscopic colectomy was conducted in a population of patients using an accelerated postcolectomy care pathway. Patients that received alvimopan were identified from an institutional review board-approved database and matched with nonalvimopan patients for age, sex, procedure, and diagnosis. Patients with a diverting ileostomy or with contraindications for alvimopam were excluded.
One hundred patients undergoing laparoscopic colectomy received alvimopan perioperatively and were matched with a similar group of nonalvimopan patients. Although patients on alvimopan were significantly less likely to develop postoperative ileus (4% vs 12%; P = .04), there was no difference in length of hospital stay (3.63 days in the alvimopan group vs 3.78 in the nonalvimopan group; P = .84) or 30-day readmission rate (4.0% vs 4.2%; P = .95).
As the cost of providing health care continues to increase, reductions in perioperative complications and hospital stay are important to hospital efficiency and patient care. Alvimopan effectively reduces the incidence of postoperative ileus in patients undergoing open colectomy; however, hospital stay and readmission rates were not altered in this laparoscopic group. Further study is required before alvimopan can be routinely used in patients undergoing laparoscopic colectomy.
外周作用型 μ 阿片受体拮抗剂阿维莫潘最近被批准用于减少开腹结肠切除术术后肠麻痹。关于阿维莫潘在腹腔镜节段性结肠切除术后的应用尚无数据。
本研究旨在评估阿维莫潘在接受腹腔镜节段性结肠切除术患者中的有效性。
对使用加速术后护理途径的节段性腹腔镜结肠切除术患者进行回顾性研究。从机构审查委员会批准的数据库中确定接受阿维莫潘的患者，并根据年龄、性别、手术和诊断与非阿维莫潘患者进行匹配。排除接受预防性回肠造口术或存在阿维莫潘禁忌证的患者。
100 例接受腹腔镜结肠切除术的患者围手术期接受阿维莫潘治疗，并与一组相似的非阿维莫潘患者进行匹配。尽管接受阿维莫潘的患者发生术后肠麻痹的可能性明显较低（4%对 12%；P =.04），但住院时间（阿维莫潘组为 3.63 天，非阿维莫潘组为 3.78 天；P =.84）或 30 天再入院率（4.0%对 4.2%；P =.95）无差异。
随着医疗保健成本的不断增加，减少围手术期并发症和住院时间对于医院效率和患者护理非常重要。阿维莫潘可有效降低接受开腹结肠切除术患者术后肠麻痹的发生率；然而，在腹腔镜组中并未改变住院时间和再入院率。在阿维莫潘可常规用于接受腹腔镜结肠切除术的患者之前，还需要进一步研究。
