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无论手术指征如何,全腹结肠切除术的短期预后情况相似:来自国家外科质量改进计划的数据。

Total abdominal colectomy has a similar short-term outcome profile regardless of indication: data from the National Surgical Quality Improvement Program.

作者信息

Alves-Ferreira Patricia C, de Campos-Lobato Luiz Felipe, Zutshi Massarat, Hull Tracy, Gurland Brooke

机构信息

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

出版信息

Am Surg. 2011 Dec;77(12):1613-8.

Abstract

The purpose of this study was to evaluate the 30-day postoperative complications rate in patients undergoing elective total abdominal colectomy (TAC) for chronic constipation, neoplastic disorders, and inflammatory bowel disease (IBD) using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP). The 2007 ACS-NSQIP sample was used to identify the Current Procedural Terminology codes for TAC and International Classification of Diseases, 9th Revision codes for chronic constipation, neoplasia, and IBD. Preoperative and intraoperative variables and postoperative complications were compared among the three diagnosis groups. Wilcoxon rank sum and Fisher exact tests were used for analysis. P < 0.05 was considered significant. Seven hundred forty-four patients were identified; chronic constipation was found in 107 (14.4%) patients, neoplasia in 312 (42.3%), and IBD in 322 (43.3%). Patients with constipation were predominantly females (85.2%). The neoplastic group was older and had greater body mass index when compared with the other groups. Patients with IBD presented greater use of steroids, lower albumin and hematocrit levels, and higher morbidity probability. Constipated patients had more neurologic and renal complications when compared with the IBD group (P = 0.01). None of the other categories of complications were statistically different among the diagnosis groups. With the exception of urinary tract infection being higher in the constipation patients compared with IBD (10 vs 4%, P = 0.03), there were no statistically significant differences among the other short-term specific complications. The 30-day complication rate after TAC is similar for chronic constipation, neoplasia, and IBD.

摘要

本研究的目的是利用美国外科医师学会国家质量改进数据库(ACS-NSQIP),评估因慢性便秘、肿瘤性疾病和炎症性肠病(IBD)接受择期全腹结肠切除术(TAC)的患者术后30天并发症发生率。使用2007年ACS-NSQIP样本确定TAC的现行手术操作术语编码以及慢性便秘、肿瘤和IBD的国际疾病分类第九版编码。比较三个诊断组的术前和术中变量以及术后并发症。采用Wilcoxon秩和检验和Fisher精确检验进行分析。P < 0.05被认为具有统计学意义。共识别出744例患者;其中107例(14.4%)为慢性便秘患者,312例(42.3%)为肿瘤患者,322例(43.3%)为IBD患者。便秘患者以女性为主(85.2%)。与其他组相比,肿瘤组患者年龄更大,体重指数更高。IBD患者使用类固醇药物更多,白蛋白和血细胞比容水平更低,发病概率更高。与IBD组相比,便秘患者出现更多神经和肾脏并发症(P = 0.01)。诊断组之间其他类别的并发症在统计学上无差异。除便秘患者的尿路感染发生率高于IBD患者(10%对4%,P = 0.03)外,其他短期特定并发症之间无统计学显著差异。慢性便秘、肿瘤和IBD患者TAC术后30天并发症发生率相似。

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