Seetahal Shiva, Obirieze Augustine, Cornwell Edward E, Fullum Terrence, Tran Daniel
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Am J Surg. 2015 Apr;209(4):623-6. doi: 10.1016/j.amjsurg.2014.12.017. Epub 2015 Feb 2.
This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous open abdominal surgery.
Using data from the National Surgical Quality Improvement Program (2005 to 2009), we identified patients who had undergone laparoscopic cholecystectomy, Nissen fundoplication, Heller myotomy, splenectomy, Roux-en-Y, sleeve gastrectomy, gastric band, appendectomy, or colectomy. Patients were then classified as to whether adhesiolysis (AD) was also carried out. Bivariate and multivariate analysis was used to compare groups.
A total of 162,415 patients met our inclusion criteria, comprising 4,501 (3%) in the AD group and 157,913 (97%) in the nonadhesiolysis (NAD) group. Patient who had received lysis of adhesion were older, had 41% higher odds of overall complications, 17% higher adjusted mean lysis of adhesion (P < .001), and 26% higher adjusted mean operation duration (P < .001).
A history of previous open abdominal surgery increases the potential complication rate and hospital length of stay during subsequent laparoscopic surgery. The extent of this relationship deserves further investigation.
本研究旨在调查既往有开腹手术史的患者行腹腔镜手术的结果。
利用国家外科质量改进计划（2005年至2009年）的数据，我们确定了接受腹腔镜胆囊切除术、尼森胃底折叠术、海勒肌切开术、脾切除术、 Roux-en-Y手术、袖状胃切除术、胃束带术、阑尾切除术或结肠切除术的患者。然后根据是否也进行粘连松解术（AD）对患者进行分类。采用双变量和多变量分析比较各组。
共有162,415例患者符合我们的纳入标准，其中粘连松解术组4,501例（3%），非粘连松解术（NAD）组157,913例（97%）。接受粘连松解术的患者年龄较大，总体并发症发生率高41%，粘连松解术调整后平均发生率高17%（P < .001），调整后平均手术时间长26%（P < .001）。
既往有开腹手术史会增加后续腹腔镜手术期间的潜在并发症发生率和住院时间。这种关系的程度值得进一步研究。
