Smith Alison, Cacchione Robert, Miller Ed, McElmurray Lindsay, Allen Robert, Stocker Abigail, Abell Thomas L, Hughes Michael G
Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA.
Am Surg. 2016 Apr;82(4):337-42.
We compared outcomes for two gastric electrical stimulation placement strategies, minilaparotomy with adjunctive care (MLAC) versus laparoscopy without adjunctive care (LAPA). For electrode placement, the peritoneal cavity was accessed with either a single 2.5 to 3.0 cm midline incision (MLAC) or three trocar incisions (LAPA). For both groups, generator was placed subcutaneously over the anterior rectus sheath. For MLAC, adjunctive pain control measures were used for placement of both electrode and generator (transversus abdominus plane block). For LAPA, those that could not be completed by laparoscopy were converted to traditional open approach and kept in the analysis. MLAC (n = 128) resulted in shorter operative times than LAPA (n = 37) (median operative time: 87.5 vs 137.0 minutes, P ≤ 0.01). Hospital length of stay was also shorter for MLAC than for LAPA (median: 2.0 vs 3.0 days, P ≤ 0.01) without any increase in readmission rates to the hospital within 30 days of discharge (11.0 vs 16.2%, P = 0.39). After equalizing learning curves, these differences were even greater (median operative time: 84.5 vs 137.0 minutes, P < 0.01; median length of stay: 1.0 vs 3.0 days; P < 0.01) without increasing 30-day readmission rates (9.1 vs 16.2%, P = 0.25). For implantation of gastric electrical stimulators, minilaparotomy can result in improved outcomes when coupled with adjunctive pain control measures.
我们比较了两种胃电刺激放置策略的结果，即小切口剖腹术加辅助护理（MLAC）与无辅助护理的腹腔镜检查（LAPA）。对于电极放置，通过一个2.5至3.0厘米的中线切口（MLAC）或三个套管针切口（LAPA）进入腹腔。对于两组，发生器均皮下放置在前直肌鞘上方。对于MLAC，在放置电极和发生器时均采用辅助疼痛控制措施（腹横肌平面阻滞）。对于LAPA，那些无法通过腹腔镜完成的手术则转为传统开放手术并纳入分析。MLAC组（n = 128）的手术时间比LAPA组（n = 37）短（中位手术时间：87.5分钟对137.0分钟，P≤0.01）。MLAC组的住院时间也比LAPA组短（中位时间：2.0天对3.0天，P≤0.01），且出院后30天内的再入院率没有增加（11.0%对16.2%，P = 0.39）。在均衡学习曲线后，这些差异更大（中位手术时间：84.5分钟对137.0分钟，P < 0.01；中位住院时间：1.0天对3.0天；P < 0.01），且30天再入院率没有增加（9.1%对16.2%，P = 0.25）。对于胃电刺激器植入，小切口剖腹术结合辅助疼痛控制措施可改善治疗效果。
