Leraas Harold J, Ong Cecilia T, Sun Zhifei, Adam Mohamed A, Kim Jina, Gilmore Brian F, Ezekian Brian, Nag Uttara S, Mantyh Christopher R, Migaly John
Department of Surgery, Duke University Medical Center, Box 3443, Durham, NC, 27710, USA.
J Gastrointest Surg. 2017 Apr;21(4):684-691. doi: 10.1007/s11605-016-3350-5. Epub 2017 Jan 12.
Hand-assisted laparoscopic surgery (HALS) is often used in procedures too complex for completely minimally invasive approaches. However, there are concerns for whether this hybrid approach abrogates perioperative benefits of the completely minimally invasive technique.
We queried the 2012-2013 National Surgery Quality Improvement Program for adults undergoing elective HALS or open colectomy (OC). After propensity matching, short-term outcomes were compared. Subset analysis was performed for segmental resections. Multivariate analysis was used to determine predictors of utilizing either approach.
This query included 8791 patients (OC 2707, HALS 6084). Predictors of HALS included male sex (OR 1.17, p = 0.006), increasing BMI (OR 1.01, p = 0.02), benign indication (OR 1.48, p < 0.001), and total abdominal colectomy (OR 10.39, p < 0.001). Younger age, black race, ASA class ≥3, inflammatory bowel disease, and low pelvic anastomosis were predictive of OC (all p < 0.05). HALS demonstrated reduced overall complications (p < 0.001), wound complications (p < 0.001), anastomotic leak (p = 0.014), transfusion (p < 0.001), postoperative ileus (p < 0.001), length of stay (p < 0.001), and readmission (p < 0.001) without increased operative time. For segmental resection, HALS demonstrated reduced overall complications, wound complications, respiratory complications, postoperative ileus, anastomotic leak, transfusion, length of stay, and readmissions (all p < 0.05).
Compared to OC, HALS demonstrates improved perioperative outcomes without increased operative time.
对于完全微创方法而言过于复杂的手术，常采用手辅助腹腔镜手术（HALS）。然而，人们担心这种混合手术方式是否会消除完全微创技术的围手术期益处。
我们查询了2012 - 2013年国家外科质量改进计划中接受择期HALS或开腹结肠切除术（OC）的成年患者。在进行倾向匹配后，比较短期结果。对节段性切除术进行亚组分析。采用多变量分析来确定采用这两种手术方式的预测因素。
该查询纳入了8791例患者（OC组2707例，HALS组6084例）。HALS的预测因素包括男性（比值比[OR]1.17，p = 0.006）、体重指数（BMI）增加（OR 1.01，p = 0.02）、良性指征（OR 1.48，p < 0.001）以及全腹结肠切除术（OR 10.39，p < 0.001）。年龄较小、黑人种族、美国麻醉医师协会（ASA）分级≥3、炎症性肠病以及低位盆腔吻合术是OC的预测因素（所有p < 0.05）。HALS显示总体并发症减少（p < 0.001）、伤口并发症减少（p < 0.001）、吻合口漏减少（p = 0.014）、输血减少（p < 0.001）、术后肠梗阻减少（p < 0.001）、住院时间缩短（p < 0.001）以及再入院率降低（p < 0.001），且手术时间未增加。对于节段性切除术，HALS显示总体并发症、伤口并发症、呼吸并发症、术后肠梗阻、吻合口漏、输血、住院时间以及再入院率均减少（所有p < 0.05）。
与OC相比，HALS在不增加手术时间的情况下，围手术期结果得到改善。
