机器人辅助右结肠切除术在强化康复路径中腔内和腔外技术的倾向评分匹配比较。
A propensity score-matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted right colectomy in an Enhanced Recovery Pathway.
机构信息
Colon and Rectal Surgery Fellow, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
General Surgery Resident, St Joseph Mercy Hospital, Ann Arbor, MI, USA.
出版信息
Am J Surg. 2018 Dec;216(6):1095-1100. doi: 10.1016/j.amjsurg.2018.06.010. Epub 2018 Jun 19.
INTRODUCTION
There may be short-term outcomes advantages for the intracorporeal approach to minimally invasive right colectomy.
METHODS
This is a retrospective propensity score-matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted right colectomy in an Enhanced Recovery colorectal surgery service.
RESULTS
55 intracorporeal and 55 extracorporeal cases were compared. Operative time was significantly longer (p < 0.001) and incision length shorter in the intracorporeal group (p = 0.007). Outcomes significantly favorable for the intracorporeal group included conversion-to-open (p = 0.013), time to first flatus (p < 0.001), time to first bowel movement (p = 0.006), and dehydration (p = 0.03). There were more extraction site hernias in the midline compared to off-midline locations, though this difference did not reach statistical significance (p = 0.06).
CONCLUSION
There are outcomes advantages for the intracorporeal technique for robotic-assisted right colectomy when compared to the extracorporeal approach for patients in an Enhanced Recovery Pathway. Training efforts should continue to advocate the intracorporeal option.
介绍
微创右结肠切除术的经体内方法可能具有短期结果优势。
方法
这是在增强型结直肠手术服务中，对机器人辅助右结肠切除术的经体内和经体外技术进行回顾性倾向评分匹配比较。
结果
比较了 55 例经体内组和 55 例外体组病例。手术时间明显更长（p<0.001），经体内组切口长度更短（p=0.007）。经体内组的结果明显有利，包括转为开放手术（p=0.013）、首次排气时间（p<0.001）、首次排便时间（p=0.006）和脱水（p=0.03）。与偏离中线位置相比，中线部位的提取部位疝更多，但差异无统计学意义（p=0.06）。
结论
与体外方法相比，在增强恢复途径的患者中，机器人辅助右结肠切除术的经体内技术具有结果优势。培训工作应继续倡导经体内选择。
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