Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Sabadell, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.
Surg Endosc. 2019 May;33(5):1508-1517. doi: 10.1007/s00464-018-6432-5. Epub 2018 Sep 10.
Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure with low morbidity. The definition of risk factors for postoperative complications would help to identify the patients likely to require more care and surveillance in an ambulatory or 1-day surgery (A-OdS) program. The main endpoints are overall 30-day morbidity and relevant morbidity. The secondary objectives are to detect risk factors for complications, rehospitalization, and the time of occurrence of the postoperative complications, and to describe the adverse effects following hospitalization that the A-OdS program would avoid.
This is an observational study of consecutive patients undergoing TEM between June 2004 and December 2016. Overall and relevant morbidity based on the Clavien-Dindo (Cl-D) classification were recorded, as were demographic, preoperative, surgical, and pathology variables. Univariate and multivariate analyses of the risk factors were carried out.
Six hundred and ninety patients underwent surgery, of whom 639 were included in the study. Overall morbidity rate was 151/639 patients (23.6%); the clinically relevant morbidity rate was 36/639 (Cl-D > II) (5.6%) and mortality 2/639 (0.3%). The most frequent complication was rectal bleeding, recorded in 16.9% (108/639 patients) and grade I in 86/108 patients (78. 9%). The period with the greatest risk of complications was the first 2 days. The rehospitalization rate after 48 h was 7%. The risk factors for complications were as follows: tumor size > 6 cm (OR 3.2, 95% CI 1.3-7.8), anti-platelet medication (OR 2.3, 95% CI 1.1-5.1), and surgeon's experience < 150 procedures (OR 2.0, 95% CI 1-4.1).
TEM is a safe procedure. The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2 days after surgery make the procedure suitable for A-OdS.
经肛门内镜微创手术（TEM）是一种具有低发病率的微创手术。确定术后并发症的危险因素有助于识别在门诊或 1 天手术（A-OdS）计划中需要更多护理和监测的患者。主要终点是总 30 天发病率和相关发病率。次要目标是检测并发症、再住院和术后并发症发生时间的危险因素，并描述 A-OdS 计划可避免的住院后不良影响。
这是一项对 2004 年 6 月至 2016 年 12 月期间接受 TEM 治疗的连续患者进行的观察性研究。记录了基于 Clavien-Dindo（Cl-D）分类的总发病率和相关发病率，以及人口统计学、术前、手术和病理变量。进行了单变量和多变量危险因素分析。
690 例患者接受了手术，其中 639 例患者纳入了本研究。总发病率为 151/639 例（23.6%）；临床相关发病率为 36/639 例（Cl-D>II）（5.6%），死亡率为 2/639 例（0.3%）。最常见的并发症是直肠出血，记录在 16.9%（108/639 例）患者中，86/108 例（78.9%）为 I 级。并发症风险最大的时期是前 2 天。48 小时后再住院率为 7%。并发症的危险因素包括：肿瘤大小>6cm（OR 3.2，95%CI 1.3-7.8）、抗血小板药物（OR 2.3，95%CI 1.1-5.1）和外科医生经验<150 例（OR 2.0，95%CI 1-4.1）。
TEM 是一种安全的手术。手术后前 2 天发病率、再住院率和术后并发症发生率低，使该手术适合 A-OdS。
