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新冠疫情期间消化与肿瘤外科手术实践策略

Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic.

作者信息

Tuech J-J, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L

机构信息

Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.

Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France.

出版信息

J Visc Surg. 2020 Jun;157(3S1):S7-S12. doi: 10.1016/j.jviscsurg.2020.03.008. Epub 2020 Mar 31.

Abstract

The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.

摘要

新冠疫情正在改变医疗保健的组织方式,并对消化外科产生直接影响。医疗保健的重点和流程正在发生变化。急诊手术仍然是优先事项。功能性手术应推迟进行。腹腔镜手术必须遵循严格的规则,以免医护人员面临额外风险。癌症手术中一个迫在眉睫的问题是——继续进行还是推迟?由于疫情可能存在额外风险,必须与推迟手术所带来的风险进行权衡。对于每种类型的癌症——结肠癌、胰腺癌、食管胃癌、肝细胞癌——都列出了发病率和死亡率,并与推迟手术所带来的肿瘤学风险和/或肿瘤倍增时间进行了比较。基于这种比较可以提出相应策略。对于T1-2、N0期结肠癌,建议推迟手术。对于晚期结肠病变,明智的做法似乎是先进行新辅助化疗,然后等待。对于T3-4期和/或N+期直肠癌,应进行放化疗,必须讨论短程放疗(之后有一段等待期),以减少在医院的暴露时间并预防感染。大多数具有高发病率和死亡率的复杂手术——食管胃癌、肝脏或胰腺手术——通常最好推迟进行。

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