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腹腔镜/微创手术在各类结直肠急症中的作用及疗效

Role and Outcome of Laparoscopic/Minimally Invasive Surgery for Variety of Colorectal Emergencies.

作者信息

Ahmed Salman E, Jha Anshu, Norman Sarah, Jha Madan, Garg Dharmendra

机构信息

General Surgery Department.

Department of Colorectal Surgery, James Cook University Hospital, Middlesbrough, UK.

出版信息

Surg Laparosc Endosc Percutan Tech. 2020 Oct;30(5):451-453. doi: 10.1097/SLE.0000000000000812.

Abstract

BACKGROUND

Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies.

METHOD

Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality.

RESULTS

A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%).The complications from most to least frequent were: CONCLUSION:: The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.

摘要

背景

近年来,腹腔镜或微创方法已成为计划性结直肠恶性肿瘤的常见治疗方式。其在急诊情况下的应用受到多种因素限制,包括资源可用性和手术专业知识。然而,最新证据表明腹腔镜方法可用于结直肠急诊,其效果与腹腔镜常规手术相当,且往往前景良好。在本研究中,作者调查了腹腔镜方法在良性和恶性结直肠急诊中的治疗结果。

方法

对前瞻性收集的9年期间的数据(手术记录、组织病理学数据库和出院记录)进行回顾性分析。标准手术方法包括传统腹腔镜手术和单孔技术(单切口腹腔镜手术)。最终分析中纳入的结果变量包括:微创方法的成功率、中转率、术后并发症、再次手术率和死亡率。

结果

2009年12月至2019年期间,共有202例急诊患者(男性110例,女性92例)接受手术,中位年龄59岁。平均手术时间为169分钟,美国麻醉医师协会分级中位数为III级。19例患者(9.4%)采用单切口腹腔镜手术。中转开腹手术率为12.3%(n = 25)。大多数患者进行了一期吻合(n = 132,65.3%)。并发症发生频率由高到低依次为:结论:本研究获得的良好结果强调了这样一个观点,即具备资源和专业知识后,有可能为急诊结肠病变提供微创治疗方法。

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