Department of Gastrointestinal Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No 420 fuma road, Jin' an district, Fuzhou, China.
Department of Anesthesiology Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No 420 fuma road, Jin' an district, Fuzhou, China.
World J Surg Oncol. 2022 Mar 4;20(1):68. doi: 10.1186/s12957-022-02504-6.
BACKGROUND: There were differences in the recovery of bowel function and prolonged postoperative ileus (PPOI) between laparoscopic right colectomy (RC) and left colectomy (LC) under the guidance of enhanced recovery after surgery. METHODS: We selected 870 patients who underwent elective laparoscopic colectomy from June 2016 to December 2021, including 272 patients who had RC and 598 who had LC. According to 1:1 proportion for propensity score matching and correlation analysis, 247 patients who had RC and 247 who had LC were finally enrolled. RESULTS: The incidence of PPOI in all patients was 13.1%. Age, sex, smoking habit, preoperative serum albumin level, operation type, and operation time were the important independent risk factors based on multivariate logistic regression and correlation analysis for PPOI (p<0.05). Age, sex, body mass index, preoperative serum albumin level, operation time, and degree of differentiation between the two groups were significantly different before case matching (p<0.05). There were no statistically significant differences in baseline characteristics and preoperative biochemical parameters between the two groups after case matching (p>0.05). The incidence of PPOI in patients who had RC was 21.9%, while that in patients who had LC was 13.0%. The first flatus, first semi-liquid, and length of stay in LC patients were lower than those in RC patients (p<0.05). CONCLUSION: The return of bowel function in LC was faster than that in RC, and the incidence of PPOI was relatively lower. Therefore, caution should be taken during the early feeding of patients who had laparoscopic RC.
背景:在加速康复外科(ERAS)指导下,腹腔镜右半结肠切除术(RC)和左半结肠切除术(LC)的肠功能恢复和术后肠麻痹(PPOI)的发生率存在差异。
方法:我们选择了 2016 年 6 月至 2021 年 12 月间接受择期腹腔镜结肠切除术的 870 例患者,包括 272 例 RC 患者和 598 例 LC 患者。根据倾向评分匹配和相关性分析的 1:1 比例,最终纳入 247 例 RC 患者和 247 例 LC 患者。
结果:所有患者的 PPOI 发生率为 13.1%。年龄、性别、吸烟习惯、术前血清白蛋白水平、手术类型和手术时间是基于多变量逻辑回归和相关性分析的 PPOI 的重要独立危险因素(p<0.05)。在病例匹配前,年龄、性别、体重指数、术前血清白蛋白水平、手术时间和两组的分化程度存在显著差异(p<0.05)。病例匹配后,两组患者的基线特征和术前生化参数无统计学差异(p>0.05)。RC 组患者的 PPOI 发生率为 21.9%,LC 组为 13.0%。LC 组患者的首次排气、首次半流质饮食和住院时间均低于 RC 组(p<0.05)。
结论:LC 的肠功能恢复更快,PPOI 的发生率相对较低。因此,腹腔镜 RC 术后患者早期喂养时应谨慎。
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