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抗血栓治疗对接受腹腔镜结直肠癌手术患者结局的影响:一项系统文献综述

Impact of Antithrombotic Therapy on the Outcome of Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Systematic Literature Review.

作者信息

Fujikawa Takahisa, Takahashi Ryo

机构信息

Surgery, Kokura Memorial Hospital, Kitakyushu, JPN.

出版信息

Cureus. 2022 Mar 22;14(3):e23390. doi: 10.7759/cureus.23390. eCollection 2022 Mar.

Abstract

In recent years, many operations have been performed as laparoscopic surgeries in the field of gastrointestinal surgery, but the effect of antithrombotic therapy (ATT) on hemorrhagic complications in patients who have undergone laparoscopic colorectal cancer surgery remains unknown. In addition, the efficacy and safety of pharmacotherapy for the prevention of venous thromboembolism (VTE) have not yet been concluded. The purpose of this systematic review study is to clarify the effect of ATT on hemorrhagic complications in patients undergoing laparoscopic colorectal cancer surgery. Articles published between 2013 and 2020 were searched on Google Scholar and PubMed, and research regarding ATT and laparoscopic colorectal cancer surgery was included after a thorough examination of each study. Each study yielded information on the study's design, type of surgical procedures, antithrombotic medications used, and surgical outcomes (both thromboembolic and hemorrhagic consequences). This systematic review comprised 20 published papers, including a total of 12,751 patients who received laparoscopic colorectal cancer surgery. Four studies on thrombosis prevention in VTE were randomized clinical trials, and the other 16 were cohort or case-control studies. For the effects of prolonged use of ATT on hemorrhagic complications, most studies demonstrated that laparoscopic colorectal cancer surgery with continued preoperative aspirin could be safely conducted without an increase in the frequency of bleeding complications. On the other hand, most included papers have shown that patients receiving VTE pharmacoprophylaxis may be at an increased risk of bleeding complications, but its effectiveness has not been statistically proven, especially in the Asian patient population. Laparoscopic colorectal cancer surgery in patients on prolonged ATT can be safely conducted with no increase in the incidence of hemorrhagic or thrombotic complications. The efficacy and safety of VTE pharmacoprophylaxis in laparoscopic colorectal surgery is still at issue. It is necessary to establish available protocols or guidelines by validating reliable studies.

摘要

近年来,胃肠外科领域的许多手术已采用腹腔镜手术方式进行,但抗血栓治疗(ATT)对接受腹腔镜结直肠癌手术患者出血并发症的影响尚不清楚。此外,预防静脉血栓栓塞(VTE)的药物治疗的有效性和安全性尚未得出结论。本系统评价研究的目的是阐明ATT对接受腹腔镜结直肠癌手术患者出血并发症的影响。在谷歌学术和PubMed上检索了2013年至2020年发表的文章,在对每项研究进行全面审查后,纳入了有关ATT和腹腔镜结直肠癌手术的研究。每项研究都提供了有关研究设计、手术程序类型、使用的抗血栓药物以及手术结果(血栓栓塞和出血后果)的信息。本系统评价包括20篇已发表的论文,共纳入12751例接受腹腔镜结直肠癌手术的患者。四项关于VTE预防血栓形成的研究为随机临床试验,其他16项为队列研究或病例对照研究。对于长期使用ATT对出血并发症的影响,大多数研究表明,持续术前使用阿司匹林进行腹腔镜结直肠癌手术可以安全进行,而不会增加出血并发症的发生率。另一方面,大多数纳入的论文表明,接受VTE药物预防的患者可能有更高的出血并发症风险,但其有效性尚未得到统计学证实,尤其是在亚洲患者群体中。长期接受ATT治疗的患者进行腹腔镜结直肠癌手术可以安全进行,出血或血栓形成并发症的发生率不会增加。VTE药物预防在腹腔镜结直肠癌手术中的有效性和安全性仍存在争议。有必要通过验证可靠的研究来制定可行的方案或指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9b7/9033526/f70fce956df1/cureus-0014-00000023390-i01.jpg

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