腹腔镜手术在结直肠外科住院医师中的手术和肿瘤学结果的回顾性分析。
Retrospective analysis of surgical and oncological results of laparoscopic surgeries performed by residents of coloproctology.
机构信息
- Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil.
出版信息
Rev Col Bras Cir. 2023 May 22;50:e20233404. doi: 10.1590/0100-6991e-20233404-en. eCollection 2023.
INTRODUCTION
with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety.
PURPOSE
to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature.
METHODS
this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year.
RESULTS
we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%.
CONCLUSIONS
videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.
简介
随着腹腔镜技术在结直肠手术中的改进和广泛接受，对住院医师进行专门培训的需求也随之增加。目前，评估住院医师施行腹腔镜结肠切除术的术后结果及其对患者安全的影响的研究较少。
目的
分析结直肠外科住院医师施行腹腔镜结肠切除术的手术和肿瘤学结果，并与文献中的数据进行比较。
方法
这是对 2014 年至 2018 年期间在里贝朗普雷图临床医院接受腹腔镜结直肠手术的住院医师施行的腹腔镜结直肠手术患者进行的回顾性分析。研究了患者的临床特征，以及一年内的主要手术和肿瘤学方面。
结果
我们分析了 191 例手术，其主要手术指征是腺癌，大多数为 III 期。手术平均持续时间为 210±58 分钟。有 21.5%的患者需要造口，主要是 Loop 结肠造口术。转化率为 23%，其中 79.5%是由于技术困难，主要的转化率预测因素是肥胖和术中意外。中位住院时间为 6 天。术前贫血与更高的并发症发生率（11.5%）和再次手术率（12%）相关。手术切除边缘受损的发生率为 8.6%。一年复发率为 3.2%，死亡率为 6.3%。
结论
住院医师施行的腹腔镜结直肠手术具有与文献中发现的数据相似的疗效和安全性。
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