丹麦在腹腔镜技术应用后行全结肠切除术治疗炎症性肠病的短期结局：一项全国范围内基于人群的研究。
Short-term outcomes following total colectomy for inflammatory bowel disease in Denmark after implementation of laparoscopy: a nationwide population-based study.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Section of Coloproctology, Department of Surgery, Aarhus University Hospital, Aarhus N, Denmark.
出版信息
Colorectal Dis. 2023 Sep;25(9):1802-1811. doi: 10.1111/codi.16691. Epub 2023 Aug 3.
AIM
A laparoscopic approach to total colectomy (TC) for inflammatory bowel disease (IBD) is being increasingly used, but data on its comparative benefits over open TC are conflicting. The aim of this study was to examine 90-day outcomes following laparoscopic and open TC for IBD in a nationwide cohort after the introduction of laparoscopy.
METHOD
IBD patients undergoing TC in Denmark from 2005 to 2017 were identified from the Danish National Patient Registry. We used Kaplan-Meier methodology to estimate mortality and Cox regression analysis to estimate adjusted mortality rate ratios (aMRRs) and adjusted hazard ratios (aHRs) of reoperation, readmission and intensive care unit (ICU) transfer, comparing patients undergoing laparoscopic versus open TC.
RESULTS
We identified 1095 patients undergoing laparoscopic TC and 1523 patients undergoing open TC. Following emergency TC, 90-day mortality was 2.8% (1.6%-4.9%) after laparoscopic TC and 9.1% (7.0%-11.8%) after open TC. Ninety-day mortality was 0.9% (0.3%-2.5%) after laparoscopic TC and 2.6% (1.5%-4.3%) after open elective TC. The aMRRs associated with laparoscopic TC were 0.45 (95% CI 0.25-0.80) in emergency cases and 0.29 (95% CI 0.10-0.86) in elective cases. Risks of readmission were comparable following laparoscopic versus open TC, both in emergency [aHR = 0.93 (95% CI 0.76-1.15)] and elective [aHR = 0.83 (95% CI 0.68-1.02)] cases, while risks of ICU transfer and reoperation were lower following laparoscopic TC, both in emergency cases [aHR = 0.53 (95% CI 0.35-0.82) and aHR = 0.26 (95% CI 0.15-0.47)] and elective [aHR = 0.58 (95% CI 0.35-0.95) and aHR = 0.37 (95% CI 0.21-0.66)] cases.
CONCLUSION
The introduction of laparoscopic TC for IBD in Denmark was not associated with increased mortality or morbidity. In fact, laparoscopic TC for IBD may be associated with lower short-term mortality and morbidity compared with open TC.
目的
腹腔镜全结肠切除术（TC）治疗炎症性肠病（IBD）的应用日益广泛，但腹腔镜 TC 与开腹 TC 相比具有优势的相关数据存在争议。本研究旨在观察丹麦全国性队列中腹腔镜 TC 治疗 IBD 患者的 90 天结局，该队列于腹腔镜技术引入后纳入患者。
方法
从丹麦国家患者登记处中识别 2005 年至 2017 年期间接受 TC 治疗的 IBD 患者。我们使用 Kaplan-Meier 方法估计死亡率，使用 Cox 回归分析估计再次手术、再入院和重症监护病房（ICU）转移的校正死亡率比值（aMRR）和校正危险比（aHR），比较腹腔镜 TC 与开腹 TC 患者的结局。
结果
我们确定了 1095 例接受腹腔镜 TC 治疗和 1523 例接受开腹 TC 治疗的患者。在急诊 TC 后，腹腔镜 TC 的 90 天死亡率为 2.8%（1.6%-4.9%），开腹 TC 的 90 天死亡率为 9.1%（7.0%-11.8%）。腹腔镜 TC 的 90 天死亡率为 0.9%（0.3%-2.5%），开腹择期 TC 的 90 天死亡率为 2.6%（1.5%-4.3%）。在急诊情况下，腹腔镜 TC 与开腹 TC 相关的 aMRR 为 0.45（95%CI 0.25-0.80），在择期情况下为 0.29（95%CI 0.10-0.86）。在急诊和择期情况下，腹腔镜 TC 与开腹 TC 的再入院风险相当[aHR 分别为 0.93（95%CI 0.76-1.15）和 0.83（95%CI 0.68-1.02）]，而 ICU 转移和再次手术的风险较低[aHR 分别为 0.53（95%CI 0.35-0.82）和 0.26（95%CI 0.15-0.47）]。
结论
丹麦引入腹腔镜 TC 治疗 IBD 并未增加死亡率或发病率。事实上，与开腹 TC 相比，腹腔镜 TC 治疗 IBD 可能与较低的短期死亡率和发病率相关。
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