脾曲游离：身体形态重要吗？
Splenic flexure mobilization: does body topography matter?
作者信息
Akyol H, Arslan N C, Kocak M, Shahhosseini R, Pekuz C K, Haksal M, Gogenur I, Oncel M
机构信息
Department of General Surgery, Altinbas University, 34217, Istanbul, Turkey.
Department of General Surgery, Istanbul Medipol University, TEM Avrupa Otoyolu Cıkışı No:1 Bagcilar, 34214, Istanbul, Turkey.
出版信息
Tech Coloproctol. 2024 Dec 20;29(1):31. doi: 10.1007/s10151-024-03070-7.
BACKGROUND
Splenic flexure mobilization can be technically challenging, and its oncological benefits remain uncertain. This study aims to explore the relationship between patient and clinical characteristics and splenic flexure mobilization time as well as the implications of prolonged splenic flexure mobilization duration.
METHODS
This retrospective cohort study includes 105 patients who underwent laparoscopic distal colorectal cancer surgery between 2013 and 2018. The study analyzed patient characteristics, duration of surgical steps, and postoperative outcomes. Splenic flexure mobilization time was assessed using operation videos, and the impact of patient-related factors on splenic flexure mobilization complexity was examined.
RESULTS
The study identified significant correlations of higher body mass index (BMI) (p = 0.0086), weight (p = 0.002), and height (p = 0.043) with longer splenic flexure mobilization time. Gender did not significantly influence splenic flexure mobilization duration. Splenic flexure mobilization time was correlated with the durations of other individual surgical steps (Step 1: medial-to-lateral dissection [p = 0.0013], Step 2: pelvic dissection [p = 0.067], Step 3: dissection of white line and mobilization of descending colon [p = 0.0088], Step 5: stapling, resection, extraction of the specimen, and anastomosis [p = 0.04]) and the overall operation time (p < 0.0001). A 10-min cutoff point predicts the total operation time more efficiently than other potential thresholds.
CONCLUSION
This research suggests that patient characteristics including BMI, weight, and height may serve as indicators for prolonged splenic flexure mobilization time in laparoscopic distal colorectal cancer surgery. Longer splenic flexure mobilization durations were correlated with extended durations of other surgical steps. A BMI-based approach to anticipate SFM duration may enhance preoperative planning, potentially aiding in surgical decision-making.
TRIAL REGISTRATION
E-10840098-772.02-61604 2.2.2019.
背景
脾曲游离在技术上具有挑战性，其肿瘤学益处仍不确定。本研究旨在探讨患者及临床特征与脾曲游离时间之间的关系，以及脾曲游离时间延长的影响。
方法
这项回顾性队列研究纳入了2013年至2018年间接受腹腔镜下远端结直肠癌手术的105例患者。该研究分析了患者特征、手术步骤持续时间和术后结果。使用手术视频评估脾曲游离时间，并检查患者相关因素对脾曲游离复杂性的影响。
结果
该研究发现，较高的体重指数（BMI）（p = 0.0086）、体重（p = 0.002）和身高（p = 0.043）与更长的脾曲游离时间显著相关。性别对脾曲游离持续时间没有显著影响。脾曲游离时间与其他各个手术步骤的持续时间相关（步骤1：由内侧向外侧游离 [p = 0.0013]，步骤2：盆腔游离 [p = 0.067]，步骤3：白线游离及降结肠游离 [p = 0.0088]，步骤5：吻合器吻合、标本切除、取出及吻合 [p = 0.04]）以及总手术时间（p < 0.0001）。10分钟的临界值比其他潜在阈值更有效地预测总手术时间。
结论
本研究表明，包括BMI、体重和身高在内的患者特征可能作为腹腔镜下远端结直肠癌手术中脾曲游离时间延长的指标。更长的脾曲游离持续时间与其他手术步骤的延长相关。基于BMI的方法来预测脾曲游离时间可能会加强术前规划，潜在地有助于手术决策。
试验注册号
E - 10840098 - 772.02 - 61604 2.2.2019。
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