使用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库比较开放性或腹腔镜结肠切除术治疗缺血性结肠炎的效果。
A comparison of open or laparoscopic colectomy outcomes for the management of ischemic colitis using the ACS-NSQIP database.
作者信息
Duggan Ben S, Becker Tim, DeLeon Genaro A, Rao Varun, Pei Kevin Y
机构信息
Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, United States.
Parkview Health Graduate Medical Education, 2200 Randallia Dr., Fort Wayne, IN 46805, United States.
出版信息
Surg Pract Sci. 2023 Jun 3;14:100188. doi: 10.1016/j.sipas.2023.100188. eCollection 2023 Sep.
INTRODUCTION
Ischemic colitis is a common manifestation of intestinal ischemia and is potentially a surgical emergency. Although such surgical emergencies were historically approached via open exploration, it is uncertain if there is a role for minimally invasive techniques. This study compares open vs laparoscopic colectomy techniques in the management of ischemic colitis.
METHODS
Using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, patients with ischemic colitis undergoing colectomy from 2005 to 2019 were compared. The primary outcome of interest was 30-day mortality. Additional outcomes of interest were procedure related readmission, procedure related reoperation, length of stay, surgical site infections (SSI), septic shock, and other complications. Outcomes of interest were compared using multivariate logistic regression.
RESULTS
7,928 patients had ischemic colitis with 7,209 undergoing open colectomy and 719 undergoing laparoscopic colectomy. The mortality rate was significantly lower using a laparoscopic approach compared to open (6.4% vs 26%, =<0.001) and associated with a lower odd of mortality (OR 0.58; 95% CI [0.35, 0.95]). Procedure related reoperation was lower in the laparoscopic group (6.5% vs 11%, <0.001), but multivariate analysis was not significant (OR 0.65; 95% CI [0.43,1]). Readmission rates were not statistically different (12% vs 10%, = 0.2). Postoperative length of stay (7 vs 12 days, =<0.001), septic shock (6.7% vs 27%, =<0.001), and organ space SSI (3.2% vs 6.9%, =<0.001) were significantly decreased using a laparoscopic approach.
DISCUSSION
30-day postoperative mortality was significantly lower using a laparoscopic. Patients that had a laparoscopic colectomy had shorter hospital stays. While patients that underwent laparoscopic procedures tended to be less sick, multivariate analysis showed decreased rates of sepsis and surgical site infections compared to open colectomies when correcting for these factors.
CONCLUSION
Laparoscopic colectomy may be a better surgical approach for patients with ischemic colitis compared to open colectomy.
引言
缺血性结肠炎是肠道缺血的常见表现，可能是一种外科急症。尽管历史上这类外科急症是通过开放探查来处理的，但微创技术是否能发挥作用尚不确定。本研究比较了开放与腹腔镜结肠切除术治疗缺血性结肠炎的技术。
方法
利用美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库，对2005年至2019年接受结肠切除术的缺血性结肠炎患者进行比较。主要关注的结局是30天死亡率。其他关注的结局包括与手术相关的再入院、与手术相关的再次手术、住院时间、手术部位感染（SSI）、感染性休克及其他并发症。使用多因素逻辑回归比较关注的结局。
结果
7928例患者患有缺血性结肠炎，其中7209例行开放结肠切除术，719例行腹腔镜结肠切除术。与开放手术相比，腹腔镜手术的死亡率显著更低（6.4%对26%，P<0.001），且死亡几率更低（OR 0.58；95%可信区间[0.35, 0.95]）。腹腔镜组与手术相关的再次手术率更低（6.5%对11%，P<0.001），但多因素分析无显著差异（OR 0.65；95%可信区间[0.43, 1]）。再入院率无统计学差异（12%对10%，P = 0.2）。采用腹腔镜手术，术后住院时间（7天对12天，P<0.001）、感染性休克（6.7%对27%，P<0.001）及器官腔隙SSI（3.2%对6.9%，P<0.001）均显著降低。
讨论
腹腔镜手术的术后30天死亡率显著更低。接受腹腔镜结肠切除术的患者住院时间更短。虽然接受腹腔镜手术的患者病情往往较轻，但多因素分析显示，校正这些因素后，与开放结肠切除术相比，腹腔镜手术的脓毒症和手术部位感染发生率更低。
结论
与开放结肠切除术相比，腹腔镜结肠切除术可能是治疗缺血性结肠炎患者的更好手术方式。
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