腹腔鏡減少小腸阻塞風險


  【24drs.com】根據刊載於4月號外科學誌人口基礎回溯登記研究結果,進行開放式腹部手術的病患,發生小腸阻塞(SBO)的機會是進行腹腔鏡腹部手術患者的至少4倍。
  
  利用瑞典全國健康福祉委員會住院病患登記庫之108,141名患者的資料,研究者發現,術後發生SBO的比率介於0.4%-13.9%,依手術類型而異;多變項分析發現,年紀、之前的腹部手術、共病症、手術技術都是SBO的風險因素,大部分的手術中,進行腹腔鏡手術病患的SBO風險最低。
  
  瑞典Scandinavian手術結果研究組Eva Angenete博士等人寫道,小腸阻塞確實是健康照護的挑戰,正確辨識風險因素可以改善降低腹部手術後之SBO風險的工具;這篇研究顯示,除了年紀、之前的腹部手術、共病症等重要因素之外,手術技術也是與SBO有關的重要因素。
  
  研究者分析了2002年1月1日至2004年12月31日間、進行腹腔鏡膽囊切除術、子宮切除術、輸卵管卵巢切除術、腸切除,前位切除術、腹會陰聯合切除、直腸固定術、闌尾切除術、減肥手術等手術的病患資料,評估了年紀、性別、共病症情況、手術技術(開放式或腹腔鏡),有SBO病史的病患則排除在外。
  
  主要結果是,在前述之手術後5年內評估發生SBO的情況。
  
  研究者發現,減重手術是腹腔鏡手術組中,唯一SBO風險較高者,但差異未達統計上的顯著程度(勝算比[OR]為0.7 [95%信心區間(CI)為 0.4 - 1.2];P > .05);輸卵管卵巢切除術是開放式腹部手術組中SBO風險最高的(OR,7.6 [95% CI,4.4 - 13.1];P < .001)。
  
  有關研究限制的討論方面,作者們指出,因為未回顧病患個人的病歷紀錄,病患可能有其他腸阻塞風險影響,不過,他們認為這個風險在各組是相當的。此外,各適應症之間可能有所影響,因為膽囊切除術、腸切除、闌尾切除術等手術之SBO發生率和共病症有關,也和進行開放式或腹腔鏡手術有關。作者們試圖在手術類別中闡述這點,但也指出需要後續研究。
  
  Angenete博士等人寫道,事實是,這是篇人口基礎研究,樣本數夠大、表示我們的研究結果確實代表手術技術會導致實際差異;腹腔鏡手術的短期效益和安全性,為了進一步減少手術併發症,腹腔鏡應作為首選的技術是可行的。
  
  麻州波士頓哈佛醫學院、布萊根婦女醫院一般外科Luke M. Funk醫師和Stanley W. Ashley醫師受邀發表評論時寫道,這結果為腹腔鏡手術減少與再度住院有關之沾黏的發生率提供新證據,對手術照護品質和費用都有重要影響。
  
  Funk醫師和Ashley醫師指出,對於保險人和健康照護政策領袖,如果多以腹腔鏡手術取代開放式手術,費用可明顯節省,美國每年花在沾黏相關併發症的住院病患費用超過20億美元,節省下來相當可觀。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6789&x_classno=0&x_chkdelpoint=Y
  

Laparoscopy Reduces Risk for Small Bowel Obstruction

By Jennifer Garcia
Medscape Medical News

April 16, 2012 — Patients who undergo an open abdominal surgery are at least 4 times more likely to develop small bowel obstruction (SBO) compared with patients who undergo laparoscopic surgery for most abdominal procedures. These are the findings of a population-based retrospective register study published in the April issue of the Archives of Surgery.

Using data from 108,141 patients in the Inpatient Register held by the Swedish National Board of Health and Welfare, the researchers found that the incidence of SBO after surgery ranged from 0.4% to 13.9%, depending on the type of surgery. A multivariate analysis revealed that age, previous abdominal surgery, comorbidity, and surgical technique were risk factors for SBO. Patients who underwent laparoscopic surgeries had the lowest SBO risk among most surgical procedures.

"Small-bowel obstruction is a substantial health care challenge, and correctly identified risk factors can provide improved tools to reduce the risk of SBO after an abdominal surgical procedure," write Eva Angenete, MD, PhD, from the Scandinavian Surgical Outcomes Research Group, Gothenburg, Sweden, and colleagues. "This study shows that, beyond important factors such as age, previous abdominal surgery, and comorbidity, the surgical technique is the most important factor related to SBO," note the authors.

The researchers analyzed surgical records for patients who underwent cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery between January 1, 2002, through December 31, 2004. Age, sex, comorbid conditions, and surgical technique (open vs laparoscopic) were evaluated. Patients with a history of surgery for SBO were excluded from the study.

The main outcome assessed was the development of SBO within 5 years after the index surgery.

The researchers found that bariatric surgery was the only procedure in which the risk for SBO was higher in the laparoscopy group, although the difference was not statistically significant (odds ratio [OR], 0.7 [95% confidence interval (CI), 0.4 - 1.2]; P > .05). Salpingo-oophorectomy was the procedure with the highest risk for SBO after open abdominal surgery (OR, 7.6 [95% CI, 4.4 - 13.1]; P < .001).

Discussing some of the study limitations, the authors note that because the patients' individual medical records were not reviewed, there is a risk that patients with other types of bowel obstruction were included. However, they considered the risk to be equally distributed in all groups. In addition, possible confounding by indication may have occurred because the analyses included comorbidity related to the incidence of SBO in cholecystectomy, bowel resection, and appendectomy but was also related to whether open or laparoscopic surgery was performed. The authors attempted to address this in their categorization of the procedures but note that this will require further study.

"The fact that this study is population based and that the group size is sufficiently large indicate that our results represent an actual difference due to surgical technique," write Dr. Angenete and colleagues. "The safety and the short-term benefits of laparoscopy are already known, and it is possible that laparoscopy should be regarded as the preferred technique in an attempt to further reduce the complications of surgery," conclude the authors.

In an invited commentary, Luke M. Funk, MD, MPH, and Stanley W. Ashley, MD, from the Department of General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, write: "This finding adds to the body of literature suggesting that laparoscopy decreases the incidence of adhesion related readmissions and has important implications for both the quality and cost of surgical care."

"For payers and health care policy leaders, it suggests that substantial cost savings could be achieved if open surgery were replaced with laparoscopic surgery more often. Given that inpatient expenditures on adhesiolysis-related complications exceed $2 billion annually in the United States, these savings could be substantial," add Dr. Funk and Dr. Ashley.

The study was funded by grants from the Swedish Cancer Foundation, the Swedish Medical Association, the Gothenburg Medical Association, the Assar Gabrielsson Foundation, the Magn Berwall's Foundation, and the Swedish Research Council. The authors and editorialists have disclosed no relevant financial relationships.

Arch Surg. 2012;147:359-365.

    
相關報導
研究發現:減重手術後的行為是關鍵
2016/4/29 上午 10:14:03
心理訓練可以改善手術結果
2014/11/11 下午 05:34:19
機械手臂泌尿科手術的結果優於開放式手術
2012/4/2 下午 04:29:37

上一頁
   1   2   3   4   5   6  




回上一頁