胃繞道手術結果 開刀型及腹腔鏡不分軒輊


  June 18, 2007(聖地牙哥) — 在美國減肥手術學會第24屆年會中, David Syn醫師提出報告指出,就手術結果而論(包括併發症和住院天數),有著10-cm切口的開刀型胃繞道手術和以腹腔鏡進行的手術是不分軒輊的。
  
  服務於美國德州樂波市Covenant醫學中心的Syn醫師提到,開刀型手術中使用的單一小切口能讓外科醫師在進行疼痛控制時更得心應手,且可視為侵入程度最低的,因為以腹腔鏡進行手術的切口加總起來也差不多是10 cm。
  
  Syn醫師表示,本研究的目的並不是要去分出兩者間的高下,而是要提出兩者都能達到相似的結果。
  
  他及其研究同仁追蹤觀察296名自始至終都相同的患者,這些患者由Syn醫師於2005年7月至2006年11月之間在兩個醫學中心進行過開刀型roux-en-Y胃繞道手術,其中有85%為女性,平均年齡為41歲,而平均身體質量指數(BMI)值為52.6 kg/m2(64 名患者的 BMI >60 kg/m2);平均來看,他(她)們身上同時患有三種疾病,其中最多的是糖尿病、高血脂症、高血壓和阻塞性睡眠呼吸中止症;上下床護理於術後3至6小時內開始進行,所有的患者都服用止吐藥物及接受適當的疼痛控制。
  
  住院時間平均為1.2天,有272名患者(92%)在手術後24小時內出院,更有7名患者(2.4%)在手術後12小時內即出院;術後併發症發生率(定義為在術後12個月內發生的症狀)為23%,發生率最高的早期併發症(術後頭30天即發生)為血清腫,17名患者(5.7%)有此狀況;術後30天發生率升高的常見併發症為腹壁疝氣(經手術後傷口),21名患者(7.1%)有此狀況;2名患者需要再次接受治療,另有3名患者有腸漏症。
  
  Syn醫師提到,僅發生1例的靜脈血栓栓塞(venous thromboembolism,以下縮寫為VTE),該名患者住在其他州,一開始狀況不錯,但在術後約3週即抱怨腹痛,他到所在地的急診就醫而被診斷為腎絞痛,當地醫護人員建議他去找Syn醫師,Syn醫師的醫院離他那兒有6小時的車程,但他當下決定不去,而最後因腸繫膜VTE而病逝。
  
  Syn醫師認為VTE的低發病率,有賴於預防治療,及早進行上下床護理是關鍵。
  
  Henry Buchwald醫學博士表示,這項研究報告可算是個里程碑,對減肥手術外科醫師和付費進行手術的人而言,應該會感到相當有興趣;Buchwald博士為明尼阿波里斯市明尼蘇達大學的手術暨生物醫學工程系教授。
  
  Buchwald博士表示,這項研究所要傳達最重要的訊息是,藉由審慎運用相對小的切口及適當的止痛,以開刀進行手術的結果和腹腔鏡進行的手術是不分上下的;Buchwald博士未參與該項研究。
  
  Buchwald博士表示,24小時內的出院率為92%,僅1例病故,2例重新接受治療,而有3例患腸漏症—我認為效果卓著。
  
  美國減肥手術學會:會議摘要16。2007年6月11-16日。

Open Bypass Surgery Outcomes E

By Norra MacReady
Medscape Medical News

June 18, 2007 (San Diego) — Open gastric bypass performed through a 10-cm incision matches laparoscopic surgery in terms of outcomes, including complications and length of stay, David Syn, MD, a surgeon at Covenant Medical Center, in Lubbock, Texas, reported at the 24th annual meeting of the American Society for Bariatric Surgery.

Indeed, the single small incision used in the open procedure allows for easier pain control and can be considered minimally invasive, since the "laparoscopic incisions added together likely equal 10 cm," he noted.

"The purpose of this study was not to prove that one approach is better than another, but to demonstrate that similar results can be achieved with both," said Dr. Syn.

He and his colleagues followed 296 consecutive patients who had undergone open gastric roux-en-Y bypass surgery performed by Dr. Syn at 2 institutions between July 2005 and November 2006. The patients were 85% female, with an average age of 41 years, and an average body mass index (BMI) of 52.6 kg/m2 (64 patients had a BMI > 60 kg/m2). They had an average of 3 comorbidities, the most common of which were diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea. Ambulation was initiated within 3 to 6 hours, with all patients receiving anti-emetics and adequate pain control.

Length of hospital stay averaged 1.2 days, with 272 (92%) of the patients discharged within 24 hours of surgery, and 7 (2.4%) within 12 hours of surgery. The incidence of postoperative complications, defined as those occurring within 12 months of surgery, was 23%. The most common early complication, which occurred in the first 30 days after surgery, was seroma, seen in 17 patients (5.7%). Incisional ventral hernia was the most common complication arising after 30 days, occurring in 21 patients (7.1%). Two patients required readmission, and 3 experienced bowel leakage.

There was only 1 case of venous thromboembolism (VTE), Dr. Syn noted. That patient, who lived out of state, did well initially, but called complaining of bowel pain about 3 weeks after surgery. He went to his local emergency department, where he was diagnosed with renal colic. He was encouraged to see Dr. Syn, whose office was 6 hours away, but decided against it and ultimately died of mesenteric VTE.

Dr. Syn attributed the low rate of VTE to good prophylaxis. "Early ambulation is key," he warned.

"This could be a landmark paper. It should be extremely interesting to bariatric surgeons and to payers," said Henry Buchwald, MD, PhD, professor of surgery and biomedical engineering at the University of Minnesota, in Minneapolis.

The most important message is that, with the judicious use of a relatively small incision and appropriate analgesia, the outcomes with open surgery can be as good as those achieved with laparoscopy, said Dr. Buchwald, who was not involved in the study.

"A 92% discharge rate within 24 hours, with only 1 death, 2 readmissions, and 3 leaks — I think that's remarkable."

ASBS: Abstract 16. June 11-16, 2007.

    
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
胃間隔手術可能對兒童族群有益
2011/3/21 上午 11:11:00
發布新版慢性疼痛指引
2010/4/8 上午 11:15:00

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁