背景:在当前的研究中,我们的目的是使用数据程序为目标的数据库,在病例匹配设计中,比较腹腔镜与开腹全结肠切除术加回肠直肠吻合术患者围手术期和术后30天的结局.
方法:2012年和2013年接受择期全结肠切除术合并回肠直肠吻合术的患者来自美国外科医生学会国家外科质量改进计划数据库。根据手术方式(腹腔镜和开腹)将患者分为两组。腹腔镜组和开放组根据年龄进行匹配(1:1),性别,诊断,身体质量指数,和美国麻醉医师学会分类。合并症,围手术期,比较两组患者术后短期(30天)结局.
结果:我们确定腹腔镜组1442例患者-549例,开腹组893例。案例匹配后,每组有326例患者.腹腔镜组有48例(14.7%)患者出现中转。开放组的腹水患者比例较高[0(0%)vs.7(2.1%)p=0.015],术前体重减轻[26(8.0%)与45(13.8%)p=0.018],和受污染的伤口分类[清洁/受污染261(80%)与240(74%),受污染55(16.9%)与54(16.6%),和肮脏/感染8(2.5%)28(8.6%),(p=0.003)]。腹腔镜组手术时间明显延长(242±98vs.202±116分钟,p<0.001),住院时间较短(9.4±8.5vs.13.3±10.7天,p<0.001),和较低的肠梗阻率(23.9vs.31.0%,p=0.045)比开放组。在调整协变量后,手术时间和住院时间的差异仍然显著[比值比(OR):0.79,置信区间(CI)0.74-0.85和OR1.36,CI1.21-1.52,p<0.001].
结论:腹腔镜下全结肠切除回肠直肠吻合术与开放入路相比,住院时间短,手术时间长。
BACKGROUND: In the current study, we aimed to compare peri- and postoperative 30-day outcomes of patients undergoing laparoscopic versus open total colectomy with ileorectal anastomosis in a
case-matched design using data procedure-targeted database.
METHODS: Patients who underwent elective total colectomy with ileorectal anastomosis in 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into two groups according to the type of surgical approach (laparoscopic and open). Laparoscopic and open groups were matched (1:1) based on age, gender, diagnosis, body mass index, and American Society of Anesthesiologists classification. Comorbidities, perioperative, and short-term (30-day) postoperative outcomes were compared between the matched groups.
RESULTS: We identified 1442 patients-549 in the laparoscopic group and 893 patients in the open group. After
case matching, there were 326 patients in each group. There were 48 (14.7%) patients who had conversion in the laparoscopic group. The open group had a higher proportion of patients with ascites [0 (0%) vs. 7 (2.1%) p = 0.015], preoperative weight loss [26 (8.0%) vs. 45 (13.8%) p = 0.018], and contaminated wound classifications [Clean/Contaminated 261 (80%) vs. 240 (74%), Contaminated 55 (16.9%) vs. 54 (16.6%), and Dirty/Infected 8 (2.5%) vs. 28 (8.6%), (p = 0.003)]. The laparoscopic group had a significantly longer operative time (242 ± 98 vs. 202 ± 116 min, p < 0.001), shorter hospital stay (9.4 ± 8.5 vs. 13.3 ± 10.7 days, p < 0.001), and lower ileus rate (23.9 vs. 31.0%, p = 0.045) than the open group. After adjusting for covariates, the differences in terms of operative time and hospital stay remained significant [odds ratio (OR): 0.79, confidence interval (CI) 0.74-0.85 and OR 1.36, CI 1.21-1.52, p < 0.001, respectively].
CONCLUSIONS: Laparoscopic approach for total colectomy with ileorectal anastomosis is associated with a shorter hospital stay but longer operative time compared with an open approach.