小肠手术治疗克罗恩病的疗效比较:NSQIP回顾性研究。

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Oguz Az Aras, Apar S Patel, Emma K Satchell, Nicholas J Serniak, Raphael M Byrne, Burt Cagir
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引用次数: 0

摘要

导言:尽管药物治疗取得了进步,但约 33% 的克罗恩病(CD)患者在初次确诊后 5 年内仍需要接受手术治疗。目前已提出了几种治疗克罗恩病的手术方法,包括小肠切除术、狭窄成形术以及切除加狭窄成形术的联合手术。在此,我们利用美国外科医生学会(ACS)全国手术质量登记处(NSQIP)对这三种手术方法治疗 CD 的 30 天疗效进行了全面分析:作者使用 CPT 和 IC-CM 10 查询了 ACS-NSQIP 数据库中 2015 年至 2020 年期间所有因 CD 而接受开腹或腹腔镜小肠切除术或狭窄成形术的患者。研究结果包括住院时间、出院处置、伤口并发症、30 天相关再入院和再次手术:结果:共确认了 2578 名患者,其中 87% 的患者接受了小肠切除术,5% 的患者接受了切除加狭窄成形术,8% 的患者仅接受了狭窄成形术。切除加狭窄成形术(联合手术)的手术时间最长(P = 0.002)。接受小肠切除术的患者住院时间最长(p = 0.030),浅/深伤口感染发生率最高(44%,p = 0.003),败血症发生率最高(3.5%,p = 0.03)。与联合手术(OR 2.09,p = 0.024)和狭窄成形术(1.9,p = 0.005)相比,小肠切除术的伤口并发症发生率更高:我们的研究表明,CD 的各种手术方法在 30 天内相关的再手术、再入院或术后处置方面与所有三种手术方法的结果相当。然而,小肠切除术出现术后伤口并发症的几率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of outcomes in small bowel surgery for Crohn's disease: a retrospective NSQIP review.

Introduction: Despite advances in medical therapy, approximately 33% of Crohn's disease (CD) patients will need surgery within 5 years after initial diagnosis. Several surgical approaches to CD have been proposed including small bowel resection, strictureplasty, and combined surgery with resection plus strictureplasty. Here, we utilize the American College of Surgeons (ACS) national surgical quality registry (NSQIP) to perform a comprehensive analysis of 30-day outcomes between these three surgical approaches for CD.

Methods: The authors queried the ACS-NSQIP database between 2015 and 2020 for all patients undergoing open or laparoscopic resection of small bowel or strictureplasty for CD using CPT and IC-CM 10. Outcomes of interest included length of stay, discharge disposition, wound complications, 30-day related readmission, and reoperation.

Results: A total of 2578 patients were identified; 87% of patients underwent small bowel resection, 5% resection with strictureplasty, and 8% strictureplasty alone. Resection plus strictureplasty (combined surgery) was associated with the longest operative time (p = 0.002). Patients undergoing small bowel resection had the longest length of hospital stay (p = 0.030) and the highest incidence of superficial/deep wound infection (44%, p = 0.003) as well as the highest incidence of sepsis (3.5%, p = 0.03). Small bowel resection was found to be associated with higher odds of wound complication compared to combined surgery (OR 2.09, p = 0.024) and strictureplasty (1.9, p = 0.005).

Conclusion: Our study shows that various surgical approaches for CD are associated with comparable outcomes in 30-day related reoperation and readmission, or disposition following surgery between all three surgical approaches. However, small bowel resection displayed higher odds of developing post-operative wound complications.

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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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