手辅助腹腔镜手术治疗小肠神经内分泌肿瘤作为开放手术替代手术治疗的评价。

IF 2.1 3区 医学 Q2 SURGERY
Branislav Klimácek, Tobias Åkerström, Matilda Annebäck, Per Hellman, Olov Norlén, Peter Stålberg
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引用次数: 0

摘要

目的:小肠神经内分泌肿瘤是小肠最常见的恶性肿瘤。根治性治疗是手术,开腹探查被认为是标准的方法。本研究旨在评估乌普萨拉大学医院内分泌外科微创手术与开放入路SI-NETs手术的效果。方法:这项回顾性队列研究纳入了2013年至2023年在乌普萨拉大学医院接受SI-NET手术的患者。比较我院于2019年前后采用手口辅助腹腔镜手术(HALS)治疗SI-NETs的两组患者的手术时间、住院时间、镇痛药使用和根治性等变量。结果进一步比较开放式和手口辅助腹腔镜入路。主要终点是II-III期患者的根治率。次要结局包括手术时间、住院时间、硬膜外镇痛和患者自控镇痛的使用。结果:97例患者中,58例(59.8%)行开放手术,39例(40.2%)行手口辅助腹腔镜手术。手术时间(121 min [91.3-150.3] vs 108 min[83-141])、住院时间(6天[4-7]vs 5天[4-8])和II-III期患者的手术根治性(85.2% vs 100%)差异无统计学意义(p = 0.079)。86.2%的探查性剖腹手术患者需要硬膜外镇痛,而HALS仅为23.1% (p)结论:手口辅助腹腔镜SI-NETs手术是一种可行的方法,既能保留根治,又能提高术后恢复,对硬膜外镇痛的要求较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of hand-assisted laparoscopic surgery of small intestinal neuroendocrine tumours as an alternative surgical treatment to open surgery.

Purpose: Small intestinal neuroendocrine tumours (SI-NETs) are the most common malignancy of the small bowel. Curative treatment is surgical, with exploratory laparotomy considered the standard approach. This study aimed to assess the outcomes of minimally invasive surgery compared to open approach for SI-NETs at the Endocrine surgical unit at Uppsala University Hospital.

Methods: This retrospective cohort study included patients who underwent surgery for SI-NET between 2013 and 2023 at Uppsala University Hospital. Variables such as operative time, length of hospital stay, use of analgesia and radicality were compared between groups of patients operated on before and after 2019, when hand-port assisted laparoscopic surgery (HALS) for SI-NETs was introduced at our unit. Outcomes were further compared between open and hand-port assisted laparoscopic approaches. The primary outcome was the rate of radicality achieved for stage II-III patients. Secondary outcomes included operative time, the length of hospital stay and the use of epidural and patient-controlled analgesia.

Results: Of 97 patients, 58 (59.8%) underwent open surgery and 39 (40.2%) underwent hand-port assisted laparoscopic surgery. There was no significant difference in operative time (121 min [91.3-150.3] vs 108 min [83-141]), length of hospital stay, 6 days [4-7] vs 5 days [4-8]), and surgical radicality in patients with stage II-III, 85.2% vs 100%, (p = 0.079). 86.2% of patients with explorative laparotomy required epidural analgesia compared to only 23.1% with HALS (p < 0.001).

Conclusion: Hand-port assisted laparoscopic surgery of SI-NETs is a feasible approach that preserves radical resection while enhancing postoperative recovery, with a lower requirement of epidural analgesia.

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来源期刊
CiteScore
3.30
自引率
8.70%
发文量
342
审稿时长
4-8 weeks
期刊介绍: Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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