单切口腹腔镜回盲切除术治疗儿童克罗恩病:15年的经验。

IF 1.1 4区 医学 Q3 SURGERY
Seth Saylors, Cory Nonnemacher, Shawn St Peter
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引用次数: 0

摘要

目的:在难治性克罗恩病中,回肠末端是需要切除的常见部位。腹腔镜回盲切除术是首选的手术方法,我们使用单切口腹腔镜技术(SILS)。与其他系列相比,我们之前报道了我们在SILS回肠切除术中的经验。该项目旨在扩大我们的单一机构经验,并评估运营经验的影响。方法:我们对2009年1月1日至2024年3月31日期间因克罗恩病行SILS回盲切除术的患者进行了单机构回顾性研究。收集手术和住院患者特征以确定并发症发生率。将先前研究的患者(2009年1月1日至2013年2月1日)与我们更新的队列进行亚组分析。结果:78例因克罗恩病行SILS回盲切除术的患者中位年龄为16.5岁(四分位数范围:15.0,17.8)。中位住院时间(LOS)为96小时(72,186)。总并发症发生率为17%。亚组分析显示,2013年以后手术的患者年龄较大(P = 0.012),术前病程(OR)较长(P = 0.051),接受抗肿瘤坏死因子治疗的可能性较大(P = 0.014)。新队列的平均手术时间明显较低(70分钟对85分钟,P = 0.007)。新队列患者的中位LOS较短(72小时比108小时,P = 0.149),并发症较低(13%比23%,P = 0.283),再手术率较低(4%比15%,P = 0.159)。结论:小儿克罗恩病行SILS回盲切除术是安全有效的。随着手术经验的增加,我们观察到手术时间和并发症发生率明显减少。证据等级:III,回顾性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single-Incision Laparoscopic Ileocecectomy in Pediatric Crohn's Disease: A 15-Year Experience.

Purpose: In refractory Crohn's disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single-institutional experience and evaluate the impact of operative experience. Methods: We completed a single-institution retrospective review of patients who underwent SILS ileocecectomy for Crohn's disease from January 1, 2009 to March 31, 2024. Operative and inpatient characteristics were collected to determine complication rates. Subgroup analysis was completed comparing previously studied patients (January 1, 2009 to February 1, 2013) to our updated cohort. Results: Seventy-eight patients underwent SILS ileocecectomy for Crohn's disease and had a median age of 16.5 years (interquartile range: 15.0, 17.8). The median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17%. On subgroup analysis, patients operated on after 2013 were older (P = .012), had a longer disease length before operating room (OR) (P = .051) and were more likely to be on anti-tumor necrosis factor therapy (P = .014). Mean operative time was significantly lower in the newer cohort (70 mins versus 85 mins, P = .007). The patients in the newer cohort had a shorter median LOS (72 hours compared to 108 hours, P = .149) and had a lower complication (13% versus 23%, P = .283) and re-operation rate (4% versus 15%, P = .159). Conclusions: SILS ileocecectomy is effective and safe in pediatric patients with Crohn's disease. As operative experience increases, we have observed a clinically significant decrease in operative time and complication rates. Level of Evidence: III, Retrospective study.

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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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