Laparoscopic Colon Surgery: Does Operative Time Matter?
Laparoscopic Colon Surgery: Does Operative Time Matter?
复制标题
DOI：
10.1007/dcr.0b013e3181b55616
复制
发表时间：
2009-10-01
影响因子：
3.9
通讯作者：
Boushey, Robin P.
中科院分区：
文献类型：
--
作者：
Scheer, Adena;Martel, Guillaume;Boushey, Robin P.
目的：确定随着手术时间的增加，与腹腔镜结肠切除术相关的围手术期益处是否保持。方法：对1991年4月至2005年5月前瞻性收集的数据库进行回顾。由于手术时间分布不同，将患者分为三组：腹腔镜右半结肠或回盲部切除术、乙状结肠切除术和全腹结肠切除术。结果：排除后，231例右半结肠和回盲肠切除，210例乙状结肠切除，46例全腹结肠切除。随着右侧/回盲部和乙状结肠切除手术时间的增加，Logistic回归分析显示，术中和术后并发症、手术节食天数或住院时间之间没有显著关联。在右侧/回盲部和乙状结肠切除组中，体重与手术时间的增加显著相关。在全腹结肠切除术组中，手术时间的增加与术后并发症(P=0.04)、手术节食天数(P=0.02)和住院天数(P=0.03)显著相关。全腹结肠切除组确定手术时间分界点。手术时间为270min的患者有更多的术后并发症(P=0.024)、较长的肠梗阻(手术饮食的中位数为5天与3天，P=0.003)和较长的住院时间(7天与5天，P=0.003)。在调整体重和诊断后，这种增加的风险仍然显著。未发现显著的学习曲线。结论：增加手术时间似乎不会对节段性结肠切除术的围手术期结果产生负面影响。全腹结肠切除术持续时间超过270分钟与术后并发症增加、手术饮食天数和住院时间有关。
PURPOSE: The purpose was to determine if the perioperative benefits associated with laparoscopic colectomies are maintained as operative time increases.METHODS: A retrospective review was performed of a database that was prospectively collected from April 1991 to May 2005. Since operative time distributions were different, patients were divided into three groups: laparoscopic right colectomy or ileocecal resection, sigmoid resection, and total abdominal colectomy. The following outcomes were assessed: intraoperative and postoperative complications, days to surgical diet, length of stay, 30-day mortality, and the presence of a learning curve.RESULTS: Following exclusions, there were 231 right colon and ileocecal resections, 210 sigmoid colectomies, and 46 total abdominal colectomies. With increasing operative time in both right/ileocecal and sigmoid resections, logistic regression demonstrated no significant association between intraoperative and postoperative complications, days to surgical diet, or length of stay. Weight was significantly correlated with increasing operative time in the right/ileocecal and sigmoid resection groups. In the total abdominal colectomy group, significant relationships between increased operative time and postoperative complications (P = 0.04), days to surgical diet (P = 0.02), and hospital stay (P = 0.03) were found. An operative time cut-point was determined in the total abdominal colectomy group. Patients with operative times >270 minutes were more likely to have postoperative complications (P = 0.024), longer ileus (five vs. three median days to surgical diet, P = 0.003), and longer length of stay (seven vs. five days, P = 0.04). This increased risk remained significant after adjusting for weight and diagnosis. No significant learning curve was identified.CONCLUSION: Increasing operative time does not appear to adversely affect perioperative outcomes in segmental colectomies. Total abdominal colectomies lasting more than 270 minutes were associated with increased postoperative complications, days to surgical diet, and length of stay.