Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study
Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study
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DOI：
10.1007/s00464-009-0652-7
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发表时间：
2010-03-01
影响因子：
3.1
通讯作者：
Techner, Lee
中科院分区：
文献类型：
--
作者：
Delaney, Conor P.;Marcello, Peter W.;Techner, Lee
虽然有证据表明腹腔镜结肠切除术（LC）比开腹肠切除术更快地恢复胃肠道（GI），但以前的研究是在单一机构进行的，或者通常不控制饮食或围手术期护理，因此难以解释结果。计划进行一项前瞻性、观察性、多中心研究，以调查LC后GI恢复、住院时间（LOS）和术后肠梗阻（POI）相关发病率。计划接受LC或手助腹腔镜（HAL）肠切除术并接受阿片类药物术后静脉自控镇痛的患者入选美国16家中心。研究设计与使用标准化加速术后护理路径的alvimopan III期开腹肠切除术试验相似。主要终点为上、下消化道恢复时间（GI-2：固体食物和排便耐受）和术后LOS。次要终点包括POI相关的发病率（术后鼻胃管插入或经消化器评估的POI导致住院时间延长或再次入院）、转换率和方案定义的POI延长（GI-2 >术后5天）。在本研究中，148例患者接受LC（左侧42例，右侧67例）或HAL（左侧39例）入路的半结肠切除术。转换率为18.8%（左LC 25.4%，左HAL 17.3%，右LC 15%）。GI-2恢复的平均时间为4.4天，平均术后LOS为4.9天，两者均未因手术入路而发生显著变化。15例患者（10.1%）发生POI延长，17例患者（11.5%）发生POI相关发病。与开腹肠切除术临床试验或大型医院数据库中报道的患者相比，LC后平均GI恢复和LOS加速（分别为0.7和1.7-2.2天）。开放性肠切除术和LC人群的总体POI相关发病率相似，表明无论手术入路如何，POI仍存在重要发病率。
Although evidence suggests that laparoscopic colectomy (LC) results in faster gastrointestinal (GI) recovery than open bowel resection, previous studies were performed at single institutions or generally not controlled for diet introduction or perioperative care, making the results difficult to interpret. A prospective, observational, multicenter study was planned to investigate GI recovery, length of hospital stay (LOS), and postoperative ileus (POI)-related morbidity after LC.Patients scheduled to undergo LC or hand-assisted laparoscopic (HAL) bowel resection and to receive opioid-based postoperative intravenous patient-controlled analgesia were enrolled in 16 U.S. centers. The study design was similar to that for trials of alvimopan phase 3 open laparotomy bowel resection using a standardized accelerated postoperative care pathway. The primary end points were time to upper and lower GI recovery (GI-2: toleration of solid food and bowel movement) and postoperative LOS. The secondary end points included POI-related morbidity (postoperative nasogastric tube insertion or investigator-assessed POI resulting in prolonged hospital stay or readmission), conversion rate, and protocol-defined prolonged POI (GI-2 > 5 postoperative days).In this study, 148 patients received hemicolectomy by the LC (42 left and 67 right) or HAL (39 left) approach. The conversion rate was 18.8% (25.4% LC left, 17.3% HAL left, 15% LC right). The mean time to GI-2 recovery was 4.4 days, and the mean postoperative LOS was 4.9 days, neither of which varied substantially by surgical approach. Prolonged POI occurred for 15 patients (10.1%), and POI-related morbidity occurred for 17 patients (11.5%). No patients were readmitted because of POI, whereas 3 patients (2%) were readmitted for all other causes.Mean GI recovery and LOS after LC were accelerated compared with those for patients in open laparotomy bowel resection clinical trials or those reported in large hospital databases (0.7 and 1.7-2.2 days, respectively). Overall POI-related morbidity was similar between the open bowel resection and LC populations, demonstrating that POI continues to present with important morbidity regardless of the surgical approach.