Ảnh hưởng của thời gian phẫu thuật đến các biến chứng phổi sau phẫu thuật trong cắt bỏ đại tràng qua nội soi so với cắt bỏ đại tràng mở

Surgical Endoscopy And Other Interventional Techniques - Tập 27 - Trang 3555-3563 - 2013
Rachel M. Owen1,2, Sebastian D. Perez2, Nathan Lytle1, Ankit Patel1, S. S. Davis1, Edward Lin1, John F. Sweeney1,2
1Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, US
2Department of Surgery Patient Safety and Data Management Program, Emory University School of Medicine, Atlanta, US

Tóm tắt

Thời gian phẫu thuật kéo dài có liên quan đến tỷ lệ biến chứng và tỷ lệ tử vong sau phẫu thuật tăng lên. Mặc dù cắt bỏ đại tràng qua nội soi (LC) thường có thời gian phẫu thuật dài hơn so với cắt bỏ đại tràng mở (OC), các nghiên cứu cho thấy một cách nghịch lý là tỷ lệ biến chứng sau LC lại giảm so với OC. Tác động trực tiếp của thời gian phẫu thuật đối với các biến chứng phổi sau phẫu thuật (PPC) sau LC so với OC chưa được phân tích. Chúng tôi đã tra cứu dữ liệu ACS/NSQIP năm 2009-2010 cho các bệnh nhân đã trải qua phẫu thuật LC và OC theo ý muốn. Mối liên quan giữa thời gian phẫu thuật và PPC (viêm phổi, thở máy >48 giờ, và thở máy không kế hoạch) đã được đánh giá. Các mô hình hồi quy đa biến đã được tạo ra để xác định ảnh hưởng độc lập của thời gian phẫu thuật đến sự phát triển của PPC, kiểm soát cho LC so với OC. Tổng cộng có 25,419 ca cắt bỏ đại tràng (13,741 ca qua nội soi và 11,678 ca mở) đã được xem xét; 765 (3%) bệnh nhân đã trải qua ít nhất một PPC. Các mô hình hồi quy cho thấy rằng đối với cả LC và OC, mỗi lần tăng 60 phút thời gian phẫu thuật lên đến 480 phút có liên quan đến việc tăng 13% xác suất PPC [tỷ lệ odds (OR) 1.13; khoảng tin cậy 95% (CI) 1.07-1.19]. Vượt quá 480 phút, mỗi khoảng thời gian bổ sung 60 phút có liên quan đến việc tăng 33% nguy cơ PPC (OR 1.33; 95% CI 1.12-1.58). Tổng quan, PPC xảy ra ít hơn một nửa sau LC [270 (2%) qua nội soi so với 497 (4.3%) mở; OR 0.45; 95% CI 0.39-0.53]. Thời gian phẫu thuật có liên quan độc lập đến nguy cơ tăng lên của PPC ở bệnh nhân trải qua LC và OC. Tuy nhiên, phương pháp nội soi có nguy cơ tuyệt đối của PPC chỉ bằng một nửa và, khi an toàn, nên được ưu tiên sử dụng mặc dù có khả năng kéo dài thời gian phẫu thuật.

Từ khóa

#cắt bỏ đại tràng #phẫu thuật qua nội soi #phẫu thuật mở #biến chứng phổi #thời gian phẫu thuật #dữ liệu ACS/NSQIP

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