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首页> 外文期刊>Surgical Endoscopy >What influences conversion to open surgery during laparoscopic colorectal resection?
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What influences conversion to open surgery during laparoscopic colorectal resection?

机译：在腹腔镜结肠直肠切除期间转化为开放手术的转化是什么？

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Introduction We analyzed the risk of morbidity and mortality in laparoscopic (Lap) conversion for colorectal surgery across a group of subspecialist surgeons with expertise in minimally invasive techniques. Methods We reviewed prospective data patients who underwent abdominopelvic procedures from 7/1/2007 to 12/31/2016 at a tertiary care facility. We identified procedures that were converted from Lap to open (Lap converted). Lap converted procedures were matched to Lap completed and open procedures based on elective versus urgent and surgeon. We also abstracted patient demographics and outcomes at 30 days using the American College of Surgeons National Surgical Quality Improvement Program defined adverse event list. We analyzed outcomes across these groups (Lap converted, Lap completed, open procedures) with x(2) and t tests and used the Bonferroni Correction to account for multiple statistical testing. Results From a database of 12,454 procedures, we identified 100 Lap converted procedures and matched them to 305 open procedures and 339 Lap completed procedures. In our dataset of abdominopelvic procedures, Lap techniques were attempted in 49 +/- 1%. We noted a higher risk of aggerate morbidity following open procedures (33 +/- 10) as compared to Lap converted (29 +/- 17%) and the matched Lap completed procedures (18 +/- 8%; p < 0.001). Converted cases had the longest operative time (222 +/- 102 min), compared to lap completed (177 +/- 110), and open procedures (183 +/- 89). There were no differences in mortality, sepsis complications, anastomotic leaks, or unplanned returns to the operating room across the three operative groups. Conclusions Although aggregate morbidity of Lap converted procedures is higher than in Lap completed procedures, it remains less than in matched open procedures. Compared to Lap completed procedures, the additional morbidity of Lap converted procedures appears to be related to additional surgical site infection risk. Our data suggest that surgeons should not necessarily be influenced by additional complications associated with conversion when contemplating complex laparoscopic colorectal procedures
机译：导言：我们分析了一组具有微创技术专长的亚专科外科医生在腹腔镜（Lap）结肠直肠手术转换中的发病率和死亡率风险。方法我们回顾了2007年7月1日至2016年12月31日在一家三级医疗机构接受腹部肾盂手术的患者的前瞻性数据。我们确定了从Lap转换为open（Lap转换）的程序。Lap转换程序与Lap完成和开放程序相匹配，基于选择性与紧急和外科医生。我们还使用美国外科医生学会国家外科质量改进计划定义的不良事件列表，提取了30天内的患者人口统计数据和结果。我们通过x（2）和t检验分析了这些组的结果（Lap转换、Lap完成、开放程序），并使用Bonferroni校正来解释多重统计检验。结果从12454个程序的数据库中，我们确定了100个圈转换程序，并将其与305个开放程序和339个圈完成程序相匹配。在我们的腹盆手术数据集中，49+/-1%的患者尝试了Lap技术。我们注意到开放手术（33+/-10）后发生聚集性疾病的风险高于转圈手术（29+/-17%）和匹配转圈手术（18+/-8%；p<0.001）。转换病例的手术时间最长（222+/-102分钟），而完成搭接手术（177+/-110分钟）和开放手术（183+/-89分钟）。三个手术组在死亡率、败血症并发症、吻合口瘘或意外返回手术室方面没有差异。结论尽管Lap转换手术的总发病率高于Lap完成手术，但仍低于匹配的开放手术。与Lap完成的手术相比，Lap转换手术的额外发病率似乎与额外的手术部位感染风险有关。我们的数据表明，在考虑复杂的腹腔镜结直肠手术时，外科医生不一定会受到与转换相关的额外并发症的影响

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