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首页> 外文期刊>Surgical Endoscopy >Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients' outcome and cost-effectiveness.
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Laparoscopic vs. open surgery for acute adhesive small-bowel obstruction: patients' outcome and cost-effectiveness.

机译：腹腔镜与开放式手术治疗急性粘连性小肠梗阻：患者的疗效和成本效益。

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BACKGROUND: Numerous studies have demonstrated the feasibility of laparoscopy in the management of acute adhesive small-bowel obstruction (AASBO). However, comparative data with laparotomy are lacking. The aim of this study was to compare laparoscopy and laparotomy for the treatment of AASBO in terms of patient outcome and cost-effectiveness. METHODS: A retrospective chart review of all patients who underwent surgery for AASBO from 1999 to 2005 was conducted. Data recorded included operative and postoperative course, among others. Operative and total hospital charges were estimated from the Patient Accounting System. RESULTS: Thirty-one patients who underwent laparoscopy were matched to a similar group of patients who underwent laparotomy. In the laparoscopy group, four patients (13%) had a laparoscopy-assisted procedure and ten patients (32%) were converted. The laparoscopy group was subdivided into laparoscopy, laparoscopy-assisted, converted, and assisted-converted subgroups. In the majority of the patients, AASBO was secondary to a single band. Overall morbidity was significantly higher in the laparotomy group (p = 0.007). Morbidity rates were statistically significant between the laparoscopy and assisted-converted subgroups (p = 0.0001) but not between the laparotomy group and assisted-converted subgroup (p = 0.19). Median hospital stay and median time to first bowel movement were significantly shorter in the laparoscopy group. Charge data were available for only the last three years of the study. Operative charges and total hospital charges were similar between the laparoscopy and the laparotomy groups (p = 0.14 and p = 0.10, respectively). There was a significant difference in total hospital charges between the laparoscopy subgroup and laparotomy group (p = 0.03). CONCLUSIONS: Laparoscopy for AASBO is associated with reduced hospital stay, early recovery, and decreased morbidity. Laparoscopy-assisted and converted surgeries do not differ significantly from laparotomy in regard to patient outcome. Operative and total hospital charges are similar for both laparoscopy and laparotomy.
机译：背景：大量研究表明，腹腔镜检查在治疗急性粘连小肠梗阻（AASBO）中的可行性。但是，缺乏剖腹手术的比较数据。这项研究的目的是从患者预后和成本效益方面比较腹腔镜和剖腹术治疗AASBO。方法：对1999年至2005年所有接受AASBO手术的患者进行回顾性图表回顾。记录的数据包括手术和术后过程等。手术费用和总医院费用由患者会计系统估算得出。结果：31例接受了腹腔镜检查的患者与一组相似的接受了剖腹手术的患者相匹配。在腹腔镜检查组中，有4例患者（13％）进行了腹腔镜辅助手术，有10例患者（32％）进行了转换。腹腔镜检查组又分为腹腔镜检查，腹腔镜辅助，转换和辅助转换的亚组。在大多数患者中，AASBO仅次于单个频段。剖腹手术组的总发病率明显更高（p = 0.007）。腹腔镜检查和辅助转换亚组之间的发病率具有统计学意义（p = 0.0001），但剖腹手术组和辅助转换亚组之间的发病率则无统计学意义（p = 0.19）。腹腔镜检查组的中位住院时间和首次排便的中位时间明显缩短。收费数据仅适用于研究的最后三年。腹腔镜检查组和剖腹手术组之间的手术费用和总医院费用相似（分别为p = 0.14和p = 0.10）。腹腔镜检查亚组和剖腹手术组之间的总住院费用存在显着差异（p = 0.03）。结论：腹腔镜检查AASBO与住院时间减少，早期康复和发病率降低有关。在患者预后方面，腹腔镜辅助手术和经转换的手术与剖腹手术没有显着差异。腹腔镜检查和剖腹手术的手术费用和总医院费用相似。

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