JAMA Surg:肿瘤外科手术医师技巧与患者预后

2020-05-11 MedSci原创 MedSci原创

研究认为,在复杂的肿瘤外科治疗过程中,术中手术技巧对患者预后的影响是十分明显的,不同外科医生在技术表现上存在显著差异,并与临床和病理结果显著相关。

复杂外科手术,特别是肿瘤手术,患者预后的差异较大,近日研究人员通过量化腹腔镜手术中的手术技能,考察其与组织病理学和临床结果的关系。
 
研究在澳大利亚开展,接受腹腔镜直肠癌全直肠系膜切除患者参与研究,包括176例临床上距肛缘15厘米或15厘米以下的T1至T3直肠腺癌患者。34名外科医生出于治疗目的进行腹腔镜全直肠系膜切除术。研究的主要终点为组织病理学(直肠系膜剥离平面以及ALaCaRT复合终点成功[直肠系膜筋膜平面,周缘≥1 mm;远缘≥1 mm])和30天预后。
 
研究建立了腹腔镜全直肠系膜切除术性能测试工具,经专家验证是可靠有效的(组内相关系数,0.889)。不同医生得分变化显著(范围25-48)。评分与术中错误次数、直肠系膜剥离平面、短期患者发病率(包括并发症的数量和严重程度)相关。得分最高1/4外科医生与最低1/4外科医生相比,获得更好的组织病理学及患者预后结果(直肠间筋膜平面:93% vs 59%,需治疗次数[NNT]:2.9;ALaCaRT终点成功率,83% vs58%;NNT:4;30天并发症率,23%vs50%;NNT:3.7)。
 
研究认为,在复杂的肿瘤外科治疗过程中,术中手术技巧对患者预后的影响是十分明显的,不同外科医生在技术表现上存在显著差异,并与临床和病理结果显著相关。
 
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  2. [GetPortalCommentsPageByObjectIdResponse(id=1692132, encodeId=72c41692132d7, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Jan 18 17:15:47 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343395, encodeId=8d691343395c9, content=<a href='/topic/show?id=d3ea4293676' target=_blank style='color:#2F92EE;'>#外科手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42936, encryptionId=d3ea4293676, topicName=外科手术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Wed May 13 10:15:47 CST 2020, time=2020-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=382731, encodeId=53e6382e31bb, content=这个真的是必须的, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Tue May 12 05:42:51 CST 2020, time=2020-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036087, encodeId=1a5d103608eb6, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon May 11 22:15:47 CST 2020, time=2020-05-11, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1692132, encodeId=72c41692132d7, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Jan 18 17:15:47 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343395, encodeId=8d691343395c9, content=<a href='/topic/show?id=d3ea4293676' target=_blank style='color:#2F92EE;'>#外科手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42936, encryptionId=d3ea4293676, topicName=外科手术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Wed May 13 10:15:47 CST 2020, time=2020-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=382731, encodeId=53e6382e31bb, content=这个真的是必须的, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Tue May 12 05:42:51 CST 2020, time=2020-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036087, encodeId=1a5d103608eb6, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon May 11 22:15:47 CST 2020, time=2020-05-11, status=1, ipAttribution=)]
    2020-05-12 njwbhuang

    这个真的是必须的

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1692132, encodeId=72c41692132d7, content=<a href='/topic/show?id=a450530853c' target=_blank style='color:#2F92EE;'>#患者预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53085, encryptionId=a450530853c, topicName=患者预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8f4729287700, createdName=bnurmamat, createdTime=Mon Jan 18 17:15:47 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343395, encodeId=8d691343395c9, content=<a href='/topic/show?id=d3ea4293676' target=_blank style='color:#2F92EE;'>#外科手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42936, encryptionId=d3ea4293676, topicName=外科手术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Wed May 13 10:15:47 CST 2020, time=2020-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=382731, encodeId=53e6382e31bb, content=这个真的是必须的, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Tue May 12 05:42:51 CST 2020, time=2020-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036087, encodeId=1a5d103608eb6, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Mon May 11 22:15:47 CST 2020, time=2020-05-11, status=1, ipAttribution=)]
    2020-05-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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