教科书式结局在结直肠癌手术评价中的应用与分析  

Application and analysis of textbook outcome in the evaluations of colorectal cancer surgery

作　　者：梁宗康 张波 孙博 武少杰 何显力 Liang Zongkang;Zhang Bo;Sun Bo;Wu Shaojie;He Xianli(Department of Graduate Studies,Xi'an Medical University,Shaanxi Xi'an 710021,China;Department of General Surgery,Second Affiliated Hospital,Air Force Medical University,Shaanxi Xi'an 710038,China)

机构地区：[1]西安医学院研究生工作部,陕西西安710021 [2]空军军医大学第二附属医院普通外科,陕西西安710038

出　　处：《腹部外科》2025年第1期54-62,共9页Journal of Abdominal Surgery

基　　金：陕西省重点产业创新链(群)-社会发展领域项目(2022ZDLSF04-05)。

摘　　要：目的 探讨影响结直肠癌手术教科书式结局(textbook outcome,TO)达成率的相关因素,并尝试提出其标准化的定义。方法 根据系统性综述和荟萃分析报告的首选项目(PRISMA)准则,对PubMed等数据库进行文献检索,对符合纳入标准的文章进行数据的提取、分析。结果 经过纳入排除标准筛选后纳入了15篇文章,总计1 345 149例结直肠癌病人术后进行了TO参数的监测,TO达成率平均为57.4%,其中结肠癌病人为60.1%,直肠癌病人为52.3%。高龄、男性、较高的美国麻醉医师协会评分、查尔森合并症指数评分、开放手术、急诊手术、存在肿瘤并发症、较高的肿瘤分期、额外的局部肿瘤侵袭性切除、手术时间较长、术前缺乏抗生素肠道准备、虚弱、依赖护理的生存状态、伴有基础疾病、体重指数≥30 kg/㎡等对达成TO具有负面影响,而年轻、女性、拥有私人保险、微创手术、具有独立的功能状态、术前机械准备、抗生素肠道准备、术前较高的红细胞压积等则对达成TO具有促进作用。结论 TO是一个已被证明能被用来衡量手术结果的高质量指标,在结直肠癌手术中,TO的定义应该包括无死亡、R0切除、无术后并发症、住院时间、无计划外再入院以及淋巴结清扫。Objective To explore the influencing factors of achievement rate of textbook outcome(TO)after colorectal cancer surgery and propose a standardized definition.Methods A systematic literature search was conducted through the databases of PubMed,Embase,Cochrane and Web of Science according to the PRISMA guidelines.Then the authors extracted the relevant articles fulfilling the inclusion criteria.Results Overall,15 articles were included with a total of 1345149 patients undergoing colorectal cancer surgery.The average TO rate was 57.4%.The average TO rate was 60.1%for colon cancer and 52.3%for rectal cancer.Advanced age,male,high ASA score,high CCI score,open surgery,emergency surgery,tumor complications,higher tumor stage,additional local tumor invasive resection,longer operative duration,lack of preoperative antibiotic bowel preparation,frailty,nursing dependent survival state,concurrent basal diseases and BMI≥30 kg/㎡were negative factors for achieving TO.Youth,female gender,owning private insurance,mini-invasive surgery,independent functional status,preoperative mechanical preparation,bowel preparation with antibiotics and higher preoperative hematocrit were associated with attaining TO.Conclusion TO is a quality indicator for measuring surgical outcomes.For colorectal cancer surgery,the definition of TO should include no death,R0 resection,no postoperative comeplications,length of hospitalization stay,no unplanned readmission and lymph node dissection.

关 键 词：结直肠癌 教科书式结局 外科手术 质量控制 

分 类 号：R735.3[医药卫生—肿瘤]