大腸癌手術のクリニカルパスの検討 : 開腹手術と腹腔鏡下手術の比較 Examination of Clinical Pathway for Colorectal Cancer : Comparison between Operation with Open and Laparoscopic-assisted Method

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目的: 当院で開院時に導入した大腸切除のクリニカルパスの妥当性および,パス達成に寄与する因子について検討した.対象と方法: 初発結腸癌および直腸S状部癌待機手術143例(開腹手術82例以下O群,腹腔鏡下手術61例以下L群)を対象とした.O群(術後4病日食事開始,10病日退院),L群(術後3病日食事開始,8病日退院)のパス管理を全例に施行した.1. 食事開始時期および術後在院期間のパスで規定した日より延長した日数,パス達成度について検討,2. 両群を前期,後期に分けて検討,3. ロジスティック回帰分析を行い,パス達成に関与する因子を検討した.結果: 1. L群の方が,術後在院日数の延長日数が短く,パス達成率は高率であった.2. 後期のL群で有意に食事開始時期が早くなり,パス達成率も上昇したが,O群での改善は認めなかった.3. パス達成に関与する因子は,O群で術後合併症,L群で術前併存症,中枢側郭清,食事開始時期であった.<br>

We examined the propriety of clinical pathway for colorectal cancer operation that was used and the factors influencing the pathway achievement. We studied 143 cases (82 cases of open method, 61 cases of laparoscopic-assisted method), all of them used two pathways open method (oral intake: 4th postoperative day, discharge: 10th postoperative day) and laparoscopic-assisted method (oral intake: 3rd postoperative day, discharge: 8th postoperative day). In this study, extended days of oral intake, postoperative hospital stay, achievement rate of the path, comparison between the former and the latter period, and factors influencing achievement of the pathway were analyzed in respect of the two methods. The laparoscopic-assisted method had a smaller number of extended days in the postoperative hospital stay and higher achievement rate than the open method. The laparoscopic-assisted method in the latter period had a smaller number of extended days in the postoperative hospital stay and higher achievement rate than that in the former. The factors influening the pathway achievement were postoperative complications in the open method group and preoperative coexistence symptom, proximal lymph node dissection, and oral intake in Laparoscopic-assisted method group.<br>

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 61(4), 161-168, 2008-04-01

    The Japan Society of Coloproctology

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