当科における結腸癌に対する結腸切除クリニカルパスの導入

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  • トウ カ トウキョウ ジョシイカ ダイガク ヒガシイリョウ センター ゲカ ニ オケル ケッチョウガン ニ タイスル ケッチョウ セツジョ クリニカルパス ノ ドウニュウ
  • Induction of Clinical Pathway to Colectomy for Colon Cancer

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The object of our study was to assess the clinical pathway used for colectomy at our department. A total of 41 patients, 25 patients with open colectomy (OC) and 16 patients with laparoscopy-assisted colectomy (LAC), were included. The differences of these two groups were analyzed for patients' background and variances of clinical pathway. In background characteristics between the OC and LAC, the depth of invasion, node status, and pathological staging were significantly more advanced in the OC than the LAC (p<0.0001, p=0.0492, and p<0.0001, respectively). So lymph node dissection were more broadly in the OC (p<0.0001). In contrast, the LAC had lower amount hemorrhage, earlier ambulatory status, earlier first flatus, and were discharged earlier than the OC (p=0.0014, p=0.0646, p<0.0001, and p=0.0475, respectively). Negative variances were identified in 38 patients in the OC and 9 in the LAC. The most common negative variances for hospital discharge was postoperative adjuvant chemotherapy. These results suggest that it is difficult to apply our current clinical pathway to both OC and LAC. To reduce negative variances and facilitate early hospital discharge, a revised pathway is needed.

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