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複合式手術室在耳鼻喉頭頸外科之初步應用

Preliminary Report on Hybrid Operating Room Usage in Otorhinolaryngology-Head and Neck Surgery

摘要


背景:複合式手術室(hybrid operating room)將先進影像檢查設備配置在開刀房內,讓外科醫師開刀時可定位病灶以進行精確手術切除或介入治療。心臟血管外科等已將複合式手術室運用於臨床,但耳鼻喉頭頸外科領域卻甚少報導。本研究分析本院複合式手術室使用情形,並分享耳鼻喉頭頸外科臨床經驗。方法:本研究蒐集童綜合醫院2018年10月至2021年1月間使用複合式手術室個案,將其中接受頭頸部手術和血管手術患者,收集有關基本資料、診斷、參與科別、病史、手術細節、結果等數據進行回顧性研究。結果:耳鼻喉頭頸外科病患占2.8%(9/316人次),77.8%(7/9人次)進行血管介入處置或進行聯合手術,88.9%(8/9人次)心血管疾病危險因子,11.1%(1/9人次)困難呼吸道,55.6%(5/9人次)血管被腫瘤包覆,22.2%(2/9人次)血管瘤。使用複合式手術室病患給付費用皆比實際發生費用少,平均虧損54,225元。在使用複合式手術室時,若要減少費用花費,可由減少術中失血量與降低插氣管內管天數著手。結論:使用複合式手術室之前應建立術前詳細規劃。耳鼻喉頭頸外科中頸動脈有腫瘤浸潤或動脈瘤之病患,可運用複合式手術室手術進行「一站式」血管介入處置,減少術中或術後大量出血併發症可能,以達較佳的醫療品質。

並列摘要


BACKGROUND: A hybrid operating room is an operating room equipped with advanced imaging equipment, an important international advancement in recent years. Using the room's imaging equipment, the surgeon can locate a lesion for precise surgical resection or other intervention. Hybrid operating rooms have been used in cardiovascular surgery, thoracic surgery, general surgery, and obstetrics and gynecology, among other fields. However, their use has rarely been reported in the field of Otorhinolaryngology-Head and Neck Surgery. We analyzed the use of the hybrid operating room in our hospital and the results obtained in Otolaryngology-Head and Neck Surgery cases. Here, we share our clinical experience. METHODS: Our retrospective analysis of cases completed in the hybrid operating room in Tungs' Taichung MetroHarbor Hospital from October 2018 to January 2021 included cases of patients who underwent head and neck surgery and vascular surgery. The data collected were the relevant basic profile, personal medical history, and therapeutic history of the patients; the diagnosis; participating departments; surgical details; and results. A comprehensive report of the patient's condition was also obtained. RESULTS: Otorhinolaryngology-Head and Neck Surgery patients accounted for 2.8% of the surgical cases (9/316), with 77.8% (7/9) undergoing a vascular intervention or combined surgery, 88.9% (8/9) having cardiovascular disease risk factors, 11.1% (1/9) having a difficult airway, 55.6% (5/9) having blood vessels encased by tumors, and 22.2% (2/9) having hemangioma. Patients using the hybrid operating room paid less than the actual cost of the room's use, for an average loss of 54,225 New Taiwan dollars. During use of a hybrid operation room, costs can be reduced if intraoperative blood loss and the duration of tracheal intubation are reduced. CONCLUSIONS: A clear vision for the use of a hybrid operating room should be established before planning its installation. When the condition of the patients using the room is more complicated than the norm, and when their survival is limited, medical economics suggests that a hybrid operating room should not be used. However, in the spirit of treating patients with kindness, Otorhinolaryngology-Head and Neck Surgery patients with tumor infiltration into the neck vessels could benefit from a hybrid operating room to reduce the possibility of perioperative and postoperative vascular complications. Use of such a room is recommended, regardless of cost, so as to improve the quality of care.

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