Ressecção hepática em centro não académico em Portugal: que resultados?
Abstract
Objectivo: O crescimento do conhecimento médico produziu necessidades profundas de remodelação no funcionamento das Especialidades Médicas. Nesse contexto surgiram disciplinas dentro da Cirurgia Geral que, não sendo ainda subespecialidades, têm vindo a ser praticadas de forma cada vez mais independente, sobretudo nos hospitais de maiores dimensões. Em 2010 foi criado o grupo de estudo e tratamento de patologia Hepato-Bilio-Pancreática cirúrgica de um dos Serviços de Cirurgia Geral do Hospital dos Autores, que tem vindo a desenvolver actividade cirúrgica no âmbito da ressecção hepática. Decorridos cinco anos, os Autores pretendem avaliar os resultados da sua actividade e compará-los com os da literatura, nomeadamente com os resultados de centros de elevado volume. Material e Métodos: Foram analisados os registos efectuados em Base de Dados prospectiva que inclui todos os doentes submetidos a ressecção hepática electiva, no Serviço, entre Janeiro 2010 e Fevereiro de 2015. Resultados: A taxa de morbilidade global foi de 25,2%, metade da qual é relativa a complicações hepato-específicas. A taxa de complicações graves (Clavien-Dindo III e IV) foi de 11,7%. A mortalidade foi de 0,9%. Quatro vírgula nove porcento dos doentes necessitaram de re-intervenção. Conclusões: Os resultados obtidos são sobreponíveis aos publicados na literatura de centros de elevado volume. Mais do que o volume, a qualidade de cuidados é reflectida pela forma global como o doente é avaliado, tratado e seguido. Se utilizados os recursos e a metodologia apropriada, os doentes que necessitem de cirurgia de ressecção hepática podem ser operados com segurança fora de centros académicos.
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