共 25 条
A Fast-Track Program Reduces Complications and Length of Hospital Stay After Open Colonic Surgery
被引:356
作者:

Muller, Sven
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机构: CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland

Zalunardo, Marco P.
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机构:
Univ Zurich Hosp, Inst Anesthesiol, CH-8091 Zurich, Switzerland CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland

Hubner, Martin
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机构: CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland

Clavien, Pierre A.
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机构: CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland

Demartines, Nicolas
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机构:
CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland
机构:
[1] CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland
[2] Univ Zurich Hosp, Inst Anesthesiol, CH-8091 Zurich, Switzerland
关键词:
RANDOMIZED CLINICAL-TRIAL;
INTRAVENOUS FLUID RESTRICTION;
EPIDURAL ANALGESIA;
MULTIMODAL OPTIMIZATION;
COLORECTAL SURGERY;
ENHANCED RECOVERY;
SURGICAL CARE;
RESECTION;
REHABILITATION;
CANCER;
D O I:
10.1053/j.gastro.2008.10.030
中图分类号:
R57 [消化系及腹部疾病];
学科分类号:
摘要:
Background & Aims: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery. Methods: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol. Results: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2-30 vs; 9 days, respectively; range, 6-30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7-10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367-8.283; P = .008) as independent predictors of postoperative complications. Conclusions: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program.
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页码:842 / 847
页数:6
相关论文
共 25 条
[1]
Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery
[J].
Andersen, J.
;
Hjort-Jakobsen, D.
;
Christiansen, P. S.
;
Kehlet, H.
.
BRITISH JOURNAL OF SURGERY,
2007, 94 (07)
:890-893

Andersen, J.
论文数: 0 引用数: 0
h-index: 0
机构:
HS Hvidovre Hosp, Dept Surg Gastroenterol, DK-2600 Hvidovre, Denmark HS Hvidovre Hosp, Dept Surg Gastroenterol, DK-2600 Hvidovre, Denmark

Hjort-Jakobsen, D.
论文数: 0 引用数: 0
h-index: 0
机构: HS Hvidovre Hosp, Dept Surg Gastroenterol, DK-2600 Hvidovre, Denmark

Christiansen, P. S.
论文数: 0 引用数: 0
h-index: 0
机构: HS Hvidovre Hosp, Dept Surg Gastroenterol, DK-2600 Hvidovre, Denmark

Kehlet, H.
论文数: 0 引用数: 0
h-index: 0
机构: HS Hvidovre Hosp, Dept Surg Gastroenterol, DK-2600 Hvidovre, Denmark
[2]
Randomized clinical trial of multimodal optimization and standard perioperative surgical care
[J].
Anderson, ADG
;
McNaught, CE
;
MacFie, J
;
Tring, I
;
Barker, P
;
Mitchell, CJ
.
BRITISH JOURNAL OF SURGERY,
2003, 90 (12)
:1497-1504

Anderson, ADG
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England

McNaught, CE
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England

MacFie, J
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England

Tring, I
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England

Barker, P
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England

Mitchell, CJ
论文数: 0 引用数: 0
h-index: 0
机构:
Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England Scarborough Gen Hosp, Combined Gastroenterol Unit, Scarborough YO12 6QL, England
[3]
Functional recovery after open versus laparoscopic colonic resection - A randomized, blinded study
[J].
Basse, L
;
Jakobsen, DH
;
Bardram, L
;
Billesbolle, P
;
Lund, C
;
Mogensen, T
;
Rosenberg, J
;
Kehlet, H
.
ANNALS OF SURGERY,
2005, 241 (03)
:416-423

Basse, L
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Jakobsen, DH
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Bardram, L
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Billesbolle, P
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Lund, C
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Mogensen, T
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Rosenberg, J
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark

Kehlet, H
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Hosp, Dept Surg Gastroenterol, DK-2650 Hvidovre, Denmark
[4]
Colonic surgery with accelerated rehabilitation or conventional care
[J].
Basse, L
;
Thorbol, JE
;
Lossl, K
;
Kehlet, H
.
DISEASES OF THE COLON & RECTUM,
2004, 47 (03)
:271-277

Basse, L
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Univ Hosp, Dept Surg Gastroenterol 435, DK-2650 Hvidovre, Denmark

Thorbol, JE
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Univ Hosp, Dept Surg Gastroenterol 435, DK-2650 Hvidovre, Denmark

Lossl, K
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Univ Hosp, Dept Surg Gastroenterol 435, DK-2650 Hvidovre, Denmark

Kehlet, H
论文数: 0 引用数: 0
h-index: 0
机构: Univ Copenhagen, Hvidovre Univ Hosp, Dept Surg Gastroenterol 435, DK-2650 Hvidovre, Denmark
[5]
The Declaration of Helsinki: an update on paragraph 30
[J].
Blackmer, J
;
Haddad, H
.
CANADIAN MEDICAL ASSOCIATION JOURNAL,
2005, 173 (09)
:1052-1053

Blackmer, J
论文数: 0 引用数: 0
h-index: 0
机构:
Canadian Med Assoc, Off Eth, Ottawa, ON K1G 3Y6, Canada Canadian Med Assoc, Off Eth, Ottawa, ON K1G 3Y6, Canada

Haddad, H
论文数: 0 引用数: 0
h-index: 0
机构:
Canadian Med Assoc, Off Eth, Ottawa, ON K1G 3Y6, Canada Canadian Med Assoc, Off Eth, Ottawa, ON K1G 3Y6, Canada
[6]
Laparoscopic surgery versus open surgery for colon cancer:: short-term outcomes of a randomised trial
[J].
Bonjer, HJ
;
Haglind, E
;
Jeekel, I
;
Kazemier, G
;
Páhlman, L
;
Hop, WCJ
;
Veldkamp, R
;
Kuhry, E
;
Haglind, E
;
Pahlman, L
;
Cuesta, MA
;
Msika, S
;
Morino, M
;
Lacy, A
;
Jeekel, I
.
LANCET ONCOLOGY,
2005, 6 (07)
:477-484

Bonjer, HJ
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Haglind, E
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Jeekel, I
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Kazemier, G
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Páhlman, L
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Hop, WCJ
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Veldkamp, R
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Kuhry, E
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Haglind, E
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Pahlman, L
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Cuesta, MA
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Msika, S
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Morino, M
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Lacy, A
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada

Jeekel, I
论文数: 0 引用数: 0
h-index: 0
机构: Dalhousie Univ, QE II Hlth Sci Ctr, Halifax, NS B3H 2Y9, Canada
[7]
Standardized perioperative care protocols and reduced length of stay after colon surgery
[J].
Bradshaw, BGG
;
Liu, SS
;
Thirlby, RC
.
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS,
1998, 186 (05)
:501-506

Bradshaw, BGG
论文数: 0 引用数: 0
h-index: 0
机构: Virginia Mason Med Ctr, Dept Anesthesia, Seattle, WA 98111 USA

Liu, SS
论文数: 0 引用数: 0
h-index: 0
机构: Virginia Mason Med Ctr, Dept Anesthesia, Seattle, WA 98111 USA

Thirlby, RC
论文数: 0 引用数: 0
h-index: 0
机构: Virginia Mason Med Ctr, Dept Anesthesia, Seattle, WA 98111 USA
[8]
Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens - A randomized assessor-blinded multicenter trial
[J].
Brandstrup, B
;
Tonnesen, H
;
Beier-Holgersen, R
;
Hjortso, E
;
Ording, H
;
Lindorff-Larsen, K
;
Rasmussen, MS
;
Lanng, C
;
Wallin, L
;
Iversen, LH
;
Gramkow, CS
;
Okholm, M
;
Blemmer, T
;
Svendsen, PE
;
Rottensten, HH
;
Thage, B
;
Riis, J
;
Jeppesen, IS
;
Teilum, D
;
Christensen, AM
;
Graungaard, B
;
Pott, F
.
ANNALS OF SURGERY,
2003, 238 (05)
:641-648

Brandstrup, B
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Tonnesen, H
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Beier-Holgersen, R
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Hjortso, E
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Ording, H
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Lindorff-Larsen, K
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Rasmussen, MS
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Lanng, C
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Wallin, L
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Iversen, LH
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Gramkow, CS
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Okholm, M
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Blemmer, T
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Svendsen, PE
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Rottensten, HH
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Thage, B
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Riis, J
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Jeppesen, IS
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Teilum, D
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Christensen, AM
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Graungaard, B
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark

Pott, F
论文数: 0 引用数: 0
h-index: 0
机构: HS Bispebjerg Univ Hosp, Clin Unit Prevent Med & Hlth Promot, DK-2400 Copenhagen NV, Denmark
[9]
Epidural analgesia enhances functional exercise capacity and health-related quality of lire after colonic surgery - Results of a randomized trial
[J].
Carli, F
;
Mayo, N
;
Klubien, K
;
Schricker, T
;
Trudel, J
;
Belliveau, P
.
ANESTHESIOLOGY,
2002, 97 (03)
:540-549

Carli, F
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada

Mayo, N
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada

Klubien, K
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada

Schricker, T
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada

Trudel, J
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada

Belliveau, P
论文数: 0 引用数: 0
h-index: 0
机构:
McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada McGill Univ, Ctr Hlth, Royal Victoria Hosp, Dept Anesthesia, Montreal, PQ HA1, Canada
[10]
Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection
[J].
Delaney, CP
;
Zutshi, M
;
Senagore, AJ
;
Remzi, FH
;
Hammel, J
;
Fazio, VW
.
DISEASES OF THE COLON & RECTUM,
2003, 46 (07)
:851-859

Delaney, CP
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA

Zutshi, M
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA

Senagore, AJ
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA

Remzi, FH
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA

Hammel, J
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA

Fazio, VW
论文数: 0 引用数: 0
h-index: 0
机构:
Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Colorectal Surg, Cleveland, OH 44195 USA