POSSUM、P-POSSUM和Cr-POSSUM对结直肠癌患者住院期间病死率预测能力的比较

目的 比较并发症和病死率的生理和手术严重性评分(physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM)、并发症和病死率的生理和手术严重性评分(Portsmouth POSSUM,P-POSSUM)、结直肠切除的并发症和病死率的生理和手术严重性评分(colorectal POSSUM,Cr-POSSUM)对结直肠癌患者住院期间病死率的预测能力.方法 调查北京大学第三医院1992-2005年903例结直肠癌外科手术切除的资料.903例中,结肠癌518例,直肠癌385例.用ROC曲线分析判断评分的判别能力,用Hosmer-Lemeshow检验判断评分的拟合优度,用不同危险因素群的O∶E值判断评分的预测能力.结果 903例患者住院期间的病死率为1.0%(9/903).POSSUM、P-POSSUM、Cr-POSSUM预测的病死率分别为5.6%、2.8%、4.8%,三种评分预测的病死率明显高于实际的病死率,O:E值分别为0.18、0.35、0.2.结论 POSSUM、P-POSSUM和Cr-POSSUM在结直肠癌手术中预测的病死率高于实际病死率.     

结直肠癌患者住院期间死亡及并发症的危险因素分析

目的研究结直肠癌患者住院期间死亡和并发症的危险因素。方法收集北京大学第三医院1992—2005年收治的903例结直肠癌患者的临床资料,对自变量（包括30个术前危险因素、13个术中危险因素）和因变量（包括住院期间死亡和并发症）进行分析,用Logistic回归确定住院期间死亡和并发症的危险因素。结果住院期间的病死率为1.0%（9/903）,总并发症发生率为21.8%（197/903）。术后发生吻合口漏、脑血管意外、肺部感染的患者住院期间病死率明显升高。住院期间死亡的高危因素包括姑息性手术、总蛋白水平低;总并发症的危险因素包括采用腹会阴联合直肠癌切除术、术前血清钠〉145mmol/L、急诊手术、术前白细胞计数〉10000/mm^3、术中输血、合并糖尿病、姑息手术、高龄、低白蛋白血症;腹部伤口感染的危险因素为急诊手术、合并糖尿病、肥胖。结论术前对住院期间的病死率和并发症发生率进行预测,对临床评价手术风险有参考意义。     

置入支架后择期手术与急诊手术在梗阻性结直肠癌中的对比研究

目的:探讨置入支架后择期手术与急诊外科手术2种治疗方式的临床价值。方法:回顾性分析90例梗阻性结直肠癌患者的临床资料。其中30例临时置入金属支架,择期手术治疗(支架组);60例行急诊手术治疗(急诊手术组)。比较支架组与急诊手术组的一期切除吻合率、手术时间、术后通气时间、并发症发生率和住院期间病死率等指标。结果:支架组一期切除吻合率(96.67%)明显高于急诊手术组(56.67%,P<0.001)。支架组术后并发症(6.67%)明显低于急诊手术组(26.67%,P<0.05)。支架组住院期间病死率与急诊手术组相比,差异无统计学意义(P>0.05)。支架组手术时间、术后通气时间分别为(156.13±49.79)min,(3.60±1.40)d,明显低于急诊手术组(P<0.05)。结论:置入支架可迅速、有效缓解梗阻性结直肠癌症状。置入支架后择期手术与急诊手术相比可增加一期切除吻合率,减少并发症,可作为缓解梗阻性结直肠癌的一项有效治疗方法。     

80岁以上高龄结直肠癌患者的术后并发症相关因素分析

目的分析80岁以上高龄结直肠癌术后并发症发生的相关因素,探讨围手术期的治疗。方法回顾性分析湖州市中心医院2008月12月至2018年12月期间收治并行手术治疗的90例80岁以上高龄结直肠癌患者的临床资料。结果择期手术79例(88%),急诊手术11例(12%);平均手术时间145.7分钟,平均获取淋巴结16.8枚,手术中平均出血量65ml。共35例(39%)出现术后并发症,其中5例患者因心肌梗死、肠瘘伴腹腔感染、呼衰、肺部感染或心衰死亡。高龄结直肠肿瘤患者术后发生并发症与有无合并肿瘤梗阻、基础疾病类型及手术方式有关(均P0.05)。结论 80岁以上高龄结直肠癌患者尽管术后并发症发生率较高,但经充分术前评估、积极治疗基础疾病以及术后处理,能够很好耐受手术。     

早期经口进食在结直肠癌术后快速流程模式中的应用

目的 探讨结直肠癌术后早期经口进食的可行性、安全性及术后早期康复情况.方法 回顾性分析2008 年1～6月期间,四川大学华西医院胃肠外科中心结直肠外科专业组收治的128例结直肠癌患者的临床资料,56 例为早期经口进食(early oral feeding,EOF)组,72 例为传统进食(traditional feeding,TF)组.比较2组病例术后住院时间,术后首次排气和排便时间,以及胃潴留、肠梗阻、重度腹泻、肺部感染、伤口感染、吻合口漏等并发症发生率.结果 EOF组术后住院时间,术后首次排气、排便时间均短于TF组,差异有统计学意义(P<0.05); EOF组胃潴留发生率高于TF组,差异有统计学意义(P<0.05),而2组肠梗阻、重度腹泻、肺部感染、伤口感染及吻合口漏的发生率差异均无统计学意义(P>0.05).早期经口进食耐受率可达89.29%(50/56).结论 结直肠癌术后行早期经口进食是安全、可行的,能促进患者的早期康复.     

结肠癌并发急性肠梗阻的外科治疗

目的 探讨结肠癌并发急性肠梗阻的治疗方法及效果.方法 回顾性分析64例结肠癌并发急性肠梗阻患者急诊手术治疗的临床资料.左半结肠癌和直肠癌43例,右半结肠癌21例.其中行I期切除吻合44例(左半结肠23例,右半结肠2l例).结果 术后发生肺部感染3例,吻合口瘘1例,切口裂开1例,伤口感染7例,并发症发生率为18.7%(1...     

结直肠癌伴糖尿病37例围手术期处理

目的总结结直肠癌伴糖尿病患者的围手术期处理经验。方法对我院2001~2009年期间手术治疗的37例结直肠癌伴糖尿病患者的临床资料进行回顾性分析。结果 37例患者均为2型糖尿病,行择期手术,术后发生切口感染7例(18.9%),吻合口漏1例(2.7%),骶前间隙积脓2例(5.4%),肺部感染4例(10.8%),泌尿系感染2例(5.4%),无酮症酸中毒发生。术后平均住院时间22 d,无围手术期死亡病例。结论结直肠癌伴糖尿病患者围手术期严格控制血糖,选择合理术式,应用有效抗生素、营养支持等治疗,可达到较满意的外科治疗效果。     

老年结直肠癌并糖尿病的围手术期处理

目的探讨老年结直肠癌合并糖尿病患者围手术期的处理。方法对28例老年结直肠癌合并糖尿病患者的手术进行了回顾性分析。结果限期手术22例,急诊手术6例。治愈率71.4%(20/28),好转率25%(7/28),病死率3.6%(1/28)。术后并发切口感染5例,肺部感染2例,心律失常2例,泌尿感染2例,真菌感染1例,吻合口瘘1例,无酮症酸中毒。结论对合并糖尿病的老年结直肠癌患者给手术带来不利因素,但强调围手术期严格控制血糖,作好必要的肠道准备,合理使用抗生素,选择合理的手术时间及麻醉方式,有效的营养支持,是获得理想的外科治疗效果的有效措施。     

结直肠癌评分系统对术后病死率预测能力的研究

目的 评估大不列颠和爱尔兰结直肠协会(Association of Coloproctology of Great Britain and Ireland,ACPGBI)评分系统在国内的临床应用价值.方法 回顾性分析1992-2005年904例结直肠癌患者的临床资料,其中结肠癌525例,直肠癌379例.按照手术时机、疾病种类将病例分为急诊手术组、非急诊手术组;结直肠专科医师手术组、其他外科医师手术组;结肠癌组、直肠癌组.分别计算各组预测病死率,根据ACPGBI评分计算预测结果,并与实际结果进行比较.数据采用t检验、x2检验、受试者工作特征曲线-ROC(receiver operator characteristic curve)、拟合优度(goodness-of-fit)检验、不同危险因素群的O:E比,并分组进行评判.结果 术后30天内实际病死率1.0%(9/904).ACPGBI预测病死率为8.3%(75/904).对于急诊手术组、非急诊手术组、专科医生手术组、非专科医生手术组、结肠癌组和直肠癌组,预测值均偏高.病死率预测高的组,实际病死率也高.结论 ACPGBI预测病死率高于结直肠癌手术后实际病死率.ACPGBI预测结直肠癌手术后病死率的趋势,有一定临床意义.     

从术后并发症角度探讨结直肠癌腹腔镜手术操作要点

英国CLASICC前瞻性随机临床对照研究结果显示,结直肠癌腹腔镜手术组术后并发症发生率为33.1%(160/484),主要包括肺部感染、切口感染、吻合口瘘、小肠梗阻等[1].     

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目的探讨高龄结、直肠癌病人并存病的围手术期处理。方法回顾性分析1996年1月至2000年7月间收治65例70岁以上有并存病的结、直肠癌病人的外科治疗？结果并存心脏病40例，高血压17例，糖尿病13例，呼吸系统疾病13例，贫血26例，低蛋白血症41例。术后并发症有肠瘘2例，伤口裂开2例、伤口感染8例，肺部感染3例，心功能不全1例。围手术期死亡2例。结论虽然并存病增加了手术风险，但术前全面了解病情，加强并存病的围手术期处理可大大提高手术成功率，降低手术死亡率和并发症发生率。     

Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality

BACKGROUND/AIMS: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. PATIENTS AND METHODS: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. RESULTS: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. CONCLUSIONS: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.     

Surgery of Colorectal Cancer: Surgical Morbidity and Five- and Ten-Year Results in 2400 Patients—Monoinstitutional Experience

The objective of this study was to determine surgical morbidity and long-term outcome of colorectal cancer surgery for quality control reasons and as the basis for new treatment modalities. Surgically treated colorectal cancer patients (mean age 65 years) were followed prospectively in a university center (110 months mean follow-up, 1978-1999). Overall survival (OAS), radicality, extent of resection, recurrence, and morbidity were analyzed (log-rank test of survival, multivariate analysis). Altogether, 2452 colorectal cancers localized in the colon (CC, 44.6%), rectum (RC, 44.8%) or multicentric (CRC, 10.6%) were of UICC stages I (19%), II (30%), III (21%), IV (20%), or undetermined (10%). Radicality and stage but not tumor localization influenced the OAS (p <0.0001). The 5-year/10-year OASs were 50%/42% (all), 78%/66% (R0), 46%/36% (R1), 4%/0% (R2), 0% (unresected) and 86%/79% (I), 70%/58% (II), 42%/33% (III), 3%/0% (IV) or 21%/12% (undetermined), respectively (p <0.0001). Multivisceral resections (17%) resulted in morbidity and survival rates equal to those for standard resection. The overall tumor recurrence rate was 27%, mainly with both local and distant relapse (15%). Surgery-related complications occurred in 18% (all), 14% (CC), 21% (RC), or 20% (CRC). The perineal infection rate (RC) was 4%, overall anastomotic leakage 1%, and mortality rate 0.8%. A prospective, uniform follow-up used over two decades warrants quality control in colorectal cancer surgery, which was curative for half of the patients. The morbidity and mortality were low and were not increased by multivisceral resections.     

Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma

BACKGROUND: It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated. METHODS: From 1991 to 2002, the medical records of 107 consecutive patients undergoing emergency surgery for obstructing or perforating colorectal carcinoma were retrospectively reviewed. Information regarding patient and tumor characteristics, treatment, and outcome was recorded. Risk factors were assessed by multivariate analysis. RESULTS: Eighty-three patients (78%) had complete obstruction and 24 (22%) had perforation. Overall and major complications occurred in 70% and 34%, respectively. The mortality rate was 15%. Independent risk factors for major morbidity were perioperative blood transfusion and high American Society of Anesthesiologists (ASA) class, whereas those for mortality were older age and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.     

大肠癌并发急性肠梗阻的外科治疗

目的 探讨大肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析l997年l0月～2002年10月76例大肠癌并发急性肠梗阻行急症手术治疗者的临床资料，其中右半结肠癌并梗阻23例，左半结肠癌和直肠并梗阻53例。结果 76例均行手术治疗，其中行～期切除吻合55例(右半结肠一期切除吻合l9例，左半结直肠一期切除吻合36例)。术后发生吻合口瘘2例，肺部感染2例，伤口感染6例，切口裂开l例，总并发症发生率为14.5％。除l例死于多器官功能衰竭外其它病例均通过非手术治疗治愈，随访统计l，3，5年生存率分别为98．3％，55％，38．5％。结论 一期切除吻合手术治疗大肠癌并肠梗阻是可行的，而合理地选择手术方式，正确的术中操作和围手术期处理对提高疗效，改善患者生活质量有所裨益。     

老年结直肠癌合并急性肠梗阻：附116报告

目的探讨老年结直肠癌合并急性肠梗阻的处理原则和方法。方法回顾性分析5年间收治的116例老年(≥60岁)结直肠癌并发急性肠梗阻患者的临床资料。全组右半结肠癌并梗阻39例,左半结肠癌并梗阻64例,直肠癌并梗阻13例。采用右半结肠一期切除吻合治疗39例,左半结肠一期切除吻合62例,Hartmann手术9例,Dixon手术4例,肿瘤近端肠管造瘘2例。结果术后出现并发症17例(14.7%)21例次,包括切口感染14例次,腹腔感染5例次和吻合口瘘2例次,死亡1例(0.9%)。115例(99.1%)痊愈出院。结论一定条件下,一期切除吻合治疗结直肠癌并发急性肠梗阻,是方便可行而安全有效的方法。     

合并慢性阻塞性肺病的老年直肠癌患者围手术期处理

目的探讨合并慢性阻塞性肺病(COPD)的老年直肠癌患者的围手术期处理。方法对40例中度以上COPD直肠癌患者进行静态肺功能评估,并进行正确的围手术期处理,研究其对患者术后的影响。结果术后心律失常4例,COPD症状加重8例,肺部感染6例,二重感染4例,呼吸功能衰竭2例,内科治疗后均缓解;伤口感染5例,无围手术期死亡。结论虽然合并COPD患者增加了手术风险,但正确内科治疗及处理,可以降低手术并发症发生率。     

Colorectal resection in peripheral New Zealand: workload, outcomes and its future

BACKGROUND: Published Australasian findings on colorectal cancer surgery workload and performance outcomes have been predominantly from urban specialist units. This study defines workload and index markers of surgical quality for colorectal resections carried out in a peripheral teaching hospital of New Zealand. METHODS: All cases of colorectal cancer surgery between 1 June 1997 and 31 May 2000 were included. RESULTS: One hundred and ninety-one colorectal resections for 197 colorectal carcinomas were carried out. Sites of carcinoma were as follows: 57 rectal (29%), 59 sigmoid (30%), 34 descending/transverse (17%) and 47 ascending/caecal (24%). Advanced pathological stage (Dukes' C or metastatic) was diagnosed in 55%. Performance outcome variables for anterior resections were as follows: wound infection, 14%; anastomotic leak rate, 10.5%; local recurrence within 2-5 years, 14%; unplanned reoperation within 30 days, 16%; and perioperative mortality, 3.5%. Performance outcomes for all other colorectal cancer resections were as follows: wound infection, 10%; no anastomotic leaks; local recurrence, 2%; unplanned reoperation, 4%; and mortality, 4.5%. CONCLUSIONS: Workload and performance outcomes of colorectal cancer resection in provincial New Zealand have been defined in this study. A high proportion of patients presenting to Southland Hospital had advanced cancer in the rectum or distal colon. The main clinical indicators of colorectal cancer surgery outcome (mortality, anastomotic leak, wound infection and local recurrence) compare favourably with accepted standards of the time. Workload is adequate to maintain such outcomes. Future colorectal surgery in non-specialized units is important and can achieve good results.     

腹腔镜辅助老年人结肠直肠癌切除术围手术期处理体会

目的　探讨腹腔镜辅助下老年人结直癌手术的安全性和可行性。方法　回顾性分析我院2002年1月~2004年10月18例老年人结直肠癌腹腔镜围手术期治疗的临床资料。结果　术后并发肺部感染1例、伤口感染2例、尿路感染2例、心功能不全1 例。无吻合口漏、切口种植、吻合口及盆腔局部复发病例。围手术期无死亡病例。结论　老年病人并存病多,但只要有针对性地进行处理,腹腔镜辅助下结直肠癌切除术是安全、可行的。     

163例高龄结直肠癌合并糖尿病患者的围手术处理体会

目的 探讨高龄结直肠癌合并糖尿病患者的围手术处理。方法 对1994-2004年围手术处理的163例高龄（年龄大于印岁）结直肠癌合并糖尿病患者作回顾性分析。结果 163例病人均作结直肠癌择期手术,术后并发症发生率39．9％,其中切口感染19．6％（32／163）,肺部感染12．3％（20／163）,吻合口漏占3．7％（6／163）,泌尿系感染为2．5％（4／163）,高渗性昏迷1．2％（2／163）,死亡0．6％（1／163）。术后平均住院20天。结论 如能做到控制血糖、选择合理的术式和手术时机,高龄结直肠癌并糖尿病患者可顺利度过围手术期,并取得良好的手术疗效。