左半结肠恶性急症的外科治疗。一种手术风险评估的新工具。

Surgical treatment of left colon malignant emergencies. A new tool for operative risk evaluation.

作者信息

Ceriati Franco, Tebala Giovanni D, Ceriati Emanuela, Coco Claudio, Tebala Domenico, Verbo Alessandro, D'Andrilli Antonio, Picciocchi Aurelio

机构信息

Department of Surgery, Catholic University School of Medicine, Rome, Italy.

出版信息

Hepatogastroenterology. 2002 Jul-Aug;49(46):961-6.

PMID:12143254

Abstract

BACKGROUND/AIMS: The surgical treatment of left colon and rectal cancer emergencies is still controversial. In our opinion the choice is to be based on the general health status of each patient.

METHODOLOGY

We retrospectively analyzed our series of 57 patients who underwent immediate resection and anastomosis.

RESULTS

Factors significantly related to short-term results were chronic renal failure, heart disease, low albumin serum levels and colonic perforation. The presence of a diverting colostomy did not result in being a protective factor toward anastomotic dehiscence. We constructed a Colorectal Tumors Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4-12) and High Risk (CTES > 12), mortality and morbidity being 4.3% and 21.7%, 24.0% and 60.0%, 88.9% and 88.9%, respectively.

CONCLUSIONS

High-risk patients may undergo a staged procedure. Moderate risk patient may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low-risk patients.

摘要

背景/目的：左半结肠癌和直肠癌急症的外科治疗仍存在争议。我们认为，治疗方式的选择应基于每个患者的总体健康状况。

方法

我们回顾性分析了57例行急诊切除吻合术的患者。

结果

与短期预后显著相关的因素包括慢性肾衰竭、心脏病、低血清白蛋白水平和结肠穿孔。转流性结肠造口术并非吻合口裂开的保护因素。我们构建了一个由上述四个因素组成的结直肠肿瘤急症评分，每个因素的分值为近似比值比（慢性肾衰竭7分，低血清白蛋白水平6分，心脏病5分，结肠穿孔4分）。每位患者分为低风险（CTES<4）、中度风险（CTES 4-12）和高风险（CTES>12），其死亡率和发病率分别为4.3%和21.7%、24.0%和60.0%、88.9%和88.9%。