直肠癌直肠系膜切除术引入后术中及术后早期并发症的审计

Audit of intraoperative and early postoperative complications after introduction of mesorectal excision for rectal cancer.

作者信息

Nesbakken Arild, Nygaard Knut, Westerheim Ola, Lunde Ole Christian, Mala Tom

机构信息

Department of Surgery, Aker Hospital, Oslo, Norway.

出版信息

Eur J Surg. 2002;168(4):229-35. doi: 10.1080/11024150260102843.

DOI:10.1080/11024150260102843

PMID:12440761

Abstract

OBJECTIVE

To compare complication rates after rectal resection using a conventional surgical technique (1983-1992) and mesorectal excision (1993-2000), and to find out whether the rate of complications changed with time after the introduction of mesorectal excision.

DESIGN

Prospective, observational study.

SETTING

University hospital, Norway.

PATIENTS

All patients who had rectal resections for cancer in the period 1983-2000.

INTERVENTIONS

In the conventional surgery period 217, and in the mesorectal excision period 176, patients had rectal resections. The mesorectal excision period was split in two, the early and the late mesorectal excision period, 88 rectal resections being performed in each period. Total mesorectal excision was done in 118 patients, and partial mesorectal excision in 58.

MAIN OUTCOME MEASURES

Major surgical complications in both periods; intraoperative bleeding, transfusions during the hospital stay, and cardiovascular complications in the mesorectal excision period.

RESULTS

23/217 (11%) developed major surgical complications in the conventional surgery period, compared with 17/88 (19%) in the early mesorectal excision period (p = 0.04). This was caused by an increased incidence of anastomotic leaks after low anterior resection, being 11/122 (9%) in the conventional surgery period and 12/52 (23%) in the early mesorectal excision period (p = 0.01). The incidence of anastomotic leaks declined to 5/61 (8%) in the late mesorectal excision period (p = 0.03). Multiple regression analysis identified a low anastomosis, major bleeding, and age over 75 years as significant risk factors for the development of anastomotic leaks. Major intraoperative bleeding occurred in 36/84 (43%) of the patients in the early and 22/82 (27%) in the late mesorectal period (p = 0.04). Blood transfusions were given to 61/84 (74%) in the early mesorectal period and 41/82 (50%) in the late period (p < 0.01).

CONCLUSIONS

The incidence of surgical complications increased significantly after the introduction of mesorectal excision, but declined with time.

摘要

目的

比较采用传统手术技术（1983 - 1992年）和直肠系膜切除术（1993 - 2000年）进行直肠切除术后的并发症发生率，并探究直肠系膜切除术引入后并发症发生率是否随时间变化。

设计

前瞻性观察性研究。

地点

挪威大学医院。

患者

1983 - 2000年期间所有因癌症行直肠切除术的患者。

干预措施

在传统手术时期有217例患者接受直肠切除术，在直肠系膜切除术时期有176例。直肠系膜切除术时期分为早期和晚期直肠系膜切除术时期，每个时期各进行88例直肠切除术。118例行全直肠系膜切除术，58例行部分直肠系膜切除术。

主要观察指标

两个时期的主要手术并发症；直肠系膜切除术时期的术中出血、住院期间输血及心血管并发症。

结果

传统手术时期23/217例（11%）发生主要手术并发症，而早期直肠系膜切除术时期为17/88例（19%）（p = 0.04）。这是由于低位前切除术后吻合口漏发生率增加，传统手术时期为11/122例（9%），早期直肠系膜切除术时期为12/52例（23%）（p = 0.01）。晚期直肠系膜切除术时期吻合口漏发生率降至5/61例（8%）（p = 0.03）。多因素回归分析确定低位吻合、大出血和年龄超过75岁是发生吻合口漏的重要危险因素。早期直肠系膜切除术时期36/84例（43%）患者发生术中大出血，晚期为22/82例（27%）（p = 0.04）。早期直肠系膜切除术时期61/84例（74%）患者接受输血，晚期为41/82例（50%）（p < 0.01）。