Verbo A, D'Alba P, Pedretti G, Coco C, Picciocchi A
Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, Roma.
Ann Ital Chir. 2003 Mar-Apr;74(2):169-75; discussion 176.
BACKGROUND/AIMS: The surgical treatment of the left colon and rectal cancer emergencies is still controversial. In our opinion the choices to be based on the general health status of the patient.
The authors analysed a series of 63 patients submitted to immediate resection and anastomosis.
Factors significantly related to short term results were chronic heart disease, low albumin serum levels, and colonic perforation. The presence of a diverting colostomy did not provide a protective factor against anastomotic dehiscence. We constructed a Colorectal Tumours 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), High Risk (CTES > 12), mortality and morbidity being 4% and 20%, 19.3% and 61.3%, 88.9% and 88.9% respectively.
High risk patients may undergo a staged procedure. Moderate risk patients may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low risk patients.
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患者的总体健康状况。
作者分析了一系列63例行即刻切除吻合术的患者。
与短期预后显著相关的因素为慢性心脏病、血清白蛋白水平低和结肠穿孔。转流性结肠造口术的存在并未提供预防吻合口裂开的保护因素。我们构建了一个由上述四个确定因素组成的结直肠肿瘤急症评分，每个因素的评分是近似比值比（慢性肾衰竭7分，血清白蛋白水平低6分，心脏病5分，结肠穿孔4分）。每位患者被分为低风险（结直肠肿瘤急症评分<4）、中度风险（结直肠肿瘤急症评分4 - 12）、高风险（结直肠肿瘤急症评分>12），死亡率和发病率分别为4%和20%、19.3%和61.3%、88.9%和88.9%。
高风险患者可采用分期手术。中度风险患者可通过即刻切除肿瘤但不进行吻合术来治疗。即刻切除吻合术可保留给低风险患者。
