Rault A, Collet D, Sa Cunha A, Larroude D, Ndobo'epoy F, Masson B
Service de chirurgie digestive, CHU de Bordeaux, hôpital Haut-Lévéque, avenue de Magellan, 33604 Pessac cedex, France.
Ann Chir. 2005 Jun;130(5):331-5. doi: 10.1016/j.anchir.2004.12.011. Epub 2005 Jan 21.
Management of obstructed colonic carcinomas is a surgical challenge because it happens more often in elderly patients. The aim of our study is to assess mortality and morbidity rates of procedures performed in emergency for this pathology.
Between January 1st, 1998 and December 31st 2003, 22 patients underwent an emergency procedure for obstructive colonic obstruction due to an adenocarcinoma. Obstruction was defined as an emesis, distension on examination, no gas or stool since 24 hours and confirmatory plain radiograph film.
Twenty patients (91%) underwent surgical procedure and two others received a colonic stent. Eleven patients (50%) underwent left colonic resection and intraoperative colonic cleansing was undertaken in 3 of these patients. One patient underwent a lateral colostomy, three patients (14%) underwent a right colectomy. A Hartmann's procedure was performed in six cases (27%). Morbidity occurred in 23% (50% were from anastomotic complication). Mortality rate was 27% (44% if aged more than 75 years old) (one superior mesenteric ischemia, and five heart and respiratory failures). Two-year survival rate was 61% and five year survival rate was 47%. Median survival was 24 months.
Our study confirms that obstructed colonic cancer has a bad prognosis because it happens in elderly and not healthy patients. Priority must be given to the restoration of colonic permeability.
梗阻性结肠癌的治疗是一项外科挑战，因为它在老年患者中更为常见。我们研究的目的是评估针对这种病理情况进行的急诊手术的死亡率和发病率。
在1998年1月1日至2003年12月31日期间，22例患者因腺癌接受了针对梗阻性结肠梗阻的急诊手术。梗阻定义为呕吐、检查时腹胀、24小时无气体或粪便且有确诊的腹部平片。
20例患者（91%）接受了手术，另外2例接受了结肠支架置入。11例患者（50%）接受了左半结肠切除术，其中3例患者术中进行了结肠清洁。1例患者接受了侧方结肠造口术，3例患者（14%）接受了右半结肠切除术。6例患者（27%）进行了Hartmann手术。发病率为23%（50%源于吻合口并发症）。死亡率为27%（75岁以上患者为44%）（1例肠系膜上动脉缺血，5例心功能和呼吸功能衰竭）。两年生存率为61%，五年生存率为47%。中位生存期为24个月。
我们的研究证实，梗阻性结肠癌预后不良，因为它发生在老年且身体不健康的患者中。必须优先恢复结肠的通畅性。
