急性穿孔性结直肠癌的治疗结果：一家区级综合医院的经验
Outcome of acutely perforated colorectal cancers: experience of a single district general hospital.
作者信息
Anwar Muzaffar Ali, D'Souza Francis, Coulter Rahael, Memon Breda, Khan Iftikhar M, Memon Muhammed Ashraf
机构信息
Department of Surgery, Whiston Hospital, Warrington Road, Prescot, Merseyside L35 5DR, UK.
出版信息
Surg Oncol. 2006 Aug;15(2):91-6. doi: 10.1016/j.suronc.2006.09.001. Epub 2006 Oct 17.
INTRODUCTION
Perforation of colorectal cancer (CRC) is rare and is associated with a significantly high mortality and morbidity. The aim of the current study was to evaluate various factors influencing the outcome in these patients.
MATERIAL AND METHODS
A retrospective analysis of 42 patients with perforated CRC between 1999 and 2003 was performed. A number of variables including age, sex, site of perforation, presence of faecal peritonitis, grade of surgeon, presence of metastasis, stage of tumour, type of surgery, ASA grade and CR POSSUM score were analysed for their influence on the outcome in these patients using MS Excel, MS Access and Stata.
RESULTS
Of the 42 patients 19 were female and 23 were male. The mean age of the patients was 70.5 (range 44-96yr). Thirty patients had perforation at the tumour, 10 proximal to the tumour, and one distal to the primary tumour. The perforation was localised in 25 patients. However, 17 patients had free perforation with frank faecal peritonitis. Twenty-one patients had resection and anastomosis, 18 patients had resection without restoration of bowel continuity and 3 had palliative colostomy. The in-hospital mortality (within 30d) was 40.5% (n=17) with only 15 patients being alive at the end of 2yr with an overall mortality of 64.3% (n=27). The outcome was not altered by variables such as sex, surgeon's grade, surgical procedure, Dukes' staging or the site of perforation (p>0.5). Univariate analysis showed that advanced age (p<0.01), higher ASA grade (p<0.001), higher CR POSSUM score (p<0.001) and degree of peritonitis (p<0.01) were strongly associated with adverse outcomes. However, in stepwise multivariate logistic regression analysis ASA grade (p=0.01) and CR POSSUM score (p=0.01) were the only significant predictors of in-hospital mortality.
CONCLUSION
The outcome of perforated colonic cancer continues to be poor. ASA score and CR POSSUM score are good predictors of the short-term outcome.
引言
结直肠癌（CRC）穿孔罕见，且死亡率和发病率显著较高。本研究旨在评估影响这些患者预后的各种因素。
材料与方法
对1999年至2003年间42例穿孔性结直肠癌患者进行回顾性分析。使用MS Excel、MS Access和Stata分析了包括年龄、性别、穿孔部位、粪性腹膜炎的存在、外科医生级别、转移的存在、肿瘤分期、手术类型、ASA分级和CR POSSUM评分等多个变量对这些患者预后的影响。
结果
42例患者中，19例为女性，23例为男性。患者的平均年龄为70.5岁（范围44 - 96岁）。30例患者肿瘤处穿孔，10例在肿瘤近端穿孔，1例在原发肿瘤远端穿孔。25例患者穿孔局限。然而，17例患者发生游离穿孔并伴有明显的粪性腹膜炎。21例患者行切除吻合术，18例患者行切除但未恢复肠道连续性，3例患者行姑息性结肠造口术。院内死亡率（30天内）为40.5%（n = 17），2年后仅15例患者存活，总死亡率为64.3%（n = 27）。性别、外科医生级别、手术方式、Dukes分期或穿孔部位等变量未改变预后（p>0.5）。单因素分析显示，高龄（p<0.01）、较高的ASA分级（p<0.001）、较高的CR POSSUM评分（p<0.001）和腹膜炎程度（p<0.01）与不良预后密切相关。然而，在逐步多因素逻辑回归分析中，ASA分级（p = 0.01）和CR POSSUM评分（p = 0.01）是院内死亡率的唯一显著预测因素。
结论
穿孔性结肠癌的预后仍然很差。ASA评分和CR POSSUM评分是短期预后的良好预测指标。
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