恶性肠梗阻治疗中手术不良结局的预测因素

Medina-Franco Heriberto, García-Alvarez Miriam N, Ortiz-López Laura J, Cuairán Jorge Zerón-Medina

Department of Surgery, Section of Surgical Oncology. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F.

Rev Invest Clin. 2008 May-Jun;60(3):212-6.

INTRODUCTION

Malignant bowel obstruction (MBO) is a common problem in patients with advanced colorectal or ovarian cancer. The management of this group of patients is complex and controversial.

OBJECTIVE

To analyze the factors associated with morbidity and mortality in patients who underwent surgery for MBO in a tertiary referral center in Mexico City.

MATERIAL AND METHODS

Hospital records of patients who underwent surgery for malignant bowel obstruction from January 1987 through December 2005 were retrospectively analyzed. Demographic data, clinical and surgical variables were recorded. Morbidity and mortality within 30-day of surgical procedure were registered. Factors associated with outcome were analyzed with the chi-square test. Survival curves were constructed with the Kaplan-Meier method.

RESULTS

One-hundred and thirty patients were included. Primary neoplasm was the cause of bowel obstruction in 51 (39.2%) patients. Resection and anastomosis was performed in 45 patients (34.6%); in 30 cases (23.1%) a palliative estoma was constructed. Hospital mortality rate was 10.8%, and major postoperative morbidity was 16.2%. Factors associated with a significant increase in surgical mortality were: advanced patient age 17.2% (p = 0.009), hipoalbuminemia 14.45% (p = 0.027) and surgery performed for neoplasms different from those of gastrointestinal origin 17.6% (p = 0.005). Surgical morbidity was significantly higher in patients with poor performance status 16.2% (p = 0.017), advanced age 18% (p = 0.04), and low albumin levels 13.5% (p = 0.03). Median survival for the entire cohort was nine months (95% CI 5-13). Actuarial one, three and five year survival were 38.4, 27.5 and 25.4%, respectively. The most significant predictor of survival was performance status.

CONCLUSIONS

When surgical management of MBO is considered, a careful assessment of the factors shown here to predict an adverse surgical outcome and poor prognosis is required.

引言

恶性肠梗阻（MBO）是晚期结直肠癌或卵巢癌患者的常见问题。这类患者的治疗复杂且存在争议。

目的

分析在墨西哥城一家三级转诊中心接受MBO手术患者的发病和死亡相关因素。

材料与方法

回顾性分析1987年1月至2005年12月期间因恶性肠梗阻接受手术患者的医院记录。记录人口统计学数据、临床和手术变量。登记手术操作30天内的发病率和死亡率。采用卡方检验分析与结局相关的因素。用Kaplan-Meier方法构建生存曲线。

结果

纳入130例患者。51例（39.2%）患者的原发性肿瘤是肠梗阻的病因。45例患者（34.6%）进行了切除和吻合术；30例（23.1%）构建了姑息性造口。医院死亡率为10.8%，主要术后发病率为16.2%。与手术死亡率显著增加相关的因素有：高龄17.2%（p = 0.009）、低白蛋白血症14.45%（p = 0.027）以及针对非胃肠道起源肿瘤进行的手术17.6%（p = 0.005）。在功能状态差的患者中手术发病率显著更高16.2%（p = 0.017）、高龄18%（p = 0.04）以及低白蛋白水平13.5%（p = 0.03）。整个队列的中位生存期为9个月（95%CI 5 - 13）。精算1年、3年和5年生存率分别为38.4%、27.5%和25.4%。生存的最显著预测因素是功能状态。