Department of Surgery and Orthopaedics, Azienda Ospedaliera C Poma Mantua, Piazza 80th Fanteria 1, 46041 Asola, MN, Italy.
Support Care Cancer. 2010 Apr;18(4):523-7. doi: 10.1007/s00520-009-0795-z. Epub 2009 Dec 13.
The aim of this study was to assess the role of defunctioning stoma (DS) in elderly high-risk patients with bowel obstruction from advanced colorectal cancer, by exploring consistent variables of outcome, because every other procedure was unfeasible.
A 6-year survey in a single surgery unit (between 1999 and 2004) was retrospectively evaluated, allowing to collect a cohort of 75 patients, aged over 65, who overall presented such critical condition. Pre-operatively, American Society of Anaesthesiologist grade classification was used. Post-operative course was monitored by focusing on gauging symptom relief. So, a validated assessment scale was employed to evaluate physical distress symptoms, graduated on a Likert scale and compared at baseline and day 7, on days 7 and 30, post-operatively. Length of hospital stay (LHS), morbidity, in-hospital (within 30 days) and overall mortality (within 6 months) were also assessed. Paired t test was used as statistical analysis to ascertain improvement of symptoms.
All symptoms improved significantly (range, p < 0.05 to p < 0.01) within the surveyed time, with exception of vomiting on day 30 (p = 0.14). Average LHS was 22.8 (standard deviation, +/-3.856) days. Overall morbidity was detected in 68 (91%) patients. In-hospital and overall mortality rates accounted for 27 (35.8%) patients and for 48 (100%) patients, respectively.
The role of DS was effective to improve symptom relief but was poor in terms of morbidity and mortality control. So, ethical concerns have to be addressed, and medical treatment or stenting for left-side obstructions only should be considered as alternative procedures.
本研究旨在评估在患有晚期结直肠癌的老年高危肠阻塞患者中，采用造口术（DS）的作用，因为其他所有方法都不可行。
对一个外科手术组（1999 年至 2004 年）进行了 6 年的回顾性评估，共收集了 75 名年龄在 65 岁以上的患有此类严重疾病的患者资料。术前使用美国麻醉师协会（ASA）分级分类。术后过程通过症状缓解进行监测。因此，采用了一种经过验证的评估量表来评估身体不适症状，根据李克特量表（Likert scale）进行分级，并在基线和第 7 天、第 7 天和第 30 天进行比较。住院时间（LHS）、发病率、住院期（30 天内）和总死亡率（6 个月内）也进行了评估。采用配对 t 检验作为统计学分析，以确定症状的改善程度。
所有症状均在调查时间内显著改善（范围，p<0.05 至 p<0.01），除了第 30 天的呕吐（p=0.14）。平均住院时间为 22.8 天（标准差，+/-3.856）。总发病率为 68 例（91%）。住院期和总死亡率分别为 27 例（35.8%）和 48 例（100%）。
DS 的作用在于改善症状缓解，但在控制发病率和死亡率方面效果不佳。因此，必须考虑道德问题，仅对左侧梗阻采用 DS 或支架治疗应作为替代治疗方法。
