造口或吻合术后长期结直肠癌幸存者的早期和晚期并发症。
Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis.
机构信息
Division of Research, Kaiser Permanente, Oakland, California, USA.
出版信息
Dis Colon Rectum. 2010 Feb;53(2):200-12. doi: 10.1007/DCR.0b013e3181bdc408.
PURPOSE
Among long-term (>or=5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life.
BACKGROUND
The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood.
METHODS
Participants (284 survivors with ostomies and 395 survivors with anastomoses) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaires from 2002 to 2005. Information on colorectal cancer, surgery, comorbidities, and complications was obtained from computerized data and analyzed by use of survival analysis and logistic regression.
RESULTS
Ostomy and anastomosis survivors were followed up for an average of 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy survivors and 10% of anastomosis survivors experienced complications (P < .01). From 31 days on, the percentages were 69% and 67% (after adjustment, P < .001). Bleeding and postoperative infection were common early complications. Common long-term complications included hernia, urinary retention, hemorrhage, skin conditions, and intestinal obstruction. Ostomy was associated with long-term fistula (odds ratio, 5.4; 95% CI 1.4-21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (P < .05).
CONCLUSIONS
Complication rates remain high despite recent advances in methods of surgical treatment. Survivors with ostomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the 2 groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life.
目的
比较永久性肠造口或吻合术的长期（≥5 年）结直肠癌幸存者的医疗和手术并发症发生率，并探讨并发症与健康相关生活质量之间的关系。
背景
结直肠癌幸存者长期健康相关生活质量的并发症发生率和影响尚不清楚。
方法
参与者（284 例造口术幸存者和 395 例吻合术幸存者）为参加综合健康计划的长期结直肠癌幸存者。通过 2002 年至 2005 年的邮寄问卷调查评估健康相关生活质量。从计算机数据中获取有关结直肠癌、手术、合并症和并发症的信息，并通过生存分析和逻辑回归进行分析。
结果
造口术和吻合术幸存者的平均随访时间分别为 12.1 年和 11.2 年。手术后 30 天内，19%的造口术幸存者和 10%的吻合术幸存者发生并发症（P<0.01）。从第 31 天起，这两个比例分别为 69%和 67%（调整后，P<0.001）。出血和术后感染是常见的早期并发症。常见的长期并发症包括疝、尿潴留、出血、皮肤状况和肠梗阻。造口术与长期瘘管有关（比值比，5.4；95%CI 1.4-21.2），而在造口术幸存者中，瘘管与健康相关生活质量下降有关（P<0.05）。
结论
尽管手术治疗方法取得了近期进展，但并发症发生率仍然很高。造口术幸存者在生存期间的早期并发症更多，但吻合术幸存者的并发症在 20 年后会赶上，此时两组的并发症发生率趋同。在有造口术的结直肠癌幸存者中，瘘管对健康相关生活质量有特别重要的影响。
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