Runkel N S, Schlag P, Schwarz V, Herfarth C
Department of Surgery, University of Heidelberg, Germany.
Br J Surg. 1991 Feb;78(2):183-8. doi: 10.1002/bjs.1800780216.
The data for 77 patients with colorectal cancer who underwent emergency surgery for acute intestinal obstruction (57 patients) or perforation (20 patients) within 24 h of admission were evaluated. The patients were older and had more advanced disease than patients undergoing elective surgery for colorectal cancer. Emergency surgery for carcinoma of the right colon consisted of primary resection in 95 per cent of cases and was followed by a 28 per cent mortality rate. Perforated tumours of the left colon and rectum were managed by primary resection in 82 per cent of cases with a 22 per cent mortality rate. In contrast, obstructing tumours of the left colon and rectum were treated by primary resection in 38 per cent of cases with a 6 per cent mortality rate, and by primary decompression in 62 per cent of cases with a 25 per cent mortality rate. The overall postoperative mortality rate was 23 per cent and increased with advanced tumour disease, perforation and peritonitis. Cardiac decompensation and intraabdominal sepsis were the major causes of death. Although the long-term survival rate following emergency surgery was worse than after elective surgery, improvements in outcome should be achieved by better management of the initial emergency situation.
对77例入院后24小时内因急性肠梗阻（57例）或穿孔（20例）接受急诊手术的结直肠癌患者的数据进行了评估。与接受结直肠癌择期手术的患者相比，这些患者年龄更大，疾病进展更严重。右半结肠癌的急诊手术95%为一期切除，术后死亡率为28%。左半结肠和直肠穿孔性肿瘤82%行一期切除，死亡率为22%。相比之下，左半结肠和直肠梗阻性肿瘤38%行一期切除，死亡率为6%，62%行一期减压，死亡率为25%。术后总体死亡率为23%，并随肿瘤疾病进展、穿孔和腹膜炎而增加。心脏代偿失调和腹腔内感染是主要死亡原因。尽管急诊手术后的长期生存率低于择期手术后，但通过更好地处理初始急诊情况，应能改善预后。
