Teloken Patrick Ely, Spilsbury Katrina, Levitt Michael, Makin Gregory, Salama Paul, Tan Patrick, Penter Cheryl, Platell Cameron
Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2014 Dec;84(12):960-4. doi: 10.1111/ans.12580. Epub 2014 Apr 3.
Urgent surgery for acute intestinal presentations is generally associated with worse outcomes than elective procedures. This study assessed the outcomes of patients undergoing urgent colorectal surgery.
Patients were identified from a prospective database. Surgery was classified as urgent when performed as soon as possible after resuscitation and usually within 24 h. Outcome measures included 30 days mortality, return to theatre, anastomotic leak and overall survival.
Two hundred forty-nine patients were included in the analysis. Median age was 65 years (interquartile range 48-74). The most common presentations were obstruction (52.2%) and perforation (23.6%). Cancer was the disease process responsible for presentation in 47.8% of patients. Thirty-day mortality was 6.8%. Age (odds ratio 1.08 95% confidence interval (CI) 1.02-1.15; P = 0.01), American Society of Anesthesiologists 4 (odds ratio 7.14 95% CI 1.67-30.4; P = 0.008) and cancer (odds ratio 6.61 95% CI 1.53-28.45; P = 0.011) were independent predictors of 30 days mortality. Relaparotomy was required in six (2.4%) cases. A primary anastomosis was performed in 156 (62.6%) patients. Anastomotic leak occurred in four (2.5%) patients. In patients with cancer, overall 5-year survival was 28% (95% CI 19-37), corresponding to 54% (95% CI 35-70) for stages I and II, 50% (95% CI 24-71) for stage III and 6% (95% CI 1-17) for stage IV disease. Urgent surgery was independently associated with worse overall survival (hazard ratio 2.65; 95% CI 1.76-3.99; P < 0.001).
In patients undergoing an urgent resection within a colorectal unit, performing a primary anastomosis is feasible and safe in the majority, relaparotomies are required in a minority and urgent surgery is an important predictor of worse prognosis in those with colorectal cancer.
急性肠道疾病的急诊手术通常比择期手术预后更差。本研究评估了接受急诊结直肠手术患者的预后。
从一个前瞻性数据库中识别患者。手术在复苏后尽快进行且通常在24小时内进行时被分类为急诊。结局指标包括30天死亡率、返回手术室、吻合口漏和总生存率。
249例患者纳入分析。中位年龄为65岁（四分位间距48 - 74岁）。最常见的表现是梗阻（52.2%）和穿孔（23.6%）。癌症是47.8%患者发病的病因。30天死亡率为6.8%。年龄（比值比1.08，95%置信区间（CI）1.02 - 1.15；P = 0.01）、美国麻醉医师协会分级4级（比值比7.14，95% CI 1.67 - 30.4；P = 0.008）和癌症（比值比6.61，95% CI 1.53 - 28.45；P = 0.011）是30天死亡率的独立预测因素。6例（2.4%）患者需要再次剖腹手术。156例（62.6%）患者进行了一期吻合。4例（2.5%）患者发生吻合口漏。在癌症患者中，总体5年生存率为28%（95% CI 19 - 37），I期和II期为54%（95% CI 35 - 70），III期为50%（95% CI 24 - 71），IV期为6%（95% CI 1 - 17）。急诊手术与较差的总生存率独立相关（风险比2.65；95% CI 1.76 - 3.99；P < 0.001）。
在结直肠科接受急诊切除术的患者中，大多数患者进行一期吻合是可行且安全的，少数患者需要再次剖腹手术，且急诊手术是结直肠癌患者预后较差的重要预测因素。
