Guo Ming-gao, Feng Yi, Liu Jia-zhe, Zheng Qi, Di Jian-zhong, Wang Yu, Fan You-ben, Huang Xin-yu
Department of Surgery, Shanghai Jiaotong University Affiliated The Six People's Hospital, 200233 Shanghai, China.
BMC Gastroenterol. 2014 Apr 15;14:76. doi: 10.1186/1471-230X-14-76.
Acute colonic obstruction is the most common complication of colorectal cancer (CRC) in elderly patients. Medical treatment has been associated with higher perioperative morbidity and mortality rates. There is a need for identification of elderly CRC patients who will do poorly so that results can be improved. The purpose of this study is to assess the 30-day outcome of elderly patients undergoing malignant colonic obstruction procedures and identify the associated factors of mortality.
A review of 233 elderly patients who received medical procedures for malignant colonic obstruction between April 2000 and April 2012 was conducted. Data regarding clinical variables, surgical procedures and outcomes, complications, and mortality were studied. Univariate and logistic regression analyses were performed on mortality risk factors.
Patients had a mean age of 78.2 years (range 70-95). A total of 126 (54.1%) patients were classified ASA III and above. Eighty (34.3%) patients had right-sided colonic obstruction. In the 153 (65.7%) patients with left-sided colonic obstruction, 40 patients received self-expandable metallic stent (SEMS) treatment and 193 patients received surgery. A total of 62.2% (n = 145) patients had post operation complications. The overall 30-day mortality was 24.5% (n = 57). ASA grading, peritonitis and Dukes staging were independent risk factors for mortality.
Medical procedures in elderly patients with malignant colonic obstruction are associated with significant complications and mortality. Identifying these high-risk patients and treating promptly may improve outcomes. SEMS treatment provides a useful alternative to surgical intervention.
急性结肠梗阻是老年患者结直肠癌（CRC）最常见的并发症。药物治疗与较高的围手术期发病率和死亡率相关。有必要识别预后较差的老年CRC患者，以便改善治疗结果。本研究的目的是评估接受恶性结肠梗阻手术的老年患者的30天预后，并确定相关的死亡因素。
回顾性分析2000年4月至2012年4月期间接受恶性结肠梗阻治疗的233例老年患者。研究了有关临床变量、手术程序和结果、并发症及死亡率的数据。对死亡危险因素进行单因素和逻辑回归分析。
患者平均年龄为78.2岁（范围70 - 95岁）。共有126例（54.1%）患者ASA分级为III级及以上。80例（34.3%）患者为右侧结肠梗阻。在153例（65.7%）左侧结肠梗阻患者中，40例接受了自膨式金属支架（SEMS）治疗，193例接受了手术。共有62.2%（n = 145）的患者术后出现并发症。30天总死亡率为24.5%（n = 57）。ASA分级、腹膜炎和Dukes分期是死亡的独立危险因素。
老年恶性结肠梗阻患者的治疗与显著的并发症和死亡率相关。识别这些高危患者并及时治疗可能改善预后。SEMS治疗为手术干预提供了一种有用的替代方法。
