Morita Shunji, Ikeda Kimimasa, Komori Takamichi, Tanida Tsukasa, Hatano Hisanori, Tomimaru Yoshito, Imamura Hiroshi, Dono Keizo
1 Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan 2 Department of Surgery, Minoh City Hospital, Minoh City, Osaka, Japan.
Dis Colon Rectum. 2016 Nov;59(11):1028-1033. doi: 10.1097/DCR.0000000000000685.
Emergency surgery for obstructing colorectal cancer is associated with high mortality and morbidity rates.
The purpose of this study was to assess outcomes of emergency surgery for obstructing colorectal cancer in a single hospital, where care was primarily provided by colorectal surgeons.
This was a retrospective cohort study.
The study was conducted at the Toyonaka Municipal Hospital.
The study included 208 consecutive patients who underwent emergency surgery for obstructing colorectal cancer between 1998 and 2013.
Surgical outcomes, including mortality and morbidity, were evaluated.
The obstructing cancers involved the right colon, left colon, and rectum in 78, 97, and 33 of the included patients. Many patients had poor performance indicators, such as age ≥75 years (42%), ASA score of III or more (38%), stage IV colorectal cancer (39%), obstructive colitis (12%), and perforation or penetration (9.6%). Colorectal surgeons performed the operations in all but 5 of the patients. Primary resection and anastomosis were accomplished in 96%, 70%, and 27% of cases involving the right colon, left colon, and rectum. Intraoperative colonic irrigation (n = 32), manual colonic decompression (n = 11), and subtotal or total colorectal resection (n = 34) were performed before left-sided anastomoses. Anastomotic leak was reported in only 2 patients. The in-hospital mortality and morbidity rates were 1.3% and 34.0%.
This study was a retrospective analysis of data from a single hospital.
Surgical outcome analysis for obstructing colorectal cancers managed by specialized colorectal surgeons demonstrates low mortality and morbidity rates. Therefore, we concluded that our management of this condition is safe and feasible.
结直肠癌梗阻的急诊手术与高死亡率和发病率相关。
本研究的目的是评估在一家主要由结直肠外科医生提供治疗的医院中，结直肠癌梗阻急诊手术的结果。
这是一项回顾性队列研究。
该研究在丰中市立医院进行。
该研究纳入了1998年至2013年间连续208例行结直肠癌梗阻急诊手术的患者。
评估手术结果，包括死亡率和发病率。
纳入患者中，梗阻性癌症累及右半结肠、左半结肠和直肠的分别有78例、97例和33例。许多患者的表现指标较差，如年龄≥75岁（42%）、美国麻醉医师协会（ASA）评分III级或更高（38%）、IV期结直肠癌（39%）、梗阻性结肠炎（12%）以及穿孔或穿透（9.6%）。除5例患者外，其余所有手术均由结直肠外科医生完成。在涉及右半结肠、左半结肠和直肠的病例中，分别有96%、70%和27%完成了一期切除吻合术。在左侧吻合术前进行了术中结肠灌洗（n = 32）、手动结肠减压（n = 11）以及次全或全结直肠切除术（n = 34）。仅2例患者报告有吻合口漏。住院死亡率和发病率分别为1.3%和34.0%。
本研究是对一家医院数据的回顾性分析。
由专业结直肠外科医生管理的结直肠癌梗阻手术结果分析显示死亡率和发病率较低。因此，我们得出结论，我们对这种情况的处理是安全可行的。
