全国小肠梗阻审计中小肠梗阻继发于恶性肿瘤的结局。

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction.

出版信息

Eur J Surg Oncol. 2019 Dec;45(12):2319-2324. doi: 10.1016/j.ejso.2019.07.014. Epub 2019 Jul 9.

DOI:10.1016/j.ejso.2019.07.014

Abstract

INTRODUCTION

Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.

METHODS

A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.

RESULTS

205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.

CONCLUSIONS

Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

摘要

简介

患有癌症并发生小肠梗阻的患者，其胃肠道连续性受损后，有发生营养不良和发病的高风险。本研究旨在描述恶性小肠梗阻患者的当前治疗方法和预后。

方法

这是一项在英国医院进行的前瞻性、多中心队列研究，纳入了 2017 年 1 月 16 日至 3 月 13 日期间因原发性肠道肿瘤（不包括左侧结肠肿瘤）或播散性腹腔内恶性肿瘤而出现小肠梗阻的患者。研究结局包括 30 天死亡率和院内并发症。采用 Cox 比例风险模型计算调整后效应估计值，以风险比（HR）及 95%置信区间（95%CI）表示。统计显著性水平设定为 P 值≤0.05（a priori）。

结果

在研究期间，有 205 例恶性小肠梗阻患者就诊于急诊外科。其中 50 例患者的梗阻是由右侧结肠癌引起，143 例由播散性腹腔内恶性肿瘤引起，10 例由小肠原发性肿瘤引起，2 例由胃肠道间质瘤引起。共有 205 例患者中的 100 例接受了梗阻的手术治疗。原发性肿瘤患者的 30 天院内死亡率为 11.3%，播散性恶性肿瘤患者的死亡率为 19.6%。严重的营养不良风险是该队列中死亡率不佳的独立预测因素（调整后的 HR 16.18，95%CI 1.86 至 140.84，P=0.012）。右侧结肠癌患者的发病率较高。