Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
World J Emerg Surg. 2023 Feb 6;18(1):12. doi: 10.1186/s13017-023-00481-z.
Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear.
We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame.
A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%.
In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.
由于疾病和治疗相关的免疫抑制，需要进行腹部急诊手术的血液学患者被认为是高危人群。然而，对于同时患有血液系统恶性肿瘤的患者，其腹部急诊手术的最佳手术治疗和围手术期管理仍不清楚。
我们在此报告了一项单中心回顾性分析，旨在研究因临床疑似胃肠道穿孔（A 组）、肠梗阻（B 组）或急性胆囊炎（C 组）而进行的腹部急诊手术对同时患有血液系统恶性肿瘤患者的死亡率和发病率的影响。本回顾性单中心研究纳入的所有患者均通过筛查胃肠道穿孔、肠梗阻和缺血性及急性胆囊炎的 ICD-10 诊断代码确定。此外，还在给定时间范围内的所有病理报告数据库中进行了关键字搜索。
本研究共纳入 56 例患者。胃肠道穿孔和肠梗阻分别发生在 26 例和 13 例患者中。其中，21 例患者接受了原发性胃肠吻合术，吻合口漏（AL）发生率为 33.3%，导致 AL 相关的 30 天死亡率为 80%。唯一与更高 AL 发生率相关的因素是手术前的败血症。对于疑似急性胆囊炎的患者，有 3 例患者发生需要腹部填塞的术后出血事件，导致围手术期总发病率为 17.6%，与手术相关的 30 天死亡率为 5.9%。
对于因胃肠道穿孔或肠梗阻而需要进行紧急腹部手术的已知或疑似血液学恶性肿瘤患者，临时或永久性造口术可能优于原发性肠吻合术。
