Phillips R K, Hittinger R, Fry J S, Fielding L P
Br J Surg. 1985 Apr;72(4):296-302. doi: 10.1002/bjs.1800720417.
Of 4583 patients in the Large Bowel Cancer Project, 713 (16 per cent) were obstructed. The site of greatest risk was the splenic flexure (49 per cent). Advanced stage was neither the full reason why some patients obstructed nor for their subsequent poor prospects (age-adjusted 5-year survival: not obstructed, 45 per cent; obstructed, 25 per cent). Also, there was no greater risk of vascular invasion, no heavier lymph node burden and no worse tumour differentiation in patients with obstruction. In-hospital mortality was high (23 per cent), was not reduced by either a policy of primary or staged resection and was not influenced by the site of obstruction. There was no survival advantage for either policy, but hospital stay after primary resection was half that of staged. Immediate anastomosis in the obstructed left colon had a high clinical leak rate (18 per cent versus 6 per cent elective; P less than 0.001). Both registrars and consultants had similar mortality rates for elective primary resection and for the management of obstruction itself (as evidenced by results after the first stage of a staged resection). Selection probably accounts for the very much better results achieved by consultants for primary resection in the presence of obstruction (in-hospital mortality: consultants, 13 per cent; registrars, 24 per cent).
在大肠癌项目的4583例患者中，713例（16%）发生肠梗阻。风险最高的部位是脾曲（49%）。晚期既不是部分患者发生肠梗阻的全部原因，也不是其预后不良的原因（年龄校正后的5年生存率：未发生肠梗阻者为45%，发生肠梗阻者为25%）。此外，肠梗阻患者发生血管侵犯的风险并不更高，淋巴结负荷并不更重，肿瘤分化也并不更差。住院死亡率很高（23%），无论是一期切除还是分期切除策略都未能降低死亡率，且不受梗阻部位的影响。两种策略均无生存优势，但一期切除后的住院时间是分期切除的一半。梗阻性左半结肠癌一期吻合的临床漏率很高（18%，择期手术为6%；P<0.001）。住院医生和顾问医生在择期一期切除和梗阻处理方面的死亡率相似（分期切除第一阶段后的结果证明）。在存在梗阻的情况下，顾问医生进行一期切除取得更好结果的原因可能在于选择病例的差异（住院死亡率：顾问医生为13%，住院医生为24%）。
