Kingston R D, Walsh S H, Jeacock J
Department of Clinical Studies, Trafford General Hospital, Manchester.
Ann R Coll Surg Engl. 1993 Sep;75(5):335-8.
A prospective study of 825 consecutive patients with colorectal cancer presenting to three general surgeons in a district general hospital over a 10-year period are reported. In all, 735 patients had an operation and are grouped according to whether their operation was within 24 h of admission (n = 63), more than 24 h after admission (n = 151), or elective (n = 521). Operative mortalities for these groups were 15.9%, 15.2% and 6.5%, respectively, significantly higher in both the emergency groups. Delayed surgery to allow complete resuscitation did not improve the operative mortality when compared with those patients having urgent surgery. Both groups of emergency patients, delayed (27%) urgent (19%), showed poorer 5-year survival than the electively treated patients (36%), many dying of non-cancer causes. Patients who undergo emergency surgery for colorectal carcinoma are more likely to be in poorer physical condition than patients undergoing elective surgery for the same condition. It appears that the physical status is the principal determinant of outcome after emergency colorectal surgery rather than any other factor.
本文报告了一项前瞻性研究，该研究对一家地区综合医院的三位普通外科医生在10年期间连续收治的825例结直肠癌患者进行了观察。总共有735例患者接受了手术，并根据手术时间分为三组：入院后24小时内手术（n = 63）、入院后超过24小时手术（n = 151）或择期手术（n = 521）。这些组别的手术死亡率分别为15.9%、15.2%和6.5%，两个急诊组的死亡率显著更高。与接受紧急手术的患者相比，延迟手术以进行充分复苏并没有降低手术死亡率。两组急诊患者，延迟手术组（27%）和紧急手术组（19%），其5年生存率均低于择期治疗的患者（36%），许多患者死于非癌症原因。因结直肠癌接受急诊手术的患者相比因相同疾病接受择期手术的患者，身体状况往往更差。似乎身体状况是急诊结直肠癌手术后预后的主要决定因素，而非其他任何因素。
