Irvin T T, Greaney M G
Br J Surg. 1977 Oct;64(10):741-4. doi: 10.1002/bjs.1800641015.
The factors affecting the prognosis of patients presenting with colonic obstruction caused by carcinoma were examined in a retrospective study of 66 patients undergoing emergency surgery for obstruction. The findings in these cases were compared with 176 patients with colonic cancer undergoing elective surgical treatment. Obstructed patients had a significantly higher surgical mortality (37.9 per cent) than elective cases (11.9 per cent). There was a significantly higher incidence of lymph node metastases in obstructed patients and those who survived surgery had a significantly lower 5-year survival rate (22.9 per cent) than elective cases (41.5 per cent). Primary resection of obstructing tumours was followed by a higher 5-year survival rate (31.8 per cent) than staged resections (7.7 per cent), but these operations were used selectively and the 5-year survivors following primary resection all had tumours of the proximal colon. Primary resection and anastomosis of the distal colon was associated with a surgical mortality of 50 per cent. Further progress in the cure of patients with obstructing cancer of the colon may be limited by the aggressive nature of the disease, but the use of primary resection in these cases should be examined in a prospective clinical trial.
在一项对66例因结肠癌导致结肠梗阻而接受急诊手术的患者进行的回顾性研究中，对影响这类患者预后的因素进行了调查。将这些病例的研究结果与176例接受择期手术治疗的结肠癌患者进行了比较。梗阻患者的手术死亡率（37.9%）显著高于择期手术患者（11.9%）。梗阻患者的淋巴结转移发生率显著更高，且手术存活患者的5年生存率（22.9%）显著低于择期手术患者（41.5%）。梗阻性肿瘤一期切除后的5年生存率（31.8%）高于分期切除（7.7%），但这些手术是选择性使用的，一期切除后的5年存活者均为近端结肠癌患者。远端结肠一期切除并吻合的手术死亡率为50%。结肠癌梗阻患者治疗的进一步进展可能会受到该疾病侵袭性本质的限制，但在这类病例中使用一期切除应在前瞻性临床试验中进行研究。
