Runkel N S, Hinz U, Lehnert T, Buhr H J, Herfarth Ch
Department of Surgery, University of Heidelberg, Germany.
Br J Surg. 1998 Sep;85(9):1260-5. doi: 10.1046/j.1365-2168.1998.00855.x.
Emergency surgery for colorectal cancer has become more aggressive and radical over the past decade. This retrospective review analyses the impact on outcome.
The results of emergency surgery within 24 h of admission were compared between 1982 and 1987 (77 patients) and 1988 and 1993 (75 patients). Patient and tumour characteristics were similar in both groups.
Right colonic obstruction or perforation was treated by primary resection and anastomosis in 11 of 12 patients before 1988 and in all 19 patients thereafter. Primary resection was also the treatment of choice for perforated cancer of the left colon and rectum before 18 of 20) and after (20 of 21) 1988. The rate of primary resection for obstructing cancer of the left colon and rectum increased from 17 of 45 to 30 of 35. One-stage resections for obstructing cancer were performed in ten of 45 and 22 of 35 patients before and after 1988 respectively. The overall mortality rate declined from 14 of 77 to three of 75 after 1988 (P< 0.01). The rate of radical lymphadenectomy rose from six of 46 patients to 42 of 69 after 1988. The 3-year survival rate increased from 50 to 74 per cent (P < 0.05).
The data support further efforts towards improving the immediate and late outcome of emergency surgery in complicated colorectal cancer.
在过去十年中，结直肠癌急诊手术变得更加积极和彻底。本回顾性分析旨在评估其对手术结果的影响。
比较1982年至1987年（77例患者）和1988年至1993年（75例患者）入院后24小时内急诊手术的结果。两组患者和肿瘤特征相似。
1988年前12例患者中有11例、之后19例患者的右半结肠梗阻或穿孔均采用一期切除吻合术治疗。1988年前20例中有18例、之后21例中有20例左半结肠和直肠癌穿孔也首选一期切除。左半结肠和直肠癌梗阻的一期切除率从45例中的17例增至35例中的30例。1988年前45例患者中有10例、之后35例患者中有22例对梗阻性癌行一期切除。1988年后总体死亡率从77例中的14例降至75例中的3例（P<0.01）。根治性淋巴结清扫率从46例患者中的6例增至69例中的42例。3年生存率从50%提高到74%（P<0.05）。
这些数据支持进一步努力改善复杂结直肠癌急诊手术的近期和远期结果。
