111例结肠癌伴发急性肠梗阻术后并发症危险因素分析

目的 探讨结肠癌伴发急性肠梗阻术后并发症（包括呼吸、循环、消化系统及局部）及其危险因素.方法 回顾性分析2001年1月至2009年12月北京大学第一医院诊治的111例结肠癌伴发急性肠梗阻患者的病例资料.结果 右半结肠癌伴发急性肠梗阻49例,其中48例（98.0%）实施肿瘤一期切除手术,1例患者因侵犯十二指肠及胰腺伴腹腔种植转移行回肠横结肠短路术.左半结肠癌伴发急性肠梗阻62例,53例（85.5%）实施肿瘤一期切除,其中23例行术中结肠灌洗及一期肿瘤切除吻合术,9例患者接受单纯结肠造口术.术后并发症发生率21.6%（24/111）,围手术期死亡率5.4%（6/111）.左半结肠癌与右半结肠癌肠梗阻术后,并发症发生率及围手术期死亡率两者差异无统计学意义（P＞0.05）.单因素分析显示,高龄（大于60岁）（P=0.012）、美国麻醉医师协会（ASA）分级3～4级（P＜0.001）者术后并发症发生率较高.多因素分析显示,ASA分级3～4级（P=0.001,OR=8.583）是术后并发症的独立危险因素.结论 结肠癌致急性肠梗阻术后并发症发生率及围手术期死亡率较高 对于ASA 3～4级患者应谨慎选择恰当术式及术后加强监护.

Factors associated with complications in patients undergoing surgery for obstructing colorectal cancer

Objective To evaluate risk factors associated with morbidity and mortality in patients undergoing surgery for obstructing colorectal cancer. Methods One hundred and eleven patients who underwent emergency surgery for obstructing colorectal cancer from January 2001 to December 2009 were retrospectively reviewed. Results Forty-nine patients had obstruction proximal to the splenic flexure and 62 patients at or distal to the splenic flexure. The morbidity and mortality rates of the emergency surgery for malignant obstruction were 21.6% and 5.4%, respectively. Twenty-three patients received resection with primary anastomosis with intraoperative lavage for left-sided lesions.There was no difference in morbidity between right-sided cancer and left-sided cancer (P＞0.05).Univariable analysis showed that complications rate was higher in patients with higher ASA score (3-4) and in those aged over (60 years. Multivariate logistic regression analysis revealed that ASA score(3-4) was an independent risk factor. Conclusions Emerrgency surgery for obstructing colorectal cancer is associated with high rates of morbidity and mortality. Selection of the proper operation and intensive treatment after surgery are recommended in high risk patients.