结直肠癌患者手术前后凝血纤溶指标的变化及意义

目的研究结直肠癌患者术前、术后凝血与纤溶指标的变化及其意义。方法结直肠癌组30例,非癌对照组20例。取空腹外周静脉血,测定白细胞计数(WBC)、血小板计数(PLT)、血浆凝血酶原时间(PT),活化部分凝血活酶时间(APTT),纤维蛋白原(FIB)、D-二聚体(D-D)、纤维蛋白溶酶原激活物抑制物1(PAI-1)、血浆凝血酶原片段1+2(F1+2)、蛋白C(PC)、肿瘤标记物癌胚抗原(CEA)、糖类抗原19-9(CA19-9)。结直肠癌组术后7天再予测定血浆D-D、PAI-1、F1+2、PC。采用SPSS13.0软件对这些不同时期的数据值进行统计学处理,分析手术前后结直肠癌患者凝血与纤溶指标的变化。结果 (1)结直肠癌组FIB、D-D、PAI-1、F1+2水平较对照组增加,差异有统计学意义(P0.05或P0.01),而PC水平明显低于正常组(P0.01),APTT结直肠癌组较对照组显著缩短(P0.05)。(2)结直肠癌组患者术后D-D水平明显高于术前及对照组(P0.01),而PAI-1、F1+2水平显著低于术前(P0.01)但仍高于对照组(P0.01),而术后蛋白C水平明显高于术前但低于对照组(P0.01)。(3)结直肠癌组手术前后PAI-1与F1+2水平两者存在显著的相关关系(r=0.985,P0.01),F1+2与PC或PAI-1与蛋白C两者均无相关关系(P0.05)。     

结直肠癌患者围手术期凝血功能的变化

研究结直肠癌手术前后患者凝血功能的变化。收集青岛市市立医院100例结直肠癌患者手术前后的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、血清D-二聚体、血栓弹力图检测数据,进行相关分析和配对分析。血栓弹力图中的凝集块形成速率(Angle)、最大幅度(MA值)分别与糖尿病和心血管疾病有明显相关性(P<0.05),年龄、心血管疾病、糖尿病以及呼吸系统疾病与术前PT、APTT、血清D-二聚体、血栓弹力图无明显相关性(P>0.05);术后PT、APTT、血清D-二聚体与术前比较差异有统计学意义(P<0.01);血栓弹力图的凝血反应时间(R值)、Angle、MA值手术前后比较差异有统计学意义(P<0.01)。结直肠癌手术后患者的凝血功能出现明显变化,呈现高凝状态。建议术后适当应用抗凝药物。     

腹部大手术患者凝血功能的变化及临床意义

目的研究腹部大手术患者凝血功能的变化,并探讨其临床意义。方法测定2000年9月至2005年3月我院35例腹部大手术者手术前后血浆凝血酶原时间(PT),部分凝血活酶时间(APTT),纤维蛋白原(FIB),血小板计数(PLT)水平的变化,以30例正常人为对照。结果腹部大手术组与对照组相比,术前FIB水平较高,两者差异有显著性(P=0.008),术后PLT水平明显降低,PT则显著延长,差异有显著性(P值分别为0.000及0.015)。腹部大手术者术前术后比较,PT明显延长,FIB和PLT水平则降低,差异均有显著性(P值分别为0.019,0.013及0.002)。伴发肝病的腹部大手术者术后FIB和PLT水平明显低于非肝病患者(P值分别为0.000及0.024)。术后死亡患者PLT水平低于存活患者,PLT水平低于50.0×109/L的患者死亡率为100%。结论腹部大手术者术前常呈高凝状态,术后则可呈现高凝,相对纤溶抑制和低凝;术中大出血或伴有肝病易诱发术后出血;术后PLT减少是预测患者死亡的独立危险因素。     

结直肠癌患者手术前后腹腔脱落肿瘤细胞检测的临床意义

目的探讨结直肠癌患者手术前后腹腔脱落肿瘤细胞检出阳性率及其与临床病理分期的关系和对预后的影响。方法对121例结直肠癌患者在手术进入腹腔后和关闭腹腔前,进行腹腔脱落细胞学检查,并与患者的临床病理分期和随访结果进行对比分析。结果全组患者腹腔冲洗液中肿瘤细胞检出阳性者术前为35例(28.9%),术后4例复发(11.4%);术后检出阳性者为13例(10.7%),术后7例复发(53.8%);手术前后均为阴性者其术后复发为2例(2.4%)。病理分期越晚肿瘤细胞检出阳性率越高(均P<0.05或0.00)。结论对结直肠癌患者手术前后进行腹腔冲洗液细胞学检查方法简单,具有一定的临床价值。     

结直肠癌患者手术前后肠道菌群变化分析

为通过观察结直肠癌患者手术前后肠道中双歧杆菌（Bifidobacteriumspp．）、乳酸杆菌（Lactobacillus）、粪肠球菌（Enterococcus如ecalis）和拟杆菌（Bacteroidaceae）的变化情况,分析肠道菌群的改变在结直肠癌发病及治疗中的作用及意义,收集正常健康人粪便标本60份、结直肠癌患者术前及术后粪便标本各60份,应用平板活菌计数法和荧光定量聚合酶链反应（PCR）法检测粪便标本中各种菌群的数量,同时采集患者的外周血标本,应用显色法检测D-乳糖和内毒素的含量。结果显示,结直肠癌患者术前粪便中乳酸杆菌、双歧杆菌数量均比正常健康人少,P〈O．05或P〈O．01;粪肠球菌、拟杆菌数量均比正常健康人多,P〈O．05或P〈O．01。结肠癌患者术后粪便中乳酸杆菌、双歧杆菌数量进一步减少,P〈0．05或P〈0．01;粪肠球菌、拟杆菌数量进一步增多,P〈O．05或P〈O．01。结直肠癌患者血清I）I乳糖、内毒素含量比正常健康人高,P〈O．Ol,手术后其含量进一步升高,P〈O．Ol。结果表明,肠道菌群的变化与结直肠癌的发生、发展及预后有一定关系。     

腹腔镜与传统开腹手术对结直肠癌患者术后免疫功能及生理反应的影响

目的探讨腹腔镜与传统开腹手术对结直肠癌患者术后免疫功能及生理反应的影响。方法将94例结直肠癌患者根据手术方式不同分为2组,各47例。观察组实施腹腔镜手术,对照组实施开腹手术。分别在术前、术后第1、8天检测MTL、GAS、IL-6、IgA、IgG、IgM、CD4~+、CD8~+水平。结果 (1)观察组对患者胃肠产生的刺激及免疫反应和应激反应影响均小于对照组,差异具有统计学意义(P0.05)。(2)2组患者术后IgA、IgG、IgM水平均较术前降低,但与术前比较及组间比较,差异均无统计学意义(P0.05)。结论腹腔镜结直肠癌手术对患者术后生理反应及免疫功能影响较小,在保护生理反应及免疫功能方面具有一定优势。     

急性胰腺炎患者凝血功能的变化及临床意义

目的探讨急性胰腺炎(AP)患者凝血功能的变化及临床意义。方法选择26例急性水肿型胰腺炎患者(AEP组),21例急性重型胰腺炎患者(SAP组)和30例年龄、性别与体质量指数(BMI)相匹配的健康人(对照组),测定凝血功能血浆凝血酶原时间(PT)、凝血酶原时间国际标准化指数(INR)、部分活化凝血酶原时间(APTT)、纤维蛋白原浓度(FIB)和血小板计数(BPC)并计算24 h内急性生理学与慢性健康状况评分(APACHEⅡ评分),观察并比较上述指标在3组中的不同。结果 SAP组的PT、INR、APTT及FIB均显著高于AEP组和对照组,AEP组的PT、INR、APTT、FIB亦显著高于对照组,差异有统计学意义(均P0.05)。与对照组相比,SAP组和AEP组的BPC均显著降低(均P0.05);与AEP组相比,SAP的BPC亦显著降低(P0.05)。SAP组的A-PACHEⅡ评分显著高于AEP组,差异有统计学意义(P0.05)。Spearman相关分析显示,AEP组和SAP组的PT、INR、APTT、FIB、BPC均与APACHEⅡ评分呈正相关(均P0.05)。结论急性胰腺炎患者凝血功能变化与病情严重程度相关。     

高龄结直肠癌患者的手术治疗及围手术期处理

目的探讨高龄结直肠癌患者手术治疗的安全性及近期治疗效果。方法回顾性分析我院外科2012年1月至2014年10月手术治疗的高龄结直肠癌患者46例临床资料。结果 46例中,合并其他慢性疾病者41例,占89%,手术根治率91.3%,术后并发症率34.8%,主要是肺部感染、心肺功能不全、切口并发症。非计划内再次手术2例,发生率4.3%。结论外科手术是治疗高龄结直肠癌患者的有效方法,严格的术前评估、规范的围手术期处理是保证手术安全、减少术后并发症的关键。     

老年结直肠癌患者的围手术期处理

目的：探讨老龄结直肠癌患者围手术期处理要点。方法：回顾分析1989～2001年间收治的60岁以上结直肠癌患者587例治疗临床资料。结果：合并其他疾病者312例，占总病例数的53．1%，围手术期死亡7例，死亡为1．2%(7／587)，并发症的发生率为33．6%(197／587)。结论：全面而充分的术前准备、合理选择手术时机和手术方式、有效预防和治疗术后并发症对于减少手术风险极为重要；高龄不是手术禁忌。     

结直肠癌患者手术前后血清中IL-6和NO水平的临床意义

目的探讨结直肠癌患者手术治疗前后血清中IL-6和NO水平变化及其临床意义。方法对40例结直肠癌患者分别采用酶联免疫分析法和化学比色法测定手术前后血清中的IL-6和NO水平,并与10名正常健康人作比较。结果结直肠癌患者手术前血清中IL-6水平高于正常人（P〈0.05）,NO水平明显低于正常人（P〈0.01）;经手术治疗2周后,患者血清IL-6水平较治疗前降低（P〈0.05）,而NO水平明显升高（P〈0.05）。结论结直肠癌患者血清中IL-6和NO水平的变化,对病情和预后判断具有重要的临床意义。     

Prognostic factors in survival of colorectal cancer patients after surgery

Objective  To determine the factors affecting survival, following resection of large bowel for colorectal carcinoma.
Method  From the cancer database of a single referral institution, a total of 1090 patients who had undergone colorectal resection between 1999 and 2002 were identified. Cases with recurrent colorectal cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were plotted using the Kaplan–Meier method. Univariate analysis of factors thought to influence survival was then made using Logrank test. Criteria studied consisted of age, sex, TNM stage, T-status, nodal status, distant metastasis, histological grade, lymphatic and vascular invasion, tumour location, preoperative carcinoembryonic antigen (CEA) level and liver function tests. Multivariate analysis was conducted using Cox regression analysis.
Results  The mean survival time for all patients was 42.8 (SEM = 2.8) months. The overall 1-, 3- and 5-year survival rates were 72%, 54% and 47%, respectively. In univariate analysis, patients' age ( P  < 0.0001), TNM stage ( P  < 0.0001), T-status ( P  = 0.015), nodal status ( P  = 0.016), distant metastasis ( P  < 0.0001), grade ( P  = 0.005), lymphatic and vascular invasion ( P  < 0.0001) and presurgery CEA level > 5 ng/ml ( P  = 0.021) were found to be predictors that could affect survival. In Cox regression analysis, age ( P  < 0.0001), TNM stage ( P  = 0.001) and grade ( P  = 0.008) were determined as independent prognostic factors of survival.
Conclusion  Age, TNM stage, T-status, nodal status, distant metastasis, grade, lymphatic and vascular invasion and presurgery CEA level can predict the postsurgical survival rate in patients with colorectal cancer.     

Laparoscopic colorectal cancer surgery in obese patients

Aim The aim of this study was to assess the oncological and postoperative outcomes of laparoscopic colorectal cancer surgery in obese patients. Method All obese (BMI > 30) patients who underwent laparoscopic colorectal cancer surgery from January 2005 to January 2008 were compared with nonobese patients undergoing similar surgery. We recorded patient demographics, intra‐operative details and postoperative morbidity and mortality. Results Sixty‐two obese and 172 nonobese patients underwent laparoscopic colorectal cancer resection. Both groups were well matched for demographic parameters. Overall mean operating times were not significantly different. Conversion to open surgery was more likely in obese patients. In particular, for rectal cancers, the conversion rate was 44% in the obese group compared with 17% in the nonobese group (P < 0.05). Postoperative morbidity was also greater in obese patients (P < 0.05). The duration of hospital stay was similar for laparoscopically completed cases (6 days obese vs 7 days nonobese), but in the obese‐converted group it was 14 days (P < 0.05). The resected specimen with respect to length, resection margin and lymph node retrieval was equivalent between obese and nonobese patients. Disease‐free survival and overall survival at a median follow up of 2 years were also similar. Conclusions Laparoscopic colorectal cancer surgery in obese patients is technically feasible and oncologically safe. Despite greater postoperative morbidity, obese patients benefit from shorter length of stay. However, a higher conversion rate, particularly for rectal cancers, should be anticipated in obese male patients.     

Audit of definitive colorectal surgery in patients with early and advanced colorectal cancer

Background : The role of surgery in patients with advanced colorectal cancer may be questioned in the era of specialized intensive palliative care. Should patients with advanced disease be advised against surgery because of the risks of the surgery itself? In this study, the perioperative outcomes in patients undergoing definitive surgery for early (Dukes’ stages A, B and C) and advanced colorectal cancer (stage D) were examined. Methods : All patients undergoing definitive surgery for colorectal cancer during a 15‐year period were identified. Details of tumour site and stage, surgery performed, perioperative complications and postoperative mortality were compared. Results : A total of 374 patients underwent definitive surgery. There were 193 men, a male : female ratio of 1:0.9. Seventy‐one patients had advanced disease. There were no differences between the early and advanced groups in perioperative requirements for either blood or total parenteral nutrition. In the advanced group, more operations were performed as emergencies than in the early group (32.4 vs 17.5%; P < 0.01) and more patients presented with bowel obstruction in the advanced group (23.9 vs 10.2%; P < 0.01). There were no site differences between the early and advanced groups and no differences between the operations performed except that endo‐anal destruction was not performed in advanced patients. There were no differences in perioperative morbidity or mortality in the groups studied. Conclusion : Resection rates, operation type and postoperative morbidity and mortality were similar in patients with both early and advanced colorectal cancers. In terms of perioperative outcome, the presence of advanced cancer, per se, should not, therefore, be a justification to decline surgery.     

老年患者凝血功能变化及骨科手术凝血相关并发症

老年患者身体机能退化,自我修复能力逐渐降低,围手术期并发症尤其是与凝血功能、脑卒中相关的并发症发生率较高。文章综述了老年患者凝血功能特点,骨科手术围手术期术中损伤、酸中毒、低体温、输血、体位等对凝血机制影响,预防骨科手术深静脉血栓形成的措施,老年患者骨折与脑卒中的关系,骨科手术预防血栓与麻醉之间的关系。提示临床医师在使...     

结直肠癌腹腔镜手术与开腹手术的分析比较

结直肠癌是危害人类健康的主要恶性肿瘤之一,手术仍然是目前主要的治疗手段.腹腔镜结直肠癌手术已开展了十余年,不断发展,在结直肠外科领域逐渐巩固了地位.本文就结直肠癌的腹腔镜手术与开腹手术在安全性、对机体病理生理的影响、疗效等方面进行比较,探讨腹腔镜在结直肠癌治疗中的应用价值.     

Characterising nationwide reasons for unplanned hospital readmission after colorectal cancer surgery

Background

Readmissions after colorectal cancer surgery are common, despite advancements in surgical care, and have a significant impact on both individual patients and overall healthcare costs. The aim of this study was to determine the 30-and 90 days readmission rate after colorectal cancer surgery, and to investigate the risk factors and clinical reasons for unplanned readmissions.

Method

A multicenter, population-based study including all patients discharged after index colorectal cancer resection from 2010 to 2020 in Aotearoa New Zealand (AoNZ) was completed. The Ministry of Health National Minimum Dataset was used. Rates of readmission at 30 days and 90 days were calculated. Mixed-effect logistic regression models were built to investigate factors associated with unplanned readmission. Reasons for readmission were described.

Results

Data were obtained on 16,885 patients. Unplanned 30-day and 90-day hospital readmission rates were 15.1% and 23.7% respectively. The main readmission risk factors were comorbidities, advanced disease, and postoperative complications. Hospital level variation was not present. Despite risk adjustment, R² value of models was low (30 days: 4.3%, 90 days: 5.2%). The most common reasons for readmission were gastrointestinal causes (32.1%) and wound complications (14.4%). Rates of readmission did not improve over the 11 years study period (p = 0.876).

Conclusion

Readmissions following colorectal resections in AoNZ are higher than other comparable healthcare systems and rates have remained constant over time. While patient comorbidities and postoperative complications are associated with readmission, the explanatory value of these variables is poor. To reduce unplanned readmissions, efforts should be focused on prevention and early detection of post-discharge complications.