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DCR:左侧梗阻性结肠癌患者首次手术干预后 90 天内的死亡率分析

2022-06-28 xuyihan MedSci原创

结肠癌是常见的发生于结肠部位的消化道恶性肿瘤,结肠癌与人们食用红肉(如牛肉)有着很大的相关性。好发于直肠与乙状结肠交界处,以40~50岁年龄组发病率最高,男女之比为2~3:1。

结直肠癌是全球第三大最常见的癌症,2019年新增结直肠癌病例超过190万。尽管大多数患者被诊断为轻度症状且处于发病的早期,但13%的患者会出现急性结肠梗阻,这部分患者占了85%的结肠癌急诊结肠切除术病例。急诊切除常用于左侧梗阻性结肠癌(LSOCC),然而,它与高死亡率相关。

因此,使用减压造口 (DS) 或自膨胀金属支架 (SEMS) 作为阻塞手术过渡(BTS)手段已被建议作为替代策略。虽然 DS 作为 BTS 越来越多地使用,但紧急切除仍然是大多数荷兰医院的首选方法。

本研究旨在在第一次干预后的 90 天内出现 LSOCC 的患者预后的差异。

本项研究是在荷兰75家医院联合进行的多中心前瞻性研究。如果患者在2009年-2016年期间接受了以治愈为目的的左侧阻塞性结肠癌切除术,则被纳入研究。第一次干预是指急诊手术切除肠道或者是自膨胀金属支架过渡到手术或减压造口过渡到手术。主要观察结局指标是首次干预后的 90 天死亡率。研究人员使用多变量逻辑分析确定风险因素。

本项研究共纳入2395名患者,第一次干预包括1848名(77%)患者进行了急诊肠道切除,332名(14%)患者进行了造口手术,215 名(9%)的患者使用自膨胀金属治疗。总体而言,152名患者(6.3%)在首次干预后的90天内死亡。减压造口与较低的90天死亡风险独立相关(HR:0.27,CI:0.094-0.62)。死亡率的其他独立预测因素是年龄、ASA 分类、肿瘤位置以及血清肌酐和 C 反应蛋白的指标水平。构建的风险模型的曲线下面积为0.84(CI:0.81-0.87)。

本项研究证实不同治疗策略对左侧梗阻性结肠癌患者的90天死亡率有显着影响。减压造口可显着降低死亡风险,尤其是在年老体弱的患者中。

 

原始出处:

Burghgraef, Thijs A. et al. Predicting Mortality Within 90 Days Of First Intervention In Patients With Left-Sided Obstructive Colon Cancer. Diseases of the Colon & Rectum.2022.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2041498, encodeId=b3d72041498de, content=<a href='/topic/show?id=7d30544167c' target=_blank style='color:#2F92EE;'>#手术干预#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54416, encryptionId=7d30544167c, topicName=手术干预)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sun Sep 04 22:34:50 CST 2022, time=2022-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229342, encodeId=c219122934244, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed Jun 29 06:57:12 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229341, encodeId=e16a12293417a, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed Jun 29 06:47:49 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229315, encodeId=0f56122931598, content=减压造口可以有效减少死亡率, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b7585483820, createdName=ms3000000731310237, createdTime=Wed Jun 29 00:08:42 CST 2022, time=2022-06-29, status=1, ipAttribution=)]
    2022-06-29 学医无涯

    学习一下

    0

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    2022-06-29 xulv123

    认真学习~~

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2041498, encodeId=b3d72041498de, content=<a href='/topic/show?id=7d30544167c' target=_blank style='color:#2F92EE;'>#手术干预#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54416, encryptionId=7d30544167c, topicName=手术干预)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Sun Sep 04 22:34:50 CST 2022, time=2022-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229342, encodeId=c219122934244, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed Jun 29 06:57:12 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229341, encodeId=e16a12293417a, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Wed Jun 29 06:47:49 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229315, encodeId=0f56122931598, content=减压造口可以有效减少死亡率, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b7585483820, createdName=ms3000000731310237, createdTime=Wed Jun 29 00:08:42 CST 2022, time=2022-06-29, status=1, ipAttribution=)]
    2022-06-29 ms3000000731310237

    减压造口可以有效减少死亡率

    0

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