CAJ | 학술논문

目的随访慢性放射性肠炎合并肠梗阻行病变肠管切除手术后的远期效果,评价手术治疗效果以及探讨影响患者术后生存因素.方法分析2001年6月至2011年3月间因放射性肠炎合并肠梗阻而进行病变肠管切除手术的120例患者的临床资料并进行术后随访,其中男性22例,女性98例,年龄23 ～ 82岁(中位年龄52岁),对患者的人口统计学资料、肿瘤病史、放化疗史、首次出现症状至接受第1次手术的时间、术后并发症、术后剩余小肠长度、术后生存率进行统计分析,评价手术治疗效果以及探讨影响患者术后生存的因素.结果术后总体并发症和中重度并发症的发生率分别为61.7％和33.3％,术后30 d内死亡率为2.5％.患者术后1、5、10年生存率分别为96％、60％、37％.与术前患者体重指数[(17.6 ±3.0)kg/m2]相比,随访终点时患者体重指数[(20.2±3.0) kg/m2]明显增加(t=6.01,P＜0.01);93％患者术后可摆脱静脉营养支持,恢复经口饮食(术前为2％,x2 =164.1,P＜0.01).多因素分析表明,当合并术前带瘤生存(HR=4.082,95％ CI:1.318 ～12.648)、美国麻醉师协会评分＞3分(HR=3.495,95％CI:1.131 ～ 10.800)及年龄＞70岁(HR=2.800,95％ CI:0.853～9.189)时,术后生存率明显降低(P＜0.05).结论慢性放射性肠炎合并肠梗阻患者行病变肠管切除手术后有很好的生存率,术后生存率主要受并存疾病影响,绝大多数患者术后可摆脱静脉营养,恢复经口饮食.
목적 수방만성방사성장염합병장경조행병변장관절제수술후적원기효과,평개수술치료효과이급탐토영향환자술후생존인소.방법 분석2001년6월지2011년3월간인방사성장염합병장경조이진행병변장관절제수술적120례환자적림상자료병진행술후수방,기중남성22례,녀성98례,년령23 ～ 82세(중위년령52세),대환자적인구통계학자료、종류병사、방화료사、수차출현증상지접수제1차수술적시간、술후병발증、술후잉여소장장도、술후생존솔진행통계분석,평개수술치료효과이급탐토영향환자술후생존적인소.결과 술후총체병발증화중중도병발증적발생솔분별위61.7％화33.3％,술후30 d내사망솔위2.5％.환자술후1、5、10년생존솔분별위96％、60％、37％.여술전환자체중지수[(17.6 ±3.0)kg/m2]상비,수방종점시환자체중지수[(20.2±3.0) kg/m2]명현증가(t=6.01,P＜0.01);93％환자술후가파탈정맥영양지지,회복경구음식(술전위2％,x2 =164.1,P＜0.01).다인소분석표명,당합병술전대류생존(HR=4.082,95％ CI:1.318 ～12.648)、미국마취사협회평분＞3분(HR=3.495,95％CI:1.131 ～ 10.800)급년령＞70세(HR=2.800,95％ CI:0.853～9.189)시,술후생존솔명현강저(P＜0.05).결론 만성방사성장염합병장경조환자행병변장관절제수술후유흔호적생존솔,술후생존솔주요수병존질병영향,절대다수환자술후가파탈정맥영양,회복경구음식.
Objective To report operative and long-term results after surgery for chronic radiation enteritis and to evaluate the therapeutic efficacy of surgery and investigate the risk factors of postoperative survival rate.Methods The 120 CRE patients performed with diseased bowel resection from June 2001 to March 2011 were analyzed retrospectively and followed up by telephone.There were 22 male and 98 female patients and their age were 23-82 years (median 52 years).Their demographic data,the cancer history,the characteristics of radiotherapy received (total dose,defined as the cumulative dose of external and endocavity radiation),the time interval between the first symptoms and the first surgical procedure,postoperative complications,length of residual small bowel,postoperative survival rate were recorded.Evaluate the therapeutic efficacy of surgery and investigate the risk factors of postoperative survival rate.Results The postoperative overall complications and the incidence of moderate to severe complications (Clavien-Dindo Grade Ⅲ-Ⅴ) were 61.7％ and 33.3％,respectively.The postopertive mortality was 2.5％.The survival probabilities were 96％,60％ and 37％ at 1-,5-and 10-years,respectively.At the end of follow up,the mean of body mass index (BMI) increased compared with the BMI of preoperatiive ((17.6 ±3.0) kg/m2vs.(20.2 ±3.0) kg/m2,t =6.01,P ＜0.01).The 93％ of patients can stop PN and regain full oral diet after operation (x2 =164.1,P ＜0.01).On multivariate analysis,survival was significantly decreased with residual neoplastic disease (HR =4.082,95％ CI:1.318-12.648),an American Society of Anesthesiologists score ＞3 (HR =3.495,95％ CI:1.131-10.800) and an age of chronic radiation enteritis diagnosis ＞70 years (HR =2.800,95％ CI:0.853-9.189).Conclusions The survival of patients with chronic radiation enteritis complicated with intestinal obstruction after intestinal resection was good and was mainly influenced by underlying comorbidities.Majority of the patients can stop PN and regain full oral diet after operation.