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放射性肠炎合并肠梗阻行病变肠管切除术后远期随访分析

Operative and long term results after diseased bowel resection for chronic radiation enteritis complicated with intestinal obstruction

摘要:

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.

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abstracts:

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.

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