摘要
目的应用英国结直肠医师协会结直肠癌术后风险评估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)对结直肠癌新辅助化疗联合手术综合治疗策略进行风险评估。方法回顾性研究了2007年7～11月期间在四川大学华西医院肛肠外科专业组收治确诊为结直肠癌的患者181例,男102例,女79例;平均年龄58.78岁;结肠癌62例,直肠癌119例。根据是否纳入多学科协作(MDT)诊治模式分为MDT组(n=65)和非MDT组(n=116),采用ACPGBI-CCM评估所有纳入患者的手术风险。结果MDT组与非MDT组之间基线一致。以中位预测死亡率(2.07%)为界分为低风险组(lower risk group,LRG,n=92)和高风险组(higher risk group,HRG,n=89)。无论在LRG或HRG中,MDT组患者胃管、尿管和引流管拔除的时间,经口进食和术后下床活动时间均比非MDT组更早(P<0.05)。LRG肿瘤切除率明显高于HRG(P<0.05);Dukes分期构成比的差异有统计学意义(P<0.05);HRG预测死亡率值明显大于LRG(P<0.05),而实际死亡例数在HRG和LRG内均为0。结论LRG的预测死亡率低于HRG与Dukes分期被纳入ACPGBI-CCM评估必备指标有密切关系,ACPGBI-CCM是否可以评价术后30d内并发症的发生率还有待进一步验证。选择应用新辅助化疗联合手术的综合治疗策略并没有显著增加患者术后预测死亡率的风险。通过术后的风险评估,全面分析MDT诊治模式下综合治疗联合流程改造的临床近期安全性,将为术后风险评估增加新的内涵。
Objective To evaluate the risk of management decision combined neo-adjuvant chemotherapy with operation for colorectal cancer by means of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland （ACPGBI-CCM）. Methods One hundred and eighty-one eligible patients （102 male, 79 female, mean age 58.78 years）, which were pathologically proved colorectal cancer in our ward from July to November 2007, involved 62 colonic and 119 rectal cancer. The enrollment were assigned into multi-disciplinary team （MDT） group （n=65） or non-MDT group （n=116）, according to whether the MDT was adopted, and the operative risk was analyzed by ACPGBI-CCM. Results The baseline characteristics of MDT and non-MDT group were coherent. The watershed of lower risk group （LRG） and higher risk group （HRG） was set as predictive mortality= 2.07 %. The time involving extraction of gastric, urethral and drainage tube, feeding, out-of-bed activity after operation in MDT group, whatever in LRG or HRG, were statistically earlier than those in non-MDT group （P〈0. 05）. The reseetable rate in LRG was statistically higher than that in HRG （P〈0. 05）, and the proportion of Dukes staging was significantly different （P〈0.05） between two groups Moreover, predictive mortality in HRG was statistically higher than that in LRG （P〈0.05）, while actually there was no death in both groups. Conclusion Dukes staging which is included as an indispensable option by ACPGBI CCM is responsible for the lower predictive mortality in LRG.Hence, the value of ACPGBI-CCM used to asses the morbidity of complications within 30 days postoperatively would be warranted by further research. The postoperative risk evaluation can serve as a novel routine to compre hensively analyze the short-term safe in the MDT.
出处
《中国普外基础与临床杂志》
CAS
2008年第9期692-696,共5页
Chinese Journal of Bases and Clinics In General Surgery
关键词
新辅助化疗
风险评估
多学科协作
结直肠癌
Neo-adjuvant chemotherapy Risk evaluation Multi-disciplinary team Colorectal neoplasmas
作者简介
汪晓东（1981年-），男，贵州省贵阳人，在职研究生在读，住院医师，从事胃肠、结直肠外科工作，E—mail：lockwan@163．com
【通讯作者】李立，E—mail：drlili116@126．com
