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目的探讨医源性脾脏损伤脾切除对结直肠癌切除患者术后长期生存的影响。方法对1990年1月1日至1999年12月31日10年间行结直肠癌手术切除并附带脾切除患者进行病例配对回顾研究。分析患者年龄、性别、依据美国麻醉学医师协会(ASA)标准评估的身体状况、疾病分期、手术类型及预后等资料。配对病例来自同一医疗中心,性别、年龄、疾病分期及手术类型完全相同。手术附带脾切除患者为试验组,未切脾者为对照组。结果55例患者行医源性脾切除术,对照组在年龄、性别、身体状况、疾病分期及手术类型上与之匹配。随访时间(从手术开始到患者死亡或者最后一次随访)为2～205个月(中位随访时间为43个月)。Cox比例危险度模型进行Kaplan-Meier法生存分析发现两组间差异有显著性意义,不切除脾脏对患者生存有利(危险度1.8,95%可信区间为1-3.3,P=0.0399),未切脾组与切脾组5年生存率分别为70%和47%,10年生存率分别为55%和38%。结论结直肠癌患者在行结肠或直肠切除时,因医源性脾脏损伤而切除脾脏者,预后较差。
Objective To investigate the effect of splenectomy with iatrogenic spleen injury on the long-term survival after resection of colorectal cancer. Methods A retrospective case-by-case study was performed on patients undergoing resection of colorectal cancer with splenectomy for the 10-year period from January 1, 1990 to December 31, 1999. Patients were analyzed for age, gender, physical condition, stage of disease, type of surgery, and prognosis as assessed by the American Association of Anesthesiologists (ASA) criteria. Matching cases from the same medical center, gender, age, disease stage and type of surgery exactly the same. Surgery with splenectomy patients for the experimental group, not the spleen were the control group. Results Fifty-five patients underwent iatrogenic splenectomy. The control group matched with age, sex, physical condition, disease stage and operation type. Follow-up time (from the start of surgery until the patient died or the last follow-up) ranged from 2 to 205 months (median follow-up was 43 months). Cox proportional hazards model Kaplan-Meier survival analysis found significant difference between the two groups, without excision of the spleen in patients with favorable survival (risk 1.8,95% confidence interval of 1-3.3, P = 0.0399), not The 5-year survival rates of the splenectomy group and the splenectomy group were 70% and 47%, respectively, and the 10-year survival rates were 55% and 38% respectively. Conclusion Colorectal cancer patients undergoing colon or rectal excision, due to iatrogenic spleen injury and excision of the spleen, the prognosis is poor.