Objective To analyze the early clinical outcome of high-operative-risk coronary artery bypass grafting （CABG） classified according European System for Cardiac Operative Risk Evaluation （EuroSCORE）. Methods Classified eighty-four patients accepted CABG from Feb. 2004 to Sep. 2004 in our ward to high-operativerisk group （≥6, n=40） and low-medium-operative-risk group （0-5, n=44） according EuroSCORE. Record the operative schemes, complications after operation and evaluate the severe state with acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and sequential organ failure assessment（SOFA） for all patients. Compare the early clinical outcome between the two groups. Results The operative mortality, ratio of long ICU-staying time, incidence of complications and severe degree of high-operative-risk group were higher than those in the low-mediumoperative-risk group. Standard EuroSCORE had significant positive correlation with either of A0, A1, Amax or S1, Smax counted in total patients （P〈0. 01）, and the same as logistic EuroSCORE （P〈 0. 05）. But when compared the relationships in certain risk ranks, only in high-operative-risk group the positive correlation was found between standard EuroSCORE and A1, Amax, S1 and Smax （P〈 0. 05）, between logistic EuroSCORE and Amax （P〈 0. 05）. Conclusion EuroSCORE could evaluate overall operative risk perfectly in our patients, and maybe more sensitively in the high-operative-risk patients. Many factors could improve the prognosis of high-operative-risk patients： accurate evaluation of the operative risk before surgery; perfect myocardial protection, effective myocardial revascularization and thorough correction of malformation in operation, and proper postoperative management in time.
ObjectiveTo explore the risk factors influenced postoperative complications of colon cancer. MethodsIn this study, 114 patients diagnosed definitely as colon cancer were enrolled from January 2009 to April 2010 in this hospital. The patients were divided into the complication group and non-complication group according to the occurrence of postoperative complications during hospital day. Furthermore, clinicopathological features and operative parameters of patients were compared in two groups, and independent factors for postoperative complications were identified by multiple regression analysis. ResultsThere were statistical differences between two groups in operation time (t=2.034, P=0.032), diabetes mellitus (χ2=5.920, P=0.015), differentiation degree of tumor (χ2=7.163, P=0.028), hospital stay (χ2=0.411, P=0.026), and ASA grades (χ2=11.585, P=0.009). The morbidity of patients with operative time gt;200 min was significant higher than that ≤100 min (χ2=8.884, P=0.003) and 100-200 min (χ2=7.318, P=0.007). The morbidity of patients with ASA Ⅳ grade was higher than that with ASA Ⅰ grade (χ2=13.426, P=0.000). For tumor differentiation, the morbidity of patients with well-differentiated tumor was higher than that with moderately differentiated tumor (χ2=4.950, P=0.026) and poorly differentiated tumor (χ2=7.476, P=0.006). The hospital stay (P=0.009), age (P=0.024), diabetes mellitus (P=0.018), and ASA grade (P=0.001) were the independent factors for postoperative complications by multivariate regression analysis. ConclusionThe physical quality indexes are the mostly common risk factors of postoperative complications for colon cancer, emphasizing on the high-risk factors and making a targeted and individual treatment plan for each patient are of great important to improve the prognosis.
Objective To validate the accuracy of the colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CCM), and to find out the relationship between clinical risk factors and the predictive value produced by ACPGBI-CCM. Methods The patients diagnosed definitely as colorectal cancer in the department of anal-colorectal surgery, West China hospital from April 2007 to July 2007 were analyzed retrospectively. And the predictive value of mortality for each patient was calculated by ACPGBI-CCM, then the difference of risk factors was compared by classifying the patients into lower risk group and higher risk group by making the median predictive mortality as a cut point. Results From April 2007 to July 2007, a total of 99 patients diagnosed definitely as colorectal cancer accepted treatment, and among which 67 patients included in this study were admitted whose average age was 60.09 years. And there were 34 male and 33 female patients; 15 right hemicolon cancer, 9 left hemicolon cancer, 43 rectal cancer; Dukes staging: A 0 case, B 37 cases, C 24 cases, D 6 cases. The observed mortality 30 days after operation was 0, whereas the predictive mortality was 0.77%-25.75% with a median value of 3.36%. Then the patients whose predictive mortality were ≤3.36% were grouped as lower risk group (34 cases), the others higher risk group (33 cases), and there was strikingly different predictive mortality between two groups 〔(8.86±4.51)% vs (1.76±0.68)%, P＜0.01〕. And between two groups, the age, internal medicine complications, preoperative chemotherapy, ASA grading, cancer resected, and operative time made predominant differences (P＜0.01); and the neoplastic complications, Dukes staging, TNM classification, postoperative pain showed differences, too (P＜0.05); however, the gender, history of abdominal operation, the distance of the neoplasm to anal edge, the cancer location, differentiated degree, postoperative hospitalization time, and total hospitalization time didn’t have any differences (Pgt;0.05). Furthermore, stratification analysis was made for risk factors, and it came out that there were great differences of predictive mortality for different age groups and ASA grading, having internal medicine complications or not, having chemotherapy or not, and for cancer resected or not, and the differences were statistically significant (P＜0.01); also different Dukes staging or differentiation could cause different mortality (P＜0.05); but the difference of mortality didn’t make any sense according to gender, having abdominal operative history or not, having neoplastic complications or not, different TNM staging and cancer location (Pgt;0.05). Conclusion The clinical applicability of the ACPGBI-CCM is ascertained in such a large volume single medical centre, but the ACPGBI-CCM overpredicts the mortality in this study which may be attributed to the different areas, nations, or the different cultures. The complications and the neo-adjuvant or adjuvant therapy are further found out that they may be independent predictive factors of survival, and more research will be needed to prove this.
ObjectiveTo explain the latest concepts of colorectal surgery, and predict the future direction of it. MethodsA review and summary based on the clinical experience of our hospitals and theses over the past years and new advances on the researches in home and abroad were performed. ResultsDoctors should attach more importance to anal preserving operation; and there should be more usage of fast track in colorectal surgery. Besides, predicting low risk of postoperative complications and digitizing colorectal surgery also needed more attention. ConclusionThose aspects of colorectal surgery in the result need further development.