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대장천공에 대한 연구

Colon Perforation

대한대장항문학회지 1999년 15권 4호 p.307 ~ 314
최광호 ( Choi Gwang-Ho ) - 고려대학교 의과대학 외과학교실

홍윤식 ( Hong Yun-Sik ) - 고려대학교 의과대학 외과학교실
서성옥 ( Seo Seong-Ok ) - 고려대학교 의과대학 외과학교실
문홍영 ( Moon Hong-Young ) - 고려대학교 의과대학 외과학교실

Abstract


Purpose: To evaluate factors that predict prognosis of colon perforation, we review the hospital records of 37 patients who underwent emergency operation for colon perforation.

Methods: Information of clinical findings, Acute Physiology and Chronic Health Evaluation (APACHE II score), perforation sites and causes, operation methods, and postoperative complications were obtained.

Results: The causes of perforation were traumatic 11 (29.7%), iatrogenic 10 (27.0%), diverticular 6 (16.2%), cancerous process 6 (16.2%), strangulated hernia 2 (5.4%), ischemic colitis 1 (2.7%) and stercoral 1 (2.7%). The longer duration from colon perforation to operation, the more severe intra-abdominal fecal contamination was seen. The complication rate was increased as the intra-abdominal fecal contamination increased or APACHE II score increased (p<0.05). But there were no correlation between the complication rate and perforation sites and causes. In according to operative managements, one-stage operation (simple closure or resection with anastomosis) group had more lower complication rate than two-stage operation (formation of colostomy) group, unexpectedly (31.3% vs. 52.4%, p>0.05). Also former group had lower complication rate compared to latter group in left colon (40% vs 50%).

Conclusion: The factors that predict of mortality and morbidity are not perforation site, causes, and operation method, but preoperative physiologic status (APACHE II score) and intra-abdominal fecal contamination. So preoperative proper and vigorous treatment for improvement of physiologic status and shortening of interval to operation are important for better results. And primary closure and resection with anastomosis is useful for colon perforation in selected circumstance regardless of its site and cause.

키워드

Colon perforation;APACHE II score;Primary repair;Colostomy
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