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응급실로 내원한 좌측 대장 병변 환자에서 수술 중 대장 세척법에 의한 단단계 수술의 안전성

The Safety of Intraoperative Colonic Irrigation for Single Stage Procedure in Emergency Based Left Colonic Pathology

대한대장항문학회지 2001년 17권 6호 p.309 ~ 315
김범렬 ( Kim Bun-Ryul ) - 영남대학교 의과대학 외과학교실

손대호 ( Son Dae-Ho ) - 영남대학교 의과대학 외과학교실
장병익 ( Jang Byung-Ik ) - 영남대학교 의과대학 내과학교실
정문관 ( Chung Moon-Kwan ) - 영남대학교 의과대학 내과학교실
심민철 ( Shim Min-Chul ) - 영남대학교 의과대학 외과학교실
김재황 ( Kim Jae-Hwang ) - 영남대학교 의과대학 외과학교실

Abstract


Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety.

Purpose: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe.

Methods: We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60±17, range: 26∼82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58±16, range: 18∼90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59±19, range: 19∼80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE Ⅲ scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD).

Results: There were no statistically significant differences in patient demographics and preoperative APACHE Ⅲ scores. The improvement of APACHE Ⅲ score was significant in SP and DC on the 3rd POD from 29.6±20.9 to 22.9±10.2 and 25.7±13.3 to 21.4±14.8 (P<0.05). There was also a significant improvement in DC (25.7±13.3 to 21.9±12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6±20.9 to 26.1±12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC.

Conclusions: Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns
procedure in emergency based left colonic pathology.

키워드

수술 중 전향적 대장 세척법;단단계 수술법;좌측 대장암;폐쇄;천공
Intraoperative antegrade colonic irrigation;One-stage operation;Left colon cancer;Obstruction;Perforation
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