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대장천공의 합병증과 사망률에 영향을 미치는 인자

Prognostic Factors for Complication and Mortality of Colonic Perforation

대한대장항문학회지 2009년 25권 3호 p.143 ~ 149
박건환 ( Park Keon-Hwan ) - 인제대학교 의과대학 일산백병원 외과학교실

김재일 ( Kim Jae-Il ) - 인제대학교 의과대학 일산백병원 외과학교실
박제훈 ( Park Je-Hoon ) - 인제대학교 의과대학 일산백병원 외과학교실
최평화 ( Choi Pyong-Wha ) - 인제대학교 의과대학 일산백병원 외과학교실
이명수 ( Lee Myung-Soo ) - 인제대학교 의과대학 일산백병원 외과학교실
허태길 ( Heo Tae-Kil ) - 인제대학교 의과대학 일산백병원 외과학교실
김철남 ( Kim Chul-Nam ) - 인제대학교 의과대학 일산백병원 외과학교실
장석효 ( Chang Surk-Hyo ) - 인제대학교 의과대학 일산백병원 외과학교실
노태호 ( Rho Tai-Ho ) - 인제대학교 의과대학 일산백병원 외과학교실

Abstract


Purpose: The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality.

Methods: The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses.

Results: Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9).

Conclusions: Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.

키워드

대장천공;예후인자
Colonic perforation;Prognostic factor
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