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폐쇄 및 천공을 동반한 대장암 응급 수술 후 합병증과 사망률 발생 위험인자 분석

Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer

대한대장항문학회지 2009년 25권 3호 p.165 ~ 171
강동백 ( Kang Dong-Baek ) - 원광대학교 의과대학 외과학교실

이정균 ( Lee Jeong-Kyun ) - 원광대학교 의과대학 외과학교실
박원철 ( Park Won-Cheol ) - 원광대학교 의과대학 외과학교실
신창열 ( Shin Chang-Yeol ) - 원광대학교 의과대학 외과학교실

Abstract


Purpose: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome.

Methods: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors.

Results: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class.

Conclusions: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

키워드

폐쇄;천공;대장암;위험인자
Obstruction;Perforation;Colorectal cancer;Risk factor
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