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숙변성 대장 천공의 예후 인자

Prognostic Factors of Patients with Stercoral Perforation of the Colon

대한소화기학회지 2020년 76권 4호 p.194 ~ 198
이형진, 김길환, 이성철, 송상현,
소속 상세정보
이형진 ( Lee Hyung-Jin ) - Dankook University College of Medicine Dankook University Hospital Department of Surgery
김길환 ( Kim Kil-Hwan ) - Dankook University College of Medicine Dankook University Hospital Department of Surgery
이성철 ( Lee Sung-Chul ) - Dankook University College of Medicine Dankook University Hospital Department of Surgery
송상현 ( Song Sang-Hyun ) - Dankook University College of Medicine Dankook University Hospital Department of Surgery

Abstract


Background/Aims: The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery.

Methods: The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7).

Results: In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%).
Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022).

Conclusions: Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.

키워드

Constipation; Emergency treatment; Lactic acid; Mortality

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