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題 名 | Colorectal Performation: Spectrum of the Disease and its Mortality=大腸直腸穿孔:病例分析與死亡因子探討 |
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作 者 | 許肇文; 金台明; 王瑞和; 王心泰; 歐文傑; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 18:3 2007.09[民96.09] |
頁 次 | 頁81-88 |
分類號 | 416.245 |
關鍵詞 | 大腸直腸穿孔; 大腸直腸憩室; 缺血性大腸炎; Colorectal perforation; Diverticulitis; Ischemic colitis; |
語 文 | 英文(English) |
英文摘要 | Purpose: colorectal perforation is a major life-threatening clinical condition that requires emergency surgical intervention. In general peritonitis caused by colorectal perforation still remains a high risk for mortality and morbidity. The aim of this study is to identify clinical characteristics, outcomes and risk factors for patients with colorectal perforation. Methods: From January 1996 to December 2005, 141 patients with colorectal perforation were selected consecutively for this study. Several clinical variables were analyzed, such as sex, age, preoperative symptoms & signs, causes of perforation, concomitant diseases, ASA scores, preoperative albumin levels, WBC count, band form WBC, persistence of symptoms and signs, intervals between diagnosis to operation, operation times, perioperative blood loss and mortality rates. The statistical methods used in this study included Chi-square analysis, student T-test, univariate logistic regression, and multivariate logistic regression. Statistical significance was determined as a value of less than 0.05. Results: 141 patients were identified, with a median age of 66.77 � 14.48 years (range: 26-95 years); 99 patients were male and 44 were female. Causes of colorectal perforation were diverticulitis (54 patients, 37.8%), ischemic colitis (38 patients, 27.0%), iatrogenic injury (14 patients, 9.9%), malignancy (13 patients, 9.2%), idiopathic ulcer or deep ulcer (5 patients, 3.5%), and trauma (3 patients, 2.1%). Overall mortality rate was 36.9% (52 patients). The highest rate of disease-specific mortality was due to malignancy (61.5%), followed by ischemic colitis (60.5%), trauma (33.3%), iatrogenic injury (21.4%) and the last is diverticulitis (18.5%). Among several prognostic factors, a p-value of less than 0.05, including age (> 60 y/o), preoperative sepsis or septic shock, perioperative blood loss (> 450 mL), emergency operation, and more than 3 concomitant diseases. Conclusions: The most common causes of colorectal perforation are diverticulitis and ischemic colitis, with malignancy and ischemic colitis causing the highest mortality rate. In this study, we clearly demonstrated that patients with colorectal perforation are associated with a higher mortality rate when their age is greater than 60 y/o, combined with preoperative sepsis or septic shock, perioperative blood loss (> 450 mL), emergency operation, and more than 3 concomitant diseases |
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