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題名 | Predictive Factors of Surgical Mortality after Hartmann's Procedure for Colorectal Emergencies in the Elderly=老年人因大腸直腸急症接受哈特曼手術後手術死亡的預測因子 |
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作者 | 徐大聞; 魏昌國; 張群明; 林世彬; 林俊宏; 李政鴻; 吳晉嘉; 尹文耀; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 29:1 2018.03[民107.03] |
頁次 | 頁56-63 |
分類號 | 416.245 |
關鍵詞 | 哈特曼手術; 預測因子; 手術死亡; 老年人; Hartmann's procedure; Predictive factors; Surgical mortality; Elderly; |
語文 | 英文(English) |
中文摘要 | 目的:穿孔與阻塞是最常見的大腸直腸外科急症,哈特曼手術至今仍然常被使用於處置大腸直腸急症,高齡會顯著增加手術的併發症與死亡機率,本研究經由分析病歷紀錄,試圖找出高齡者接受哈特曼手術後死亡的預測因子。方法:從2002年1月到2006年12月,將年齡大於等於65歲並且因大腸直腸外科急症接受哈特曼手術的病人的病歷紀錄加以分析,病人被依性別、年齡、診斷、腫瘤位置、癌症分期、檢驗數據、手術前後事件、以及美國麻醉學會(ASA)分數加以分組,分析所有可能預測手術死亡的因子。結果:總共96位病患被列入分析,六十位病人罹患大腸直腸癌,三位有子宮頸或是卵巢癌,三十三位為良性疾病造成的大腸直腸外科急症。慢性阻塞性肺病、糖尿病、心臟病、或是高血壓跟死亡率的增加有相關,但是未達到統計學上的意義。穿孔的病人較阻塞的病人有較低的死亡率(8.8%與19.4%),但是仍然未達到統計學上的意義(p=0.287),升高的血清肌酸酐濃度或是降低的血紅素濃度跟手術後死亡率的增加有達到統計學上的相關性。結論:血清肌酸酐上升與血紅素降低是老年人因大腸直腸外科急症接受哈特曼手術後手術死亡的預測因子。 |
英文摘要 | Purpose. The most frequent colorectal emergencies faced by surgeons are obstructions and perforations. Hartmann's procedure is still frequently used to treat colorectal emergencies. Advanced age significantly increases surgical morbidity and mortality in colorectal surgeries. In this study, patient outcomes were analyzed to determine factors predictive of surgical mortality in elderly patients who underwent Hartmann's procedure. Methods. The records of patients 65 years of age or older diagnosed with a colorectal emergency and treated with Hartmann's procedure from January 2002 to December 2006 were retrospectively reviewed. The patients were divided into subgroups by sex, age, diagnosis, tumor location, cancer stage, laboratory data, perioperative events, and American Society of Anesthesiologists (ASA) score. All potential predictive factors of surgical mortality were analyzed. Results. Atotal of 96 patients were included in the analysis. Sixty patients had primary colorectal cancer, three had cervical or ovarian cancer, and 33 were diagnosed with colorectal emergencies caused by benign diseases. The presence of chronic obstructive pulmonary disease (COPD), diabetes mellitus, heart disease, or hypertension was correlated with an increased mortality rate; however, none of these factors reached statistical significance. Patients with bowel perforations had a mortality rate that was lower than that of patients with obstructions (8.8% to 19.4%) but still did not reach statistical significance (p = 0.287). Elevated serum creatinine level or decreased hemoglobin level was significantly correlated with an increased mortality rate. Conclusions. Elevated serum creatinine and low hemoglobin level were predictive factors of surgical mortality in elderly patients who underwent Hartmann’s procedure for a colorectal emergency. |
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