대장천공의 합병증과 사망률에 영향을 미치는 인자 (Prognostic Factors for Complication and Mortality of Colonic Perforation)

서지정보

· 발행기관 : 대한대장항문학회
· 수록지 정보 : Annals of Coloproctolgy / 25권 / 3호 / 143 ~ 149페이지
· 저자명 : 박건환, 최평화, 김재일, 노태호, 허태길, 박제훈, 이명수, 김철남, 장석효

초록

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).
Conclusion: 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.

영어초록

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).
Conclusion: 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.

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