Kim Justin, Mittal Raj, Konyalian Viken, King Justin, Stamos Michael J, Kumar Ravin R
Harbor-University of California Los Angeles Medical Center, Torrance, California 90509, USA.
Am Surg. 2007 Oct;73(10):991-3.
Despite advances in perioperative care and operative techniques, urgent colorectal operations are associated with higher morbidity and mortality. To evaluate our rate of complications in elective and urgent colorectal operations, we performed retrospective chart review of 209 consecutive patients who underwent colorectal resection between 1998 and 2002 at Harbor-UCLA Medical Center. One hundred, forty-three (71%) patients underwent elective colorectal resection. A total of 19 (13.3%) complications occurred in the elective group, compared with 24 (38.1%) in the urgent group (P = 0.003). Both right-sided and left-sided operations were associated with higher incidence of complications when performed urgently. Wound infection occurred in 7.7 per cent of patients undergoing an elective operation and 14.3 per cent in an urgent setting (P = 0.21). Intra-abdominal abscess occurred in 1.4 per cent of patients undergoing elective operation, compared with 11.1 per cent in the urgent operation group. Four (1.9%) patients developed wound dehiscence, 1 in elective and 3 in the urgent group (P = 0.09). Anastomotic leak occurred in 1.9 per cent of patients, 2 in each group (P = 0.6). There were six deaths, 3 in elective and 3 in urgent cases (P = 0.4). Urgent operation of the colon and rectum is associated with higher incidence of complications. Both right- and left-sided resections have a higher complication rate when performed in a nonelective setting.
尽管围手术期护理和手术技术取得了进展,但急诊结直肠手术的发病率和死亡率仍较高。为了评估我们在择期和急诊结直肠手术中的并发症发生率,我们对1998年至2002年期间在哈伯-加州大学洛杉矶分校医学中心连续接受结直肠切除术的209例患者进行了回顾性病历审查。143例(71%)患者接受了择期结直肠切除术。择期组共发生19例(13.3%)并发症,而急诊组为24例(38.1%)(P = 0.003)。无论是右侧还是左侧手术,在急诊进行时并发症发生率都较高。择期手术患者伤口感染发生率为7.7%,急诊时为14.3%(P = 0.21)。择期手术患者腹腔内脓肿发生率为1.4%,而急诊手术组为11.1%。4例(1.9%)患者出现伤口裂开,择期组1例,急诊组3例(P = 0.09)。吻合口漏发生率为1.9%,每组各2例(P = 0.6)。共有6例死亡,择期和急诊各3例(P = 0.4)。结肠和直肠的急诊手术并发症发生率较高。无论是右侧还是左侧切除术,在非择期情况下进行时并发症发生率都较高。