Yamamoto Takehito, Kita Ryosuke, Masui Hideyuki, Kinoshita Hiromitsu, Sakamoto Yusuke, Okada Kazuyuki, Komori Junji, Miki Akira, Uryuhara Kenji, Kobayashi Hiroyuki, Hashida Hiroki, Kaihara Satoshi, Hosotani Ryo
Department of Surgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480 Japan.
Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuoku, Kobe 650-0047 Japan.
World J Emerg Surg. 2015 Jun 25;10:24. doi: 10.1186/s13017-015-0020-y. eCollection 2015.
Even after surgery and intensive postoperative management, the mortality rate associated with colorectal perforation is high. Identification of mortality markers using routinely available preoperative parameters is important.
We enrolled consecutive patients with colorectal perforation who underwent operations from January 2010 to January 2015. We divided them into a mortality and survivor group and compared clinical characteristics between the two groups. Additionally, we compared the mortality rate between different etiologies: malignant versus benign and diverticular versus nondiverticular. We used the χ (2) and Mann-Whitney U tests and a logistic regression model to identify factors associated with mortality.
We enrolled 108 patients, and 52 (48 %) were male. The mean age at surgery was 71 ± 13 years. The postoperative mortality rate was 12 % (13 patients). Multivariate logistic regression analysis showed that a high patient age (odds ratio [OR], 1.09; 95 % confidence interval [CI], 1.020-1.181) and low preoperative systolic blood pressure (OR, 0.98; 95 % CI, 0.953-0.999) were independent risk factors for mortality in patients with colorectal perforation. In the subgroup analysis, there was no significant difference between the malignant and benign group (11.8 % vs. 23.9 %, respectively; p = 0.970), while the diverticular group had a significantly lower mortality rate than the nondiverticular group (2.6 % vs. 17.1 %, respectively; p = 0.027).
Older patients and patients with low preoperative blood pressure had a high risk of mortality associated with colorectal perforation. For such patients, operations and postoperative management should be performed carefully.
即使经过手术及强化的术后管理，结直肠穿孔相关的死亡率依然很高。利用常规可得的术前参数识别死亡标志物很重要。
我们纳入了2010年1月至2015年1月间连续接受手术的结直肠穿孔患者。我们将他们分为死亡组和存活组，并比较两组间的临床特征。此外，我们比较了不同病因（恶性与良性、憩室性与非憩室性）之间的死亡率。我们使用χ²检验、曼-惠特尼U检验和逻辑回归模型来识别与死亡率相关的因素。
我们纳入了108例患者，其中52例（48%）为男性。手术时的平均年龄为71±13岁。术后死亡率为12%（13例患者）。多因素逻辑回归分析显示，高龄患者（比值比[OR]，1.09；95%置信区间[CI]，1.020 - 1.181）和术前收缩压较低（OR，0.98；95% CI，0.953 - 0.999）是结直肠穿孔患者死亡的独立危险因素。在亚组分析中，恶性组和良性组之间无显著差异（分别为11.8%和23.9%；p = 0.970），而憩室性组的死亡率显著低于非憩室性组（分别为2.6%和17.1%；p = 0.027）。
老年患者及术前血压低的患者与结直肠穿孔相关的死亡风险高。对于此类患者，应谨慎进行手术及术后管理。
