Nakagawa Yutaro, Ito Shuhei, Nakahara Kozue, Sakamoto Kyohei, Hosoda Yasuhito, Hayashi Takaomi, Nakamura Ren, Komiya Kazune, Ishii Fuminori, Morimoto Mitsuaki, Yoshida Yasushi, Noritomi Tomoaki
Department of Surgery, Fukuoka Tokushukai Hospital, Kasuga, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):279-288. doi: 10.23922/jarc.2024-021. eCollection 2024.
The prognosis of patients with colorectal diverticular perforations requiring surgery is poor, and the efficacy of polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) in these patients has not yet been established. In the present study, we evaluated the prognostic factors and the efficacy of PMX-DHP in surgically treated patients with perforated colorectal diverticula.
Of the 116 patients with colorectal perforations who underwent emergency surgery at our hospital between April 2018 and May 2023, we retrospectively reviewed 46 patients with perforated colorectal diverticula. Preoperative, surgical, and postoperative factors were compared between the survival and mortality groups. Subgroup analysis was performed to evaluate the efficacy of PMX-DHP in severe cases.
The postoperative mortality group included 7 patients (15.2%), and PMX-DHP was performed in 14 (30.4%). PMX-DHP was performed significantly more often in the mortality group (P<0.01). In multivariate analysis, antithrombotic drug administration (hazard ratio, 16.600; 95% confidence interval, 1.32-209; P<0.05) and higher lactate levels (≥ 3.0 mmol/L) (hazard ratio, 42.300; 95% confidence interval, 2.69-667, P<0.01) were independent risk factors for postoperative mortality. PMX-DHP was performed in severe cases (patients with higher lactate levels, APACHE II scores, ventilator management frequencies, and noradrenalin use). PMX-DHP was not effective in improving prognosis in severe cases.
Administration of antithrombotic drugs and higher lactate levels (≥ 3.0 mmol/L) are independent prognostic factors in colorectal diverticular perforations. PMX-DHP may not be effective in patients with severe preoperative conditions.
需要手术治疗的结直肠憩室穿孔患者预后较差，多粘菌素B固定纤维柱直接血液灌流（PMX-DHP）在这些患者中的疗效尚未确定。在本研究中，我们评估了接受手术治疗的结直肠憩室穿孔患者的预后因素及PMX-DHP的疗效。
在2018年4月至2023年5月期间于我院接受急诊手术的116例结直肠穿孔患者中，我们回顾性分析了46例结直肠憩室穿孔患者。比较生存组和死亡组的术前、手术及术后因素。进行亚组分析以评估PMX-DHP在重症病例中的疗效。
术后死亡组有7例患者（15.2%），14例（30.4%）接受了PMX-DHP治疗。死亡组接受PMX-DHP治疗的比例显著更高（P<0.01）。多因素分析中，抗血栓药物使用（风险比，16.600；95%置信区间，1.32 - 209；P<0.05）和较高的乳酸水平（≥3.0 mmol/L）（风险比，42.300；95%置信区间，2.69 - 667，P<0.01）是术后死亡的独立危险因素。PMX-DHP用于重症病例（乳酸水平较高、急性生理与慢性健康状况评分系统II评分较高、呼吸机管理频率较高及使用去甲肾上腺素的患者）。PMX-DHP对改善重症病例的预后无效。
抗血栓药物使用和较高的乳酸水平（≥3.0 mmol/L）是结直肠憩室穿孔的独立预后因素。PMX-DHP对术前病情严重的患者可能无效。
