- 期刊
Colorectal Perforation: Spectrum of the Disease and Its Mortality
大腸直腸穿孔：病例分析與死亡因子探討
摘要
目的 大腸直腸穿孔長久以來一直被視為是一種死亡率極高的疾病，然而國內關於這方面的資料一直偏重於個別疾病合併大腸直腸穿孔，未曾有大腸直腸穿孔整體資料的討論，本篇目的則將針對大腸直腸穿孔做一臨床上的回顧，並分析影響死亡率的危險因子。 方法 本篇分析1996年至2005年共141位大腸直腸穿孔之病人，分析的因子包括：性別、年齡、術前症狀、穿孔原因、合併疾病、ASA score、術前白蛋白值、白血球指數、band from白血球指數、症狀持續時間、診斷至手術時間、手術時間、術中失血量、與死亡率。 結果 平均年齡為66.77歲，穿孔原因依高低排列次序為：憩室炎、缺血性大腸炎、醫源性傷害、惡性腫瘤、不明原因或深度潰瘍、與創傷。整體死亡率為36.9%。死亡率依高低排列依次為：惡性腫瘤、缺血性大腸炎、創傷、醫源性傷害、憩室炎、影響死亡率的危險因子p值小於0.05者有：年齡大於60歲，術前即診斷敗血症或敗血性休克，術中失血大於450毫升，緊急手術，病人本身有大於3種以上之他種疾病。 結論 大腸直腸穿孔最常見的原因為憩室穿孔及缺血性大腸炎穿孔，死亡率最高者為大腸直腸癌穿孔及缺血性大腸炎穿孔。影響死亡率的危險因子包括：年齡大於60歲，術前即診斷敗血症或敗血性休克，術中失血大於450毫升，緊急手術，病人本身有大於3種以上之他種疾病。
並列摘要
Purpose. colorectal perforation is a major life-threatening clinical condition that requires emergency surgical intervention. In general peritonitis caused by colorectal perforation still remains a high risk for mortality and morbidity. The aim of this study is to identify clinical characteristics, outcomes and risk factors for patients with colorectal perforation. Methods. From January 1996 to December 2005, 141 patients with colorectal perforation were selected consecutively for this study. Several clinical variables were analyzed, such as sex, age, preoperative symptoms & signs, causes of perforation, concomitant diseases, ASA scores, preoperative albumin levels, WBC count, band form WBC, persistence of symptoms and signs, intervals between diagnosis to operation, operation times, perioperative blood loss and mortality rates. The statistical methods used in this study included Chi-square analysis, student T-test, univariate logistic regression, and multivariate logistic regression. Statistical significance was determined as a value of less than 0.05. Results. 141 patients were identified, with a median age of 66.77±14.48 years (range: 26-95 years); 99 patients were male and 44 were female. Causes of colorectal perforation were diverticulitis (54 patients, 37.8%), ischemic colitis (38 patients, 27.0%), iatrogenic injury (14 patients, 9.9%), malignancy (13 patients, 9.2%), idiopathic ulcer or deep ulcer (5 patients, 3.5%), and trauma (3 patients, 2.1%). Overall mortality rate was 36.9% (52 patients). The highest rate of disease-specific mortality was due to malignancy (61.5%), followed by ischemic colitis (60.5%), trauma (33.3%), iatrogenic injury (21.4%) and the last is diverticulitis (18.5%). Among several prognostic factors, a p-value of less than 0.05, including age (＞60 y/o), preoperative sepsis or septic shock, perioperative blood loss (＞450 mL), emergency operation, and more than 3 concomitant diseases. Conclusions. The most common causes of colorectal perforation are diverticulitis and ischemic colitis, with malignancy and ischemic colitis causing the highest mortality rate. In this study, we clearly demonstrated that patients with colorectal perforation are associated with a higher mortality rate when their age is greater than 60 y/o, combined with preoperative sepsis or septic shock, perioperative blood loss (＞450 mL), emergency operation, and more than 3 concomitant diseases.