Selection of surgical procedures for colonic injuries - A retrospective analysis of risk factors.:A Retrospective Analysis of Risk Factors
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Study objectives and design: With respect to the management of colonic injuries, controversy continues to surround the topic of which operative option (primary repair?, colostomy? or exteriorized repair?) should be pursued. Therefore, to identify the limits to which primary repair of a colonic injury can be safely performed and to clarify which risk factors are most associated with the development of morbidity, a retrospective analysis has been conducted of 49 patients who underwent surgery at our emergency medical center, for a transmural injury of the colon, over the past 18 years. The patients were divided into two groups; 22 cases treated from April 1975 through December 1984 were designated as the early group, and 27 cases treated from January 1985 through August 1993 were designated as the recent group. The mortality and morbidity rates were then compared between the two groups and an analysis was conducted of several risk factors. Main results: 1) The 2 groups were identical in terms of injury severity score (early group: 23.1±11.7; recent group: 23.4±10.1), and injury mechanisms (early group: blunt trauma 11, stabbing 10, gunshot 1; recent group: blunt trauma 13, stabbing 14). 2) In contrast to the early group, a remarkable decrease in the use of colostomy was noted in the recent group, from 55% (12/22) to 15% (4/27). On the other hand, there was a marked increase in the number of primary repairs, from 45% (10/22) in the early group to 81% (22/27) in the recent group. 3) Mortality decreased from 3/22 (14%) in the early group to 2/27 (7.4%) in the recent group and morbidity from 14/22 (64%) to 10/27 (37%), respectively. 4) Among the 22 patients in the recent group who underwent primary repair, there were 6 who manifested shock on admission, 2 with the complication of pancreatic injuries, 7 with left-sided colon injuries, 3 of delayed laparotomy (over 24 hours after sustaining the injury), and 5 requiring massive blood transfusion (over 10 units). Despite the risk factors associated with each of these cases, no patient died or developed serious complications, such as anastomotic leakage. Among these risk factors, the need for transfusion of more than 10 units was the only one significantly associated with the development of morbidity (p<0.01). Conclusion: The primary method for repair of colonic injuries was found to be safely performed, even in cases with the surgical risk factors evaluated above. More liberal use of primary repair for colonic injury is warranted. However, patients requiring massive blood transfusion should be closely observed.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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