بررسی سرانجام رزکسیون و آناستوموز اولیه‌ی کولون چپ در بیماران اورژانسی در ١٠ سال گذشته در بیمارستان الزهرا (س) اصفهان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار? گروه جراحی? دانشکده ی پزشکی? دانشگاه علوم پزشکی اصفهان? اصفهان?ایران

2 دانشجوی پزشکی، دانشکده‌ی پزشکی و کمیته‌ی تحقیقات دانشجویی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: اعمال جراحی که به طور اورژانسی در بیماری‌های انسدادی بر روی کولون چپ انجام می‌شود اغلب دو مرحله‌ای هستند، یعنی ابتدا برای بیمار کولستومی تعبیه می‌شود و سپس عمل ترمیم در مرحله‌ی بعدی انجام می‌شود. در این مطالعه عوارض درمانی عمل یک مرحله‌ای یعنی رزکسیون و آناستاموز اولیه‌‌ی هم‌زمان، بررسی شد.روش‌ها: در یک مطالعه‌ی گذشته‌نگر پرونده‌ی بیمارانی که به طور اورژانسی با ولولوس سیگمویید، سرطان کولون چپ و پارگی‌های کولون ناشی از تروما به بیمارستان الزهارا (س) مراجعه کرده بوند، بررسی شد. عوارض درمانی در بیمارانی که جراحی رزکسیون و آناستوموز اولیه‌ی اورژانسی داشتند مورد بررسی قرار گرفتند.یافته‌ها: 109 بیمار مبتلا به انسداد کولون چپ شامل 25 نفر (9/22 درصد) با سرطان کولون چپ و 16 نفر (7/14 درصد) با پارگی‌های ناشی از ترومای کولون چپ و 68 نفر ( 4/62 درصد) نفر با ولولوس سیگمویید بودند. از این 109 بیمار، 46 بیمار (2/42 درصد) تحت رزکسیون و آناستوموز اولیه، 25 بیمار (9/22 درصد) تحت ریداکشن و 38 بیمار (9/34 درصد) تحت کلوستومی قرار گرفتند. میانگین سنی افراد در ولولوس سیگمویید 58 سال، سرطان کولون 62 سال و تروما 23 سال بود. در ولولوس سیگمویید از 30 بیمار که تحت رزکسیون و آناستوموز اولیه قرار گرفتند 5 بیمار (7/16 درصد) فوت کردند و طبق اطلاعات موجود در پرونده‌ها 25 بیمار در قید حیات، عفونت زخم، آبسه و لیک از آناستوموز پیدا نکردند. فقط 1 بیمار (4 درصد) جراحی مجدد داشت. در سرطان انسدادی از 12 بیمار با رزکسیون و آناستوموز اولیه، 4 بیمار (3/33 درصد) فوت کردند و از 8 بیمار در قید حیات 1 بیمار (5/12 درصد) دچار عفونت زخم و 1 بیمار (5/12 درصد) مبتلا به آبسه‌ی داخل شکمی شد و لیک از آناستوموز وجود نداشت. 5 بیمار (5/62 درصد) نیز نیاز به جراحی مجدد داشتند. در تروما از 4 بیماری که تحت رزکسیون و آناستوموز اولیه قرار گرفتند عوارض درمانی و عود جراحی و مرگ و میر وجود نداشت.نتیجه‌گیری: با توجه به نتایج به دست آمده، عمل یک مرحله‌ای کولون چپ از عوارض قابل قبولی برخوردار می‌باشد و چون بسیاری از عوارض عمل دو مرحله‌ای خود به خود حذف می‌شود برای درمان بیماران انسداد کولون چپ پیشنهاد می‌شود.

کلیدواژه‌ها

عنوان مقاله [English]

Results of Left Colon Primary Anastomosis in Emergency Colon Disease from 1998 to 2008 in Alzahra Hospital, Isfahan, Iran

نویسندگان [English]

  • Behnam Sanei 1
  • Mohsen Mahmudieh 1
  • Fahimeh Khademolhoseini 2
1 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine And Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Traditionally, left colon obstruction is managed by a multistage defunctioning colostomy and resection. This paper presents the complications of single stage operation on a series of patients managed by primary anastomosis.Methods: In this retrospective study with the use of the patients file we gained the number of emergency patients, the number of patients under emergency sigmoid volvolus and left sided colon obstructive cancer, and left-sided colonic lacerations caused by the trauma. Complications of patients who had emergency resection and anastomosis surgery were studied.Findings: 109 patients were afflicted with left-sided colon obstruction, 25 patients (22.9%) had left sided colon obstructive cancer, 16 patients (14.7%) left sided colon lacerations caused by trauma, and 68 patients (62.4%) had emergency sigmoid volvolus. Of the 109 patients, 46 patients (42.2%) underwent resection and primary anastomosis, 25 patients (22.9%) reduction, and 38 patients (34.9%) underwent colostomy. The average age of sigmoid volvolus was 58 years, left sided colon obstructive cancer 62 years, and left-sided colon lacerations caused by trauma was 23 years. In sigmoid volvolus of the 30 patients who underwent resection and primary anastomosis 5 died (16.7%). According to the existing information, of the 25 living patients no one had wound infection, abscess, anastomotic leakage, and only 1 patient (4%) had a second surgery. In left-sided colon obstructive cancer, of the 12 patients who underwent resection and primary anastomosis 4 patients died (33.3%), and from the 8 living patients only 1 patient had (12.5%) infection wound and 1 patient (12.5%) had abscess, no patients had anastomotic leakage, and 5 patients (62.5%) need second surgery. In left-sided colon lacerations caused by trauma the 4 patients had no complications, and there were no deaths. Conclusion: Regarding the results of this study it can be concluded that left colon primary anastomosis can be performed safely in selected patients with acute obstruction of left colon. 

کلیدواژه‌ها [English]

  • Obstruction
  • Primary anastomosis
  • Left colon

مراجع

  1. Bagarani M, Conde AS, Longo R, Italiano A, Terenzi A, Venuto G. Sigmoid volvulus in west Africa: a prospective study on surgical treatments. Dis Colon Rectum 1993; 36(2): 186-90.
  2. Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E. Feasibility of single-stage resection and primary anastomosis in patients with acute noncomplicated sigmoid volvulus. Am J Surg 2007; 193(4): 421-6.
  3. Anderson JR, Lee D. The management of acute sigmoid volvulus. Br J Surg 1981; 68(2): 117-20.
  4. Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 2005; 48(2): 205-9.
  5. van GD, Fa-Si-Oen P, Noach LA, Rietra PJ, Peterse JL, Boom RP. Complications after colorectal surgery without mechanical bowel preparation. J Am Coll Surg 2002; 194(1): 40-7.
  6. Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37(9): 916-20.
  7. Bulger EM, McMahon K, Jurkovich GJ. The morbidity of penetrating colon injury. Injury 2003; 34(1): 41-6.
  8. Constantinides VA, Heriot A, Remzi F, Darzi A, Senapati A, Fazio VW, et al. Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann's procedures. Ann Surg 2007; 245(1): 94-103.
  9. Brunicardi F, Andersen D, Billiar D, Dunn D, Hunter J, Pollock RE. Schwartz's Principles of Surgery. 8th ed. New York: McGraw-Hill Professional; 2004.
  10. Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, et al. Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum 2008; 51(3): 306-11.
  11. De U, Ghosh S. Single stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety-seven cases. ANZ J Surg 2003; 73(6): 390-2.
  12. Kuzu MA, Aslar AK, Soran A, Polat A, Topcu O, Hengirmen S. Emergent resection for acute sigmoid volvulus: results of 106 consecutive cases. Dis Colon Rectum 2002; 45(8): 1085-90.
  13. Patriti A, Contine A, Carbone E, Gulla N, Donini A. One-stage resection without colonic lavage in emergency surgery of the left colon. Colorectal Dis 2005; 7(4): 332-8.
  14. Sudhindaran S, Sinha S. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg 2000; 87(3): 376-7.
  15. Dorudi S, Wilson NM, Heddle RM. Primary restorative colectomy in malignant left-sided large bowel obstruction. Ann R Coll Surg Engl 1990; 72(6): 393-5.
  16. Sule AZ, Iya D, Obekpa PO, Ogbonna B, Momoh JT, Ugwu BT. One-stage procedure in the management of acute sigmoid volvulus. J R Coll Surg Edinb 1999; 44(3): 164-6.
  17. Sule AZ, Misauno M, Opaluwa AS, Ojo E, Obekpa PO. One stage procedure in the management of acute sigmoid volvulus without colonic lavage. Surgeon 2007; 5(5): 268-70.
  18. Poon RT, Law WL, Chu KW, Wong J. Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 1998; 85(11): 1539-42.
  19. McGinnis LS. Surgical treatment options for colorectal cancer. Cancer 1994; 74(7 Suppl): 2147-50.
  20. Irabor DO. Acute sigmoid volvulus:experience with primary resection and anastomosis in a tropical African population. J Chinese Clin Med 2008; 3(6): 343-6.
  21. Gonzalez RP, Merlotti GJ, Holevar MR. Colostomy in penetrating colon injury: is it necessary? J Trauma 1996; 41(2): 271-5.
  22. Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE. Sigmoid volvulus in Department of Veterans Affairs Medical Centers. Dis Colon Rectum 2000; 43(3): 414-8.
  23. Herrera FA, Coimbra R, Easter DW. Penetrating colon injuries: primary anastomosis versus diversion. J Surg Educ 2008; 65(1): 31-5.
  24. Cornwell EE, III, Velmahos GC, Berne TV, Murray JA, Chahwan S, Asensio J, et al. The fate of colonic suture lines in high-risk trauma patients: a prospective analysis. J Am Coll Surg 1998; 187(1): 58-63.
  25. Sabiston DC, Lyerly HK. Textbook of Surgery: the Biological Basis of Modern Surgical Practice. 17th ed. Amsterdam: Elsevier; 2005.
  26. Sola JE, Bender JS, Buchman TG. Morbidity and timing of colostomy closure in trauma patients. Injury 1993; 24(7): 438-40.
  27. Berne JD, Velmahos GC, Chan LS, Asensio JA, Demetriades D. The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries. Surgery 1998; 123(2): 157-64.
  28. Pachter HL, Hoballah JJ, Corcoran TA, Hofstetter SR. The morbidity and financial impact of colostomy closure in trauma patients. J Trauma 1990; 30(12): 1510-3.
  29. Gonzalez RP, Falimirski ME, Holevar MR. Further evaluation of colostomy in penetrating colon injury. Am Surg 2000; 66(4): 342-6.
  30. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg 1994; 81(9): 1270-6.
  31. Huang TJ, Wang JY, Lee LW, Chen FM, Chuan CH, Chan HM, et al. Emergency one-stage surgery for obstructing left-sided colorectal carcinomas. Kaohsiung J Med Sci 2002; 18(7): 323-8.
  32. De Salvo GL, Gava C, Pucciarelli S, Lise M. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev 2002; (1): CD002101.
  33. Phillips RK, Hittinger R, Fry JS, Fielding LP. Malignant large bowel obstruction. Br J Surg 1985; 72(4): 296-302.
  34. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003; 5(3): 262-9.
  35. Enshaei A. Results of left colon primary anastomosis in obstructive colon disease from 1997 to 2002 at UrmiaEmam Hospital. Urmia Med J 2003; 1(14): 46-51.
  36. Naaeder SB, Archampong EQ. One-stage resection of acute sigmoid volvulus. Br J Surg 1995; 82(12): 1635-6.
  37. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-sided lesions. J Am Coll Surg 2001; 192(6): 719-25.
  38. Sule AZ, Ajibade A. Adult large bowel obstruction: a review of clinical experience. Ann Afr Med 2011; 10(1): 45-50.
  39. Oren D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Colon Rectum 2007; 50(4): 489-97.
  40. Friedman JD, Odland MD, Bubrick MP. Experience with colonic volvulus. Dis Colon Rectum 1989; 32(5): 409-16.
  41. Oren D. Kolon volvuluslar. In: Alemdaroglu K, Akcal T, Bugra D, editors. Kolon rektum va anal bolge hastaliklari.Istanbul, Turkey: Tasarim; 2004. p. 351-60. [In Turkish].
  42. Dulger M, Canturk NZ, Utkan NZ, Gonullu NN. Management of sigmoid colon volvulus. Hepatogastroenterology 2000; 47(35): 1280-3.
  43. Öncu M, Piskin B, Calik A, YandN M, Alhan E. Volvulus of the sigmoid colon. S Afr J Surg 1991; 29: 48-9.
  44. Arnold GJ, Nance FC. Volvulus of the sigmoid colon. Ann Surg 1973; 177(5): 527-37.
  45. Trauma Treatment Guidelines. PCS Scientific Publication; No. 10
  46. Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg 1979; 190(4): 430-6.
  47. Miller PR, Chang MC, Hoth JJ, Holmes JH, Meredith JW. Colonic resection in the setting of damage control laparotomy: is delayed anastomosis safe? Am Surg 2007; 73(6): 606-9.
  48. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005; 189(4): 384-7.
  49. Villar JM, Martinez AP, Villegas MT, Muffak K, Mansilla A, Garrote D, et al. Surgical options for malignant left-sided colonic obstruction. Surg Today 2005; 35(4): 275-81.
  50. Zmora O, Mahajna A, Bar-Zakai B, Hershko D, Shabtai M, Krausz MM, et al. Is mechanical bowel preparation mandatory for left-sided colonic anastomosis? Results of a prospective randomized trial. Tech Coloproctol 2006; 10(2): 131-5.
  51. Jung B, Pahlman L, Nystrom PO, Nilsson E. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 2007; 94(6): 689-95.
  52. Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003; 46(1): 24-30.
  53. Fa-Si-Oen P, Roumen R, Buitenweg J, van d, V, van GD, Putter H, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 2005; 48(8): 1509-16.
  54. Rodriguez-Bigas MA, Grothey A. Overview of the management of primary colon cancer. Uptodate 19.1. [Online] 2011 Jan. Available from: URL: http://www.uptodate.com/contents/overview-of-the-management-of-primary-colon-cancer?source=search_result&search=.Surgical+management+of+primary+colon+cancer&selectedTitle=2~150.
  55. Ostrow B. When is Primary Anastomosis Safe in the Colon? [Onlin]. 2005 Jul. [cited 2010 Mar]. Available from: URL: http://www.utoronto.ca/ois/SIA/2005/Primary_anastomosis.htm.
  56. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 1998; 85(9): 1260-5.
  57. Baker DM, Wardrop PJ, Burrell H, Hardcastle JD. The management of acute sigmoid volvulus in Nottingham. J R Coll Surg Edinb 1994; 39(5): 304-6.
  58. Irvin TT, Greaney MG. The treatment of colonic cancer presenting with intestinal obstruction. Br J Surg 1977; 64(10): 741-4.
  59. Rosenberg IL, Graham NG, De Dombal FT, Goligher JC. Preparation of the intestine in patients undergoing major large-bowel surgery, mainly for neoplasms of the colon and rectum. Br J Surg 1971; 58(4): 266-9.
  60. Tyson RR, Spaulding EH. Should antibiotics be used in large bowel preparation. Surg Gynecol Obstet 1959; 108(5): 623-6.
  61. Torralba JA, Robles R, Parrilla P, Lujan JA, Liron R, Pinero A, et al. Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum 1998; 41(1): 18-22.
  62. Forloni B, Reduzzi R, Paludetti A, Colpani L, Cavallari G, Frosali D. Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 1998; 41(1): 23-7.
  63. Arnaud JP, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Dis Colon Rectum 1994; 37(7): 685-8.
  64. Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hershko D, Shabtai M, et al. Colon and rectal surgery without mechanical bowel preparation: a randomized prospective trial. Ann Surg 2003; 237(3): 363-7.
  65. Ram E, Sherman Y, Weil R, Vishne T, Kravarusic D, Dreznik Z. Is mechanical bowel preparation mandatory for elective colon surgery? A prospective randomized study. Arch Surg 2005; 140(3): 285-8.
  66. Bucher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg 2004; 139(12): 1359-64.
  67. Khoury DA, Beck DE, Opelka FG, Hicks TC, Timmcke AE, Gathright JB, Jr. Colostomy closure. Ochsner Clinic experience. Dis Colon Rectum 1996; 39(6): 605-9.
  68. Riesener KP, Lehnen W, Hofer M, Kasperk R, Braun JC, Schumpelick V. Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment. World J Surg 1997; 21(1): 103-8.
  69. Mealy K, O'Broin E, Donohue J, Tanner A, Keane FB. Reversible colostomy--what is the outcome? Dis Colon Rectum 1996; 39(11): 1227-31.
  70. Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg 2008; 12(11): 2037-44.
مجله دانشکده پزشکی اصفهان
دوره 29، شماره 164 - شماره پیاپی 164
آذر و دی 1390
صفحه 2127-2141

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  • تاریخ دریافت: 01 شهریور 1390
  • تاریخ بازنگری: 31 فروردین 1403
  • تاریخ پذیرش: 17 فروردین 1401

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