Table 1 Comparsion of background of the 86 patients with colorectal perforation All Survival Death p-value No. of patients 86 (100%) 74 (86%) 12 (14%)

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1 Japanese Journal of Acute Care Surgery 2013; 3: 55~60 原著 非外傷性大腸穿孔 86 症例の臨床的検討 上田健太郎岩﨑安博山添真志川副友川嶋秀治國立晃成酒谷佳世山上裕機加藤正哉 x 所属 : 和歌山県立医科大学救急集中治療医学講座住所 : 和歌山県和歌山市紀三井寺 811-1

2 Table 1 Comparsion of background of the 86 patients with colorectal perforation All Survival Death p-value No. of patients 86 (100%) 74 (86%) 12 (14%) A ge 71.2 ± ± ± Gender Male 41 (48%) 36 (42%) 5 (6%) Female 45 (52%) 38 (44%) 7 (8%) Preoperative comorbidity Comorbidity (+) 64 (74%) 53 (62%) 11 (12%) Heart disease Lung failure Renal failure (HD) Hepatitis Collagen disease (Steroid patients) Hypertension Diabetes mellitus Brain disease Hypothyroidism Cancer Comorbidity (-) 22 (26%) 21 (24%) 1 (2%) Table 2 Comparsion of primary disease and site of perforation All (n=86) Survival (n=74) Death (n=12) p-value Primary disease Benign 74 (86%) 63 (74%) 11 (12%) Diverticulitis Idiopathic Ischemic Hard stools Iatrogenic Torsion Crohn disease Foreign body Malignant 12 (14%) 11 (12%) 1 (2%) Site of perforation Right colon 15 (17%) 14 (16%) 1 (1%) Cecum Ascending Transverse Left colon, rectum 71 (83%) 60 (70%) 11 (13%) Descending Sigmoid Rectum

3 Table 3 Analysis of preoperative status (A) and preoperative blood examination (B) All (n=86) Survival (n=74) Death (n=12) p-value (A) preoperative status SIRS P resent 67 (78%) 56 (65%) 11 (13%) 19 (22%) 18 (21%) 1 (1%) Vital shock P resent 22 (26%) 13 (15%) 9 (11%) 64 (74%) 61 (71%) 3 (3%) DIC Present 21 (24%) 16 (18%) 5 (6%) 65 (76%) 58 (68%) 7 (8%) Time from onset to surgery hours 58 (67%) 48 (55%) 10 (12%) >24 hours 28 (33%) 26 (31%) 2 (2%) Time from onset to surgery hours 41 (48%) 32 (37%) 9 (11%) >12 hours (B) preoperative blood examination 45 (52%) 42 (49%) 3 (3%) ph 7.43 ( ) 7.44 ( ) 7.36 ( ) Lactate (mmol/dl) 1.8 (0.1-12) 1.7 (0.1-12) 6.1 ( ) Total protein (g/dl) 6.6 ( ) 6.7 ( ) 5.7 ( ) AST (IU/l) 25 (9-371) 23 (9-313) 37 (22-371) CPK (IU/l) 85 (8-2905) 80 (8-2905) 155 ( ) BUN (mg/dl) 25 (5-143) 23 (5-143) 32 (15-55) Table 4 Comparsion of surgical and postoperative management All (n=86) Survival (n=74) Death (n=12) p-value Peritonitis General peritonitis (+) 63 (74%) 52 (61%) 11 (13%) General peritonitis (-) 23 (26%) 22 (25%) 1 (1%) Localized peritonitis Retoroperionitis Mesenteric abscess No peritonitis Surgical method Resection with proximal stoma 63 (74%) 52 (61%) 11 (13%) Resection with primary anastomosis 20 (24%) 19 (23%) 1 (1%) Simple closure 1 (1%) 1 (1%) 0 (0%) Colostomy 2 (2%) 2 (2%) 0 (0%) O peration time (min) 142 ± ± ± ICU management P resent 58 (67%) 47 (54%) 11 (13%) PMX-DHP 28 (33%) 27 (32%) 1 (1%) Present 22 (26%) 16 (19%) 6 (7%) 64 (74%) 58 (67%) 6 (7%)

4 Table 5 The multivariate analyses of the factors predicting survival using logistic regression Predictive factor Univariable analyses Multivariable analyses P value Relative Risk (95% CI) P value Age (years) ( ) Vital Shock (+ / -) ( ) ph ( ) Lactate ( ) Total protein ( ) AST CPK BUN Mann-Whitney U-test Fisher's exact test ( ) ( ) ( ) Table 6 Summary of 12 dead patients No Age Preoperative complication Cause of death ICU PMX-DHP Lactate 1 80 Heart failure, Af Sepsis, DIC, MOF Renal failure (HD), Hepatitis Sepsis, DIC, MOF Liver cirrhosis Sepsis, DIC, MOF No complication Sepsis, DIC, MOF Interstitial pneumonia, Steroid Interstitial pneumonia Polymyalgia rheumatica, Steroid Aspiration pneumonia Hypertension Sepsis, DIC, MOF Angina pectoris, Terminal cancer ARDS, End stage of cancer Heart failure, OMI, Hypertension Congestive herat failure Heart failure, Cerebral infarction Congestive herat failure Renal failure (HD), Angina pectoris, Sepsis, DIC, MOF + + Terminal cancer Heart failure, OMI, Hypertension, Congestive herat failure + + Asthma 5.7

5

6 Clinical study of prognostic factors in 86 patients with non-traumatic colorectal perforation Kentaro Ueda 1), Yasuhiro Iwasaki 1), Shinji Yamazoe 1), Yu Kawazoe 1), Syuji Kawashima 1), Kosei Kunitatsu 1), Kayo Sakatani 1), Hiroki Yamaue 2), Seiya Kato 1) Department of Emergency and Critical Care Medicine, Wakayama Medical University 1) Second Department of Surgery, Wakayama Medical University 2) Background: Colorectal perforation easily causes septic shock and life-threatening complications. We studied the predictive factors regarding prognoses of patients with a colorectal perforation. Methods: We reviewed 86 patients who underwent emergency surgery for non-traumatic colorectal perforation between April 2006 and March 2013 in our medical center. Results: The average age of 86 patients was 71 years, and the most common cause and site of colorectal perforation were each diverticulitis (49%) and the left colon and rectum (83%). Before surgery, 78%, 26%, 24%, and 73% of patients had SIRS, vital shock, DIC, and general peritonitis, respectively. The overall survival rate was 86%, and the main cause of death in 12 cases was septic shock in six cases and a worsening of comorbidity in six cases. The survival rate in 22 patients undergoing postoperative endotoxin absorption therapy (PMX-DHP) was 73%. The predictive factors in univariate analysis were age, shock vital, ph, lactate, total protein, AST, CPK, and BUN. And, multivariate logistic regression analysis showed the age and shock vital to be significantly associated with mortality. Conclusion: The age and shock vital were the independent prognostic determinant of survival identified by this study, and careful managements of the comorbidity were important to improve the survival rate. Key words :colorectal perforation,prognostic factor, septic shock

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