Ramazan TOPÇU, Barış Doğu YILDIZ, Tezcan AKIN, Hüseyin BERKEM, Sadettin ER, Cemal ULUSOY, Murat KENDİRCİ, Bülent Cavit YÜKSEL, İlyas Hakan ÖZEL, Süleyman HENGİRMEN

Kolorektal kanserlere bağlı gelişen akut sol kolon obstrüksiyonlarının retrospektif analizi

Amaç: Kolorektal tümörlere bağlı akut sol kolon tıkanıklığı bulguları gösteren olgularda acil koşullarda uygulanan rezeksiyon primer anastomoz sonuçlarının değerlendirilmesi ve bu sonuçların Hartmann Prosedür uygulanan hastaların sonuçlarıyla karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Ağustos 2005-Mart 2011 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi Acil Cerrahi Servisi’ne yatış yapılan kolorektal kansere bağlı akut sol kolon obstrüksiyonu nedeniyle ameliyat edilen 84 hasta çalışmaya alındı ve retrospektif olarak incelendi. Hastaların tümü acil serviste değerlendirilip acil ameliyathanede opere edilmiştir. Hastaların tedavisinde Hartmann kolostomi ve rezeksiyon primer anastomoz cerrahi prosürleri kullanıldı. Barsak temizliği yapılmadan operasyona alındı ve intraoperatif rezeksiyon sonrası tüm hastalara manuel dekompresyon yapıldıktan sonra ya rezeksiyon primer anastomoz ya da Hartmann Prosedür yapıldı. Bulgular: Stoma açılan grupta postoperatif yoğun bakım ihtiyacı olan hasta sayısı 25, ventilatör ihtiyacı olanların sayısı 16, stoma revizyonu yapılan hasta sayısı 3 idi. Kardiyopulmoner morbidite sayısı 10, reoperasyon 9, mortalite sayısı 13 olarak saptandı. Anastomoz yapılan grupta ise postoperatif yoğun bakım ihtiyacı olan hasta sayısı 13, ventilatör ihtiyacı olanların sayısı 4’tü ve anastomoz yapılanların 2’sinde anastomoz kaçağı olduğu görüldü. Yeniden operasyona giren hasta sayısı 2 idi, mortalite sayısı 5 olarak saptandı. Her iki grup arasında postoperatif yoğun bakım ihtiyacı, ventilatör ihtiyacı, reoperasyon ve mortalite açısından p değerleri <0,05 olup anlamlı idi.Sonuç: Kolorektal kansere bağlı akut sol kolon obstrüksiyonu nedeniyle ameliyat edilecek hastalarda; genel durumu iyi, komorbiditesi ve ASA skoru düşük olan hastalara cerrahın tecrübesine dayanarak intraoperatif manuel dekompresyonla rezeksiyon-primer anastomoz yapılmasını önermekteyiz.

Anahtar Kelimeler:

Sol kolon obstrüksiyonu, Hartmann prosedür, anastomoz

Retrospective analysis of acute left colon obstructions due to colorectal cancers

Objectives: In cases showing acute left colon obstruction due to colorectal tumors, it was aimed to evaluate the results of emergency resection primary anastomosis and compare these results with those of Hartmann Procedure.Material and Method: 84 patients who were operated due to colorectal cancer-induced acute left colon obstruction who were admitted to the Ankara Numune Training and Research Hospital Emergency Surgery Service between August 2005 and March 2011 were included in the study and analyzed retrospectively. All of the patients were evaluated in the emergency room and operated in the emergency operating room. In the treatment of patients, Hartmann colostomy and resection primer anastomosis surgical procedures were used. It was operated without bowel cleansing, and after an intraoperative resection, either primary anastomosis or threshing colostomy was performed after manual decompression.Results: The number of patients in need of postoperative intensive care was 25, the number of patients with ventilator need was 16, and the number of patients with stoma revision was 3 in the group with stoma. Cardiopulmonary morbidity number was 10, reoperation was 9 and mortality was 13. In the anastomosis group, there were 13 patients with need for intensive care, 4 patients with ventilator needs and 2 patients with anastomosis leakage. The number of patients re-operated was 2. The mortality number was found to be 5. The postoperative intensive care requirement, ventilator requirement, reoperation and mortality values were p<0.05 and statistically significant between the two groups.Conclusion: Patients who will be operated on for acute left colon obstruction due to colorectal cancer; We recommend performing resection-primary anastomosis by performing intraoperative manual decompression based on the surgeon’s experience in patients with a good general condition and low comorbidity and ASA score.

Keywords:

Left colon obstruction, Hartmann procedure, anastomosis,

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