Perioperative Komplikationen bei Operationen am Kolon

Abstract

Im Zeitraum des 01.01.2003 bis zum 31.12.2006 wurden im Berliner Auguste- Viktoria Krankenhaus insgesamt 325 Kolonresektionen und Dickdarmkontinuitätswiederherstellungen mit Anlage einer primären Kolonanastomose durchgeführt. Anhand dieser Operationen sollten perioperative Komplikationen retrospektiv erfasst und ausgewertet werden. Das Patientenspektrum setzt sich aus 62,2% Frauen und 37,8% Männern zusammen, das gemeinsame mediane Alter aller Patienten beträgt 68 Jahre. Die Operationsindikation war in 53,5% der Fälle ein Kolonkarzinom. Die Gesamtzahl der Malignome am Operationsgut betrug 57,5%. Weitere wesentliche Operationsindikationen waren die Divertikulitis mit 25,2%, die Kolonkontinuitätswiederherstellung mit 7%, der Ileus mit 6,4% und die Appendizitis mit 1,5%. Von den 325 Operationen waren 88,3% elektive Eingriffe und 11,7% Notfalloperationen. 72% der Anastomosennähte wurden maschinell angefertigt und 28% der Anastomosen wurden durch eine Handnaht angelegt. 55,6% aller operierten Patienten verließen ohne jegliche postoperative Komplikation die chirurgische Station. Bei insgesamt 144 Patienten trat mindestens eine postoperative Komplikation auf. Davon waren 37,5% (n=54) allgemeiner Art (Harnwegsinfekt, Durchgangssyndrom etc.). Bei 29 Patienten (20%) kam es postoperativ zu einer rein chirurgischen Komplikation (Serom, Wundinfektion, Ileus, etc). Von einer Kombination aus allgemeiner und chirurgischer Komplikation wurden 42,3% (n=61) Patienten, der insgesamt 144 betroffenen Patienten, ermittelt. In 85% aller Fälle heilten die Operationswunden primär. Bei 15% der Patienten kam es zu einer postoperativen Wundheilungsstörung. In der vorliegenden Arbeit konnte eine Tendenz für postoperative Komplikationen bei präoperativ vorhanden Risikofaktoren und Comorbiditäten festgestellt werden. Weiterhin wurde in dieser Studie der Trend ermittelt, dass ein erhöhtes Operationsalter und Notfalloperationen die postoperative Komplikationsrate erhöhen. Das trifft insbesondere auf die postoperative Leckagerate und auch auf ein septisches Geschehen zu. Damit schließt sich die vorliegende Arbeit tendenziell aktuellen Studien an.

In the period 01.01.2003 up to 31.12.2006 was accomplished in the citizen of Berlin Auguste Viktoria hospital altogether 325 Kolonresection and large intestine continuity re-establishments with plant of a primary Kolonanastomose. On the basis these operations perioperative complications should be seized and evaluated retrospectively. The patient spectrum consists of 62,2% woman and 37.8% men, common mediane the age of all patients amounts to 68 years. The operation indication was in 53,5% of the cases a Kolonkarzinom. The total number of the Malignomes at the operation property amounted to 57.5%. Further substantial operation indications were the Diverticulitis with 25,2%, the Kolon re-establishment with 7%, the Ileus with 6,4% and the Appendizitis with 1,5%. From the 325 operations 88.3% were elektive interferences and 11.7% emergency operations. 72% of the anastomosis seams were made and 28% of the anastomoses were put on by machine by a hand seam. 55.6% of all operated patients left the surgical station without any post office-operational complication. With altogether 144 patients at least an post-operational complication arose. Of it were 37.5% (n=54) of general kind (cystitis, passage syndrome etc.). With 29 patients (20%) it came post- operationally to a purely surgical complication (serom, wound infection, Ileus, etc.). By a combination of general and surgical complication 42.3% (n=61) became patient, who determines altogether 144 patients concerned. In 85% of all cases the operative wounds healed primarily. With 15% of the patients it came to an post-operational wound healing disorder. In the available work a tendency for post-operational complications could be determined with präoperativ available factors of risk and Comorbiditäten. Further in this study the trend was determined that a increased operation age and emergency operations increase the post-operational complication rate. That applies in particular to the post-operational leakage rate and also to September table a happening. Thus the available work follows tendentious current studies. From an anastomosis insufficiency 24 patients were concerned in this study. Of it 6 patients at the consequences of an anastomosis insufficiency in comorbidity with a sepsis died. Mediane the age of these patients amounted to the point of time of death 79.5 years and lies thereby 10 years over medianen the age of the remaining patients. The used seam materials and seam techniques, the operation times and the operating surgeons had tendentious no influence on the available insufficiency rate. The operated patients were on the average 19 days on the surgical station. With patients with a minor complication a mediane could be determined residence duration by up to 21 days. Patients with post-operational major complication were on the average up to 28 days and in individual cases up to 10 weeks in by surgery stationary treatment. 9 patients died after the 28.postoperativen day. The total lethality rate amounts to 8.5%. At surgical complications 5 patients died. Further 25 patients died at internal complications or at the combination of surgical, internal and neurological complication. Preoperative comorbidity and factors of risk, a increased age of the patients to the point of operation time and an accomplished emergency interference are tendentious factors for the increase of the lethality rate.