Ulus Travma Acil Cerrahi Derg. 2012; 18(4): 311-316 | DOI: 10.5505/tjtes.2012.36418

Sol kolonun týkayýcý malign lezyonlarýnda total-subtotal kolektomi ve primer anostomoz iyi bir tedavi alternatifi midir?

Kemal Arslan, Mehmet Ali Eryýlmaz, Ahmet Okuþ, Osman Doðru, Ömer Karahan, Hande Köksal
Konya Eðitim Ve Araþtýrma Hastanesi Genel Cerrahi Klinikleri

AMAÇ
Bu çalýþmada, sol kolonun týkayýcý malign lezyonlarýnda total-subtotal kolektomi anostomoz ile diðer cerrahi tedavi yöntemleri karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmaya Konya Eðitim ve Araþtýrma Hastanesine 2004-2007 yýllarý arasýnda transvers kolon distalinde týkanýklýk bulgularý ile baþvuran ve cerrahi tedavi uygulanan hastalar dahil edildi. Hastalar cerrahi prosedüre göre üç gruba ayrýldý. Bunlar: Grup I: Hartmann prosedürü; Grup II: Rezeksiyon, anostomoz ve saptýrýcý ileostomi; Grup III: Total veya subtotal kolektomi ve primer anastomoz. Hastalarýn dosyalarý geriye dönük olarak incelendi.
BULGULAR
Altmýþ iki hastanýn yaþ ortalamasý 64 (daðýlým, 38-89 yaþ) idi. Birinci grupta 15, ikinci grupta 21, üçüncü grupta 26 hasta vardý. Gruplar arasýnda yaþ ortalamalarý, cinsiyet, ASA skoru ve tümör evresi bakýmýndan anlamlý fark yoktu. Çalýþma gruplarý arasýnda ameliyat süresi ve ameliyat sonrasý morbidite, mortalite ve beþ yýllýk saðkalým açýsýndan anlamlý fark yoktu, ancak hastanede kalma süresi ve tedavi maliyetleri açýsýndan Grup I ve Grup II’ye göre Grup III’de anlamlý olarak düþüktü.
SONUÇ
Deneyimli cerrahlar tarafýndan yapýlan total-subtotal kolektomi ve primer anostomozun diðer bir veya iki aþmalý cerrahi prosedürlere göre daha iyi bir alternatiftir.

Anahtar Kelimeler: Sol kolon týkayýcý tümörlerinin tedavisi, total veya subtotal kolektomi, Hartmann prosedürü; rezeksiyon; saptýrýcý ileostomi.

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Is total-subtotal colectomy and primary anastomosis a good treatment alternative in malignant obstructive lesions of the left colon?

Kemal Arslan, Mehmet Ali Eryýlmaz, Ahmet Okuþ, Osman Doðru, Ömer Karahan, Hande Köksal
Konya Education And Research Hospital General Surgery Departman

BACKGROUND
This study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon.
METHODS
Patients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively.
RESULTS
The mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups.
CONCLUSION
We suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures.

Keywords: Treatment of obstructive lesions of the left colon, total or subtotal colectomy; Hartmann procedure; resection; diverting ileostomy.

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ATIF KOPYALA