ÝNTRAMURAL PH TESPÝTÝ ÝLE KOLON ANASTOMOZLARININ PROGNOZ TAYÝNÝ

Ekim 1992 - Eylül 1995 tarihleri arasýnda Kartal Eðitim ve Araþtýrma Hastanesi Genel Cerrahi servislerinde kolon rezeksiyonu sonucu, kolokolik anastomoz uygulanan 20 hastadan bir çalýþma grubu oluþturuldu. Ayný sürede kolon anastomozu yapýlmamýþ, diðer batýn ameliyatlarý geçiren 20 hastadan da bir kontrol grubu meydana getirildi. Her iki gruptaki olgulara, transanal yolla sigmoid kolon tonometri katateri konup, intramural PH'lar postop 1. günden baþlanarak postoperatif beþinci güne kadar takip edildi. Kontrol grubunda PH 5. gün ortalama 7.26 ± 0.022 iken, çalýþma grubunda PH, ortalama 7.06±0.113 idi. Çalýþma grubu içinde yeralan, acil olgularda, çift kat veya stapler ile anastomoz yapýlanlarda, birlikte diðer organ yaralanmalarý olan olgularda, intramural PH ortalamasýnýn diðer olgulara göre daha düþük olduðu gözlendi. PH'nýn 6.9 veya altýna indiði 2 olguda klinik olarak ta anastomoz kaçaðý saptandý ve hastalar relaparotomiye alýndý. Ýstatiksel olarak kontrol ve çalýþma gruplarý arasýnda intramural PH açýsýndan anlamlý fark bulundu (p<0.01). Bu bulgular ýþýðýnda kolokolik anastomozlu hastalarda, sigmoid kolon tonometri katateri ile intramural PH takibinin, anastomoz iyileþmesi hakkýnda bilgi verebilecek bir yardýmcý muayene yöntemi olabileceði ve klinik takip ve diðer laboratuar tetkikleri ile birlikte erken anastomoz kaçaðý açýsýndan klinisyeni uyarýcý olabileceði düþünüldü.

PROGNOSTIC EVALUATION OF COLONIC ANASTOMOSAS BY INTRAMURAL MEASUREMENTS

We created a study group from 20 patients who were performed colocolic anastomosis between October 1992 and September 1995'at Kartal training and research hospital. At the same time, control group was created from 20 patients who underwent abdominal operations without colonic anastomosis. Colonic sigmoid catheter was inserted to all patients transanally and observed their intramural PH posoperatif five days. While in control mean PH was 7.26±0.022 in the fifth day, in study group mean PH was 7.06±0.113. In study group, patients who were performed double row or stapler anastomosis technics or who were urgent cases or multisystem injuries were observed that intramural PH was lower in fifth day than the others. In two patients whose PH were 6.9 or lower, clinical leakage were seen and relaparatomies were performed. Significant differences between control and study groups were seen and relaparatomies were performed. Significant differences between control and study groups were found in statistically (p<0.01). As a result, we consider that intramural PH monitoring by using colonic sigmoid catheter and following clinical and laboratory observation can be useful for clinician in early subclinic anastomotic leakage.