Læknablaðið - 01.02.2017, Blaðsíða 21

LÆKNAblaðið 2017/103 77
R A N N S Ó K N
ráð fyrir að sjúklingar sem fóru beint í aðgerð hafi verið veikari
en þeir sem fengu stuðningsmeðferð. Þar sem ASA-skor var illa
skráð og sjúklingar ekki flokkaðir í undirflokka eftir alvarleika
einkenna, var ekki hægt að styðja það með gögnum. Það verður
því að hafa í huga við allan samanburð að hóparnir geta verið
mjög ólíkir.
Margbreytileiki hópsins er einnig helsti styrkur þessarar rann-
sóknar. Rannsóknin nær til allra sjúklinga með rof á ristli á Ís-
landi á rannsóknartímabilinu, þar sem gera má ráð fyrir að önnur
sjúkrahús en þau sem tóku þátt meðhöndli ekki sjúklinga sem
uppfylla inntökuskilyrði. Rannsóknin er með bæði langt rann-
sóknartímabil og mikinn fjölda sjúklinga og gefur því góða mynd
af þessu alvarlega vandamáli sem rof á ristli er hér á landi, orsök-
um þess og árangri meðferðar.
Þakkir
Höfundar vilja þakka riturum þeirra sjúkrahúsa sem þátt tóku
fyrir hjálp við að afla gagna. Sérstakar þakkir fær Gunnhildur
Jóhannsdóttir, Landspítala, og Hjörtur Brynjólfsson, læknir á
Sjúkrahúsinu á Akureyri. Þá fá Martin Ingi Sigurðsson og Sigrún
Helga Lund þakkir fyrir veitta tölfræðiaðstoð.
ENGLISH SUMMARY
Introduction: Colon perforation is a serious illness with mortality report-
ed from 0-39%. Surgery used to be the gold standard but treatment has
changed as studies have indicated comparable results with less invasive
treatment. The aim of this study was to evaluate the incidence of acute
colon perforations in Iceland, causes and treatment.
Material and methods: A retrospective, nationwide, multicenter analy-
sis was performed based on ICD-10 codes from databases of the main
hospitals in Iceland. Age, gender, year of perforation, cause, means of
diagnosis, treatment and outcome were registered. Patients under 18
years and post mortem diagnosis were excluded.
Results: 225 patients met criteria, 131 women (58%) and 94 men (42%),
median age 70 years (range 30-95). The most common causes were
diverticulitis (67%), colonoscopy (12%) and complications during opera-
tions (5%). During the first five study years, 27% received conservative
treatment while 71% underwent surgery. By the end of the study era this
ratio was 45% and 54% respectively. The rate of permanent stoma was
10%.
Conclusions: Diverticulitis was the most common cause of colon per-
foration in Iceland during the study period. Many patients still undergo
surgery but there has been a dramatic change toward more conservative
treatment. The rate of stoma closure is comparable to studies else-
where.
Incidence, cause and treatment of colonic perforations in Iceland 1998-2007: A nationwide study
Kristín Jónsdóttir1, Elsa B. Valsdóttir2, Shreekrishna Datye3, Fritz Berndsen4, Páll Helgi Möller1,2
1University Hospital of Iceland, Dept. General Surgery, 2University of Iceland, Faculty of Medicine, 3Akureyri Teaching Hospital, 4Akranes Hospital and Health Care Center, Iceland.
Key words: Colon perforation, diverticulitis, Hartmann’s reversal.
Correspondence: Elsa B. Valsdóttir, elsava@landspitali.is
Heimildir
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