Hepato-gastroenterology · 2002
Results of endotoxin absorption after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia.
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Tsugawa Kouji, Koyanagi Nobuhiro, Hashizume Makoto, Wada Hiroya, Ayukawa Katsuhiko, Akahoshi Kazuya, Tomikawa Morimasa, Sugimachi Keizo
Аннотация
BACKGROUND/AIMS: The purpose of this study is to analyze the results of endotoxin absorption therapy after a subtotal resection of the small intestine and a right hemicolectomy for severe superior mesenteric ischemia.
METHODOLOGY: From April 1980 through August 1999, 82 patients with severe superior mesenteric ischemia were operated on an emergency basis, and they were divided into two groups. Group 1 (n = 51), did not undergo postoperative endotoxin absorption therapy, while group 2 (n = 31), underwent this therapy. The two groups were compared based on the outcome variables.
RESULTS: When the number of risk factors was 1 or 2, the mortality rate in group 2 was significantly lower than in group 1 (p < 0.05). For postoperative lung or liver failure, the mortality rate was significantly higher in group 1 than in group 2. For an intraabdominal abscess, the mortality rate was significantly higher in group 1 than in group 2. Twenty-two of the thirty-one patients in group 2 survived. In the surviving cases, this therapy significantly decreased the intravenous concentration of endotoxin (p = 0.04). As for the fatalities (n = 9), no significant change in the concentration of endotoxin before or after endotoxin absorption was recognized. By the first postoperative month, the survival rate was significantly lower in group 1 than in group 2 (58.8% vs. 71.0%, P = 0.04).
CONCLUSIONS: In conclusion, we may now safely say that both stoma and a resection are recommended while endotoxin absorption using blood filtration may also be an effective additional therapy for post-operative septic shock.
METHODOLOGY: From April 1980 through August 1999, 82 patients with severe superior mesenteric ischemia were operated on an emergency basis, and they were divided into two groups. Group 1 (n = 51), did not undergo postoperative endotoxin absorption therapy, while group 2 (n = 31), underwent this therapy. The two groups were compared based on the outcome variables.
RESULTS: When the number of risk factors was 1 or 2, the mortality rate in group 2 was significantly lower than in group 1 (p < 0.05). For postoperative lung or liver failure, the mortality rate was significantly higher in group 1 than in group 2. For an intraabdominal abscess, the mortality rate was significantly higher in group 1 than in group 2. Twenty-two of the thirty-one patients in group 2 survived. In the surviving cases, this therapy significantly decreased the intravenous concentration of endotoxin (p = 0.04). As for the fatalities (n = 9), no significant change in the concentration of endotoxin before or after endotoxin absorption was recognized. By the first postoperative month, the survival rate was significantly lower in group 1 than in group 2 (58.8% vs. 71.0%, P = 0.04).
CONCLUSIONS: In conclusion, we may now safely say that both stoma and a resection are recommended while endotoxin absorption using blood filtration may also be an effective additional therapy for post-operative septic shock.