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Nýgengi, orsakir og meðferð við bráðu rofi á ristli á Íslandi 1998-2007

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Authors
Kristín Jónsdóttir
Elsa B Valsdóttir,
Shreekrishna Datye
Fritz Berndsen
Páll Helgi Möller
Issue Date
2017-02-03

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Other Titles
Incidence, cause and treatment of colonic perforations in Iceland 1998-2007: A nationwide study
Citation
Læknablaðið 2017,103(2):73-77
Abstract
Inngangur: Rof á ristli er alvarlegt sjúkdómsástand með háa dánartíðni. Áður fyrr var meðferðin fyrst og fremst skurðaðgerð en á undanförnum árum hafa rannsóknir sýnt sambærilegan árangur með stuðningsmeðferð. Tilgangur þessarar rannsóknar var að skoða nýgengi, orsakir, meðferð og afdrif sjúklinga með brátt rof á ristli á Íslandi á tímabilinu 1998-2007. Efniviður og aðferðir: Gerð var afturskyggn leit í sjúkraskrám Landspítala, Sjúkrahússins á Akureyri og Heilbrigðisstofnunar Vesturlands á Akranesi að líklegum greiningarkóðum miðað við greiningarkerfi Alþjóðaheilbrigðisstofnunarinnar. Safnað var gögnum um kyn, aldur, greiningarár, orsakir, greiningu, meðferð og afdrif einstaklinga með brátt rof á ristli. Niðurstöður: 225 sjúklingar uppfylltu skilyrði rannsóknarinnar, 131 kona (58%) og 94 karlar (42%). Miðgildi aldurs var 70 ár (bil 30-95 ár). Algengustu ástæður rofs voru sarpabólga (67%), áverki við ristilspeglun (12%) og fylgikvillar aðgerða. Á fyrri 5 árum rannsóknartímabilsins fengu 27% sjúklinganna meðferð án aðgerðar en 71% fór í aðgerð. Á seinni 5 árunum var hlutfallið 45% og 54%. Um 24% sjúklinganna fengu varanlegt stóma. Tæpur helmingur sjúklinga, eða 101 (46%), fékk 140 fylgikvilla og var skurðsárasýking þar algengust. Þrjátíu daga dánartíðni var 11% en eins árs dánartíðni 20%. Ályktun: Sarpabólga var algengasta orsök rofs á ristli á Íslandi á rannsóknartímabilinu. Á sama tímabili jókst notkun stuðningsmeðferðar á meðan skurðaðgerðum fækkaði. Hlutfall þeirra sjúklinga sem fengu stóma og fóru síðar í aðgerð þar sem gerð var endurtenging er hátt Introduction: Colon perforation is a serious illness with mortality reported 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 analysis 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 operations (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 perforation 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 elsewhere.hérlendis og fyllilega sambærilegt því sem lýst er í erlendum rannsóknum.
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Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn
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http://www.laeknabladid.is/tolublod/2017/02/nr/6305
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Archived with thanks to Læknablaðið
ae974a485f413a2113503eed53cd6c53
10.17992/lbl.2017.02.121
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Icelandic Journal Articles (Peer Reviewed)

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