慢性腎不全維持透析患者の消化器外科手術症例の検討

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  • A Clinical Study on the Gastrointestinal Surgery in Regular Hemodialysis Patients.

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This paper reports a clinical study of gastrointestinal surgery in regular hemodialysis patients. There were 52 operations in the elective procedure group (group A) of 49 patients and 33 operations in the emergency group (group B) of 32 patients from 1979 to 1989 in our hospital. The incidence of postoperative complications was 28.8% in group A, which was lower than that in group B (48.5%). The mortality rate within the 1st postoperative month was 3.8% in group A, which was markedly lower than that in group B (21.2%). The main lethal causes were pulmonary complications in group A and septic multiple-organ failure in group B. In 17 patients (51.5%) of group B, emergency operations were performed for perforations of the lower gastrointestinal (G-I) tract, most of which were due to the gangrene type of ischemic colitis (11 patients). In these patients surgery should be performed within 24 hours from the onset of illness, because the longer the preoperative interval, the poorer is the postoperative prognosis. Even in group A, the incidence of postoperative complications and mortality in patients older than 60 years were 66.7% and 58.3% respectively, which were significantly higher than those in patients younger than 60 (17.5% and 2.5% respectively). Cancer patients older than 60 should be considered to be at high risk for major G-I tract surgery (e.g. esophageal cancer), because all 6 patients who were older than 60 and died during the early postoperative interval in the hospital were cancer patients. The plasma fibronectin levels in group A were significantly lower than those in healthy adult controls, preoperatively and on the 3rd and 7th postoperative days. The above results suggest that these patients have impaired host defense mechanisms against postoperative infections and for wound healing.

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