과거 복부 또는 골반수술이 대장내시경에 미치는 영향

Effect of Previous Abdominal or Pelvic Surgery on Colonoscopy

  • 정창욱 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 심상군 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 박건태 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 오지은 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 이지은 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 우재곤 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 조대현 (성균관대학교 의과대학 삼성창원병원 내과학교실) ;
  • 유길종 (성균관대학교 의과대학 삼성창원병원 내과학교실)
  • Jeong, Chang-Wook (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Shim, Sang-Goon (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Geon-Tae (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Oh, Ji-Eun (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Yi, Ji-Eun (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Woo, Jae-Gon (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Cho, Dae-Hyeon (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Yoo, Gil-Jong (Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine)
  • 발행 : 2011.05.30

초록

목적: 이전에 수술을 받은 환자에서의 대장내시경 삽입시간은 다양하게 보고되고 있다. 이 연구는 복부수술이 대장내시경의 삽입에 영향을 주는지 알아보고자 하였다. 대상 및 방법: 2008년 5월부터 2010년 5월까지 삼성창원병원에서 대장내시경을 받은 3,600명의 환자 중 이전에 복부수술을 받은 192명을 대상으로 하였다. 환자의 나이, 성별, 키, 몸무게, 체질량지수, 허리둘레, 대장내시경 삽입시간, 삽입지연율, 장 정결도, 이전의 복부수술 방법을 조사하였다. 이전의 복부수술은 대장절제군, 대장절제 이외의 복부수술군, 골반수술군, 복강경수술군으로 나누었다. 결과: 수술군의 평균 삽입시간은 7.73${\pm}$5.95분으로 비수술군(6.4${\pm}$3.88분)과 비교해서 길게 측정되었다. 대장절제군의 나이가 많고 삽입시간이 짧으며(5.11${\pm}$3.32분) 삽입지연율이 낮았다(6%). 대장절제 이외의 복부수술군, 골반수술군, 복강경수술군의 비교에서는 통계적으로 차이는 없었다. 결론: 과거의 복부수술은 대장내시경의 삽입을 어렵게 한다. 대장절제군의 삽입시간이 짧고 삽입지연율이 낮았으나 다른 수술들의 차이는 없었다.

Background/Aims: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time. Methods: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups. Results: The average colonoscope insertion time in patients with prior abdominal surgery (7.73${\pm}$5.95 min) was longer than that of the non-surgery group (6.4${\pm}$3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11${\pm}$3.32 min) than patients in the other groups. Conclusions: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group.

키워드

참고문헌

  1. Webb WA. Colonoscoping the "difficult" colon. Am Surg 1991;57:178-182.
  2. Rex DK. Achieving cecal intubation in the very difficult colon. Gastrointest Endosc 2008;67:938-944. https://doi.org/10.1016/j.gie.2007.12.028
  3. Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc 2001;54:558-562. https://doi.org/10.1067/mge.2001.118950
  4. Saunders BP, Fukumoto M, Halligan S, et al. Why is colonoscopy more difficult in women? Gastrointest Endosc 1996;43:124-126. https://doi.org/10.1016/S0016-5107(06)80113-6
  5. Shah HA, Paszat LF, Saskin R, Stukel TA, Rabeneck L. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007;132:2297-2303. https://doi.org/10.1053/j.gastro.2007.03.032
  6. Sanaka MR, Shah N, Mullen KD, Ferguson DR, Thomas C, McCullough AJ. Afternoon colonoscopies have higher failure rates than morning colonoscopies. Am J Gastroenterol 2006;101:2726-2730. https://doi.org/10.1111/j.1572-0241.2006.00887.x
  7. Hsieh YH, Kuo CS, Tseng KC, Lin HJ. Factors that predict cecal insertion time during sedated colonoscopy: the role of waist circumference. J Gastroenterol Hepatol 2008;23:215-217. https://doi.org/10.1111/j.1440-1746.2006.04818.x
  8. Lee SK, Kim TI, Shin SJ, Kim BC, Kim WH. Impact of prior abdominal or pelvic surgery on colonoscopy outcomes. J Clin Gastroenterol 2006;40:711-716. https://doi.org/10.1097/00004836-200609000-00010
  9. Takahashi Y, Tanaka H, Kinjo M, Sakumoto K. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy. Dis Colon Rectum 2005;48:1295-1300. https://doi.org/10.1007/s10350-004-0940-1
  10. Hull T, Church JM. Colonoscopy-how difficult, how painful? Surg Endosc 1994;8:784-787. https://doi.org/10.1007/BF00593441
  11. Waye JD, Bashkoff E. Total colonoscopy: is it always possible? Gastrointest Endosc 1991;37:152-154. https://doi.org/10.1016/S0016-5107(91)70674-3
  12. Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol 2000;95:2784-2787. https://doi.org/10.1111/j.1572-0241.2000.03186.x
  13. Church JM. Complete colonoscopy: how often? And if not, why not?. Am J Gastroenterol 1994;89:556-560.
  14. Cirocco WC, Rusin LC. Factors that predict incomplete colonoscopy. Dis Colon Rectum 1995;38:964-968. https://doi.org/10.1007/BF02049733
  15. Oh SY, Sohn CI, Sung IK, et al. Factors affecting the technical difficulty of colonoscopy. Hepatogastroenterology 2007;54:1403-1406.
  16. Bernstein C, Thorn M, Monsees K, Spell R, O'Connor JB. A prospective study of factors that determine cecal intubation time at colonoscopy. Gastrointest Endosc 2005;61:72-75. https://doi.org/10.1016/S0016-5107(04)02461-7
  17. Chung YW, Han DS, Park KH, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol 2009;43:448-452. https://doi.org/10.1097/MCG.0b013e3181662442
  18. Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc 2004;59:482-486. https://doi.org/10.1016/S0016-5107(03)02875-X
  19. Gupta T, Mandot A, Desai D, Abraham P, Joshi A, Shah S. Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy. Endoscopy 2007;39:706-709. https://doi.org/10.1055/s-2007-966375
  20. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 2001;18:260-273. https://doi.org/10.1159/000050149
  21. Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 2010;14:1619-1628. https://doi.org/10.1007/s11605-010-1189-8
  22. Saifuddin T, Trivedi M, King PD, Madsen R, Marshall JB. Usefulness of a pediatric colonoscope for colonoscopy in adults. Gastrointest Endosc 2000;51:314-317. https://doi.org/10.1016/S0016-5107(00)70361-0
  23. Marshall JB, Perez RA, Madsen RW. Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy. Gastrointest Endosc 2002;55:838-841. https://doi.org/10.1067/mge.2002.124562