Abstract：
BACKGROUND: To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure.
METHODS: Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis.
RESULTS: Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4-23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00-30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00-12.25] days) and non-surgical group (9.00[7.00-13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00-16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00-10.00]) than in the non-surgical group (9.00[7.00-11.00]) and surgical group (11.00[9.00-13.00]) ( p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00-5.25]) than in the non-surgical group (7.00[6.13-9.00]) and surgical group (8.00[6.53-10.00]), respectively ( p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687-0.993), 1.077 (1.005-1.154), and 1.025 (1.006-1.043), respectively (all p < 0.05).
CONCLUSIONS: OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction.
METHODS: Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis.
RESULTS: Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4-23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00-30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00-12.25] days) and non-surgical group (9.00[7.00-13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00-16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00-10.00]) than in the non-surgical group (9.00[7.00-11.00]) and surgical group (11.00[9.00-13.00]) ( p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00-5.25]) than in the non-surgical group (7.00[6.13-9.00]) and surgical group (8.00[6.53-10.00]), respectively ( p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687-0.993), 1.077 (1.005-1.154), and 1.025 (1.006-1.043), respectively (all p < 0.05).
CONCLUSIONS: OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction.
摘要：
背景：为了比较急性穿孔性消化性溃疡（PPU）患者的临床结果，非手术,和手术干预，探讨OTSC封闭的有效性和安全性。
方法：住院，抗生素使用,饮食恢复时间，并对死亡率进行回顾性分析。采用二元Logistic回归分析确定影响PPU并发脓毒症的危险因素。
结果：患者分为三个治疗组：OTSC（n=62），非手术（n=72），和手术组（n=55）。从症状发作到入院的中位时间（IQR）为9.0（4-23）h。OTSC组中88.71％（55/62）的患者在24h内（中位[IQR]时间：14.5[7.00-30.25]h）进行了OTSC闭合。OTSC和手术组的穿孔直径分别为9.87mm±5.97mm和8.55mm±6.17mm,分别。OTSC（9.50[7.00-12.25]天）和非手术组（9.00[7.00-13.00]天）的中位住院时间（IQR）相似（p>0.05），但短于手术组（12.00[10.00-16.00]天），(p<0.05)。OTSC组（7.00[3.00-10.00]）抗生素使用的中位持续时间短于非手术组（9.00[7.00-11.00]）和手术组（11.00[9.00-13.00]）（p<0.05）；OTSC组（4.00[2.00-5.25]）恢复口服喂养的时间短于非手术组（7.8.00[6.13]分别为(p<0.05)。各组间死亡率无差异(p=0.109)。入院时白蛋白水平较低，年龄较大,肌酐水平升高与脓毒症风险增加相关，OR（95CI）为0.826（0.687-0.993），1.077(1.005-1.154),和1.025（1.006-1.043），分别(均p<0.05)。
结论：OTSC封堵术可改善无脓毒症的急性PPU患者的临床结局。年龄,低蛋白血症,基线肾功能障碍会增加败血症的风险，而死亡率与脓毒症和多器官功能障碍有关。
方法：住院，抗生素使用,饮食恢复时间，并对死亡率进行回顾性分析。采用二元Logistic回归分析确定影响PPU并发脓毒症的危险因素。
结果：患者分为三个治疗组：OTSC（n=62），非手术（n=72），和手术组（n=55）。从症状发作到入院的中位时间（IQR）为9.0（4-23）h。OTSC组中88.71％（55/62）的患者在24h内（中位[IQR]时间：14.5[7.00-30.25]h）进行了OTSC闭合。OTSC和手术组的穿孔直径分别为9.87mm±5.97mm和8.55mm±6.17mm,分别。OTSC（9.50[7.00-12.25]天）和非手术组（9.00[7.00-13.00]天）的中位住院时间（IQR）相似（p>0.05），但短于手术组（12.00[10.00-16.00]天），(p<0.05)。OTSC组（7.00[3.00-10.00]）抗生素使用的中位持续时间短于非手术组（9.00[7.00-11.00]）和手术组（11.00[9.00-13.00]）（p<0.05）；OTSC组（4.00[2.00-5.25]）恢复口服喂养的时间短于非手术组（7.8.00[6.13]分别为(p<0.05)。各组间死亡率无差异(p=0.109)。入院时白蛋白水平较低，年龄较大,肌酐水平升高与脓毒症风险增加相关，OR（95CI）为0.826（0.687-0.993），1.077(1.005-1.154),和1.025（1.006-1.043），分别(均p<0.05)。
结论：OTSC封堵术可改善无脓毒症的急性PPU患者的临床结局。年龄,低蛋白血症,基线肾功能障碍会增加败血症的风险，而死亡率与脓毒症和多器官功能障碍有关。
