背景:穿孔性消化性溃疡仍然是印度最常见的外科急症之一,具有显著的发病率和死亡率。这项研究的目的是确定影响消化性溃疡穿孔患者术后发病率和死亡率的围手术期危险因素。
方法:这项观察性回顾性研究包括了在过去8年中在我们机构接受穿孔性消化性溃疡手术的500名患者。他们的临床表现,对围手术期管理进行了研究和分析。
结果:共分析了500例病例,其中96%为男性。平均年龄为46.5岁。共有160例患者出现十二指肠穿孔,328例出现胃穿孔,平均大小为8.6mm。大多数患者(96.2%)接受了穿孔的网膜补片闭合,平均住院时间为14天。最常见的主要和次要术后并发症分别是插管时间延长和肺部不适。术后渗漏率为5.8%的病例中有6.2%需要重新检查。年龄>60岁,共病的存在,术前休克和穿孔大小>1cm被确定为术后发病率的独立预测因子.总死亡率为11.6%,而男性和女性的特定死亡率分别为11.8%和5%。年龄>60岁,演示时感到震惊,腹部强直和穿孔大小>1cm是死亡率的独立预测因素.
结论:老年,合并症,演示时感到震惊,穿孔尺寸>1厘米,较高的ASA等级,手术时间延长和胆红素污染>500mL是术后发病率和死亡率增加的独立预测因素.
BACKGROUND: Perforated peptic ulcer remains one of the most common surgical emergencies in India with significant morbidity and mortality. The aim of this study was to identify the perioperative risk factors influencing the post-operative morbidity and mortality in patients with perforated peptic ulcer disease.
METHODS: Five-hundred patients who underwent surgery for perforated peptic ulcer in our institution in the preceding 8 years were included in this observational retrospective study. Their clinical presentations, peri-operative managements were studied and analysed.
RESULTS: Five hundred cases were analysed of which 96% were males. Mean age was 46.5 years. A total of 160 patients had duodenal perforation and 328 had gastric perforation with a mean size of 8.6 mm. Most patients (96.2%) underwent omental patch closure of the perforation with mean length of hospitalization being 14 days. The most common major and minor postoperative complications were prolonged intubation and pulmonary complaints respectively. Re-exploration was needed in 6.2% of cases with a post-operative leak rate of 5.8%. Age >60 years, presence of comorbid illnesses, shock at presentation and perforation size >1 cm were identified as independent predictors of postoperative morbidity. Overall mortality was 11.6% while specific mortality among males and females were 11.8% and 5% respectively. Age >60 years, shock at presentation, presence of abdominal rigidity and size of perforation >1 cm were independent predictors of mortality.
CONCLUSIONS: Old age, comorbidities, shock at presentation, perforation size >1 cm, higher ASA grade, prolonged surgery and biliopurulent contamination >500 mL were independent predictors of both increased post-operative morbidity and mortality.