非手术治疗消化性溃疡穿孔38例

虽然随着诊疗水平的不断提高,消化性溃疡的内科治愈率不断提高,但穿孔仍时有发生。我院2006年12月—2010年12月共收治82例,其中非手术治疗38例,占46.3%。     

134例消化性溃疡择期胃切除术的指征分析

目的探讨消化性溃疡择期胃切除术适应证的合理性。方法对134例溃疡病经择期胃切除术病人的临床资料进行回顾性分析。结果术后均无并发症发生,全部病人治愈出院,出院后所有病人均获得随访,无溃疡病复发。结论本病的手术指征应局限于疤痕性幽门梗阻、巨大性及不能排除恶变的溃疡,反复出血以及系统内科治疗无效等病例。提高对溃疡病药物疗法的新知识以及要有高度的责任心,是降低不合理胃切除术的重要措施。     

消化性溃疡穿孔非手术治疗28例报告

目的探讨消化性溃疡穿孔非手术治疗的适应证和治疗方法。方法回顾性分析急性消化性溃疡穿孔非手术治疗28例的临床资料。结果消化性溃疡穿孔治愈27例;1例失败,后采用手术治疗。27例中1例于2个月后作胃癌根治手术。结论选择性非手术治疗消化性溃疡穿孔是一种有效的方法,对消化性溃疡穿孔的治疗有重要的临床意义。     

消化性溃疡穿孔非手术治疗病例报告及分析

目的探讨消化性溃疡穿孔的非手术治疗。方法回顾我院近年来消化性溃疡穿孔行非手术治疗的病例，并结合文献进行分析。结果十二指肠溃疡单纯穿孔患者非手术治疗均有效，而胃穿孔患者非手术治疗后中转手术。结论十二指肠溃疡单纯穿孔非手术治疗有可能成为一种趋势。     

消化性溃疡穿孔保守疗法的适应证分析

目的 探讨消化性溃疡穿孔非手术疗法的适应证及其相关病理,优缺点及注意问题。方法 收集我院1970年1月～1997年12年,103例消化性溃疡穿孔行保守疗法的病例,对其资料进行分析,并与手术组作比较。结果 治愈率94.7％,死亡6例,死亡者均为老年人,与手术组相比,其并发症明显较低,有显著的差异性(P<0.05)。结论 消化性溃疡穿孔非手术的指征应是腹膜炎较轻、局限、中毒症状不明显的青壮年,溃疡穿孔较小,胃内容物溢至腹腔不多。老年人溃疡穿孔应选择手术治疗。     

试谈消化性溃疡穿孔非手术治疗中的几个问题

消化性溃疡穿孔（Peptic ulcer perforation,PPU）仍是腹部外科十分常见的急腹症。文献强调手术治疗是PPU的标准治疗方法,及时手术是决定患者生存的因素之一‘引,而非手术治疗在这一严重威胁生命的急腹症处置中是没有作用的。     

消化性溃疡穿孔的诊断和治疗

目的 总结消化性溃疡穿孔的外科诊治经验，以提高对溃疡病穿孔的诊治水平。方法 对1991～2002年间收冶的166例消化性溃疡穿孔患者的临床资料进行回顾性分析。结果166例中，术前确诊152例(91．6％)，误诊14例(8．4％)。行保守治疗20例(12．0％)，无中转手术病例。穿孔修补术28例(16．9％)，胃大部分切除术118例(71.1％)，术后无再穿孔、幽门梗阻、吻合口漏和残端破裂等近期严重并发症及死亡病例。结论 术前X线和B超联合应用可提高溃疡病穿孔的确诊率。胃大部分切除术的近期并发症与单纯穿孔修补术或非手术疗法并发症的发生无显著性差异，但远期疗效优于后两者。     

胃十二指肠溃疡穿孔非手术治疗的临床观察

目的探讨胃十二指肠溃疡穿孔(perforated gastroduodenal ulcer,PGDU)非手术治疗效果。方法回顾性分析2008年1月至2015年1月深圳市福田区人民医院PGDU病人186例,按拟定的适应证选择非手术综合治疗,按临床标准评估疗效,治疗达标后通过早期胃镜检查确定穿孔病因。结果本组186例PDGU病人中,全部经非手术治愈,无一例死亡。治疗期间接受胃镜检查177例(95.1%),确诊为胃十二指肠溃疡;未行胃镜检查确诊9例(4.9%)。餐后穿孔需腹腔穿刺引流的比例(71.8%)比空腹穿孔需要穿刺引流的比例(5.5%)高,差异有统计学意义(P0.05)。腹腔积液与无腹腔积液平均发热时间[(4.2±0.6)d比(2.2±0.5)d)]相比较,差异有统计学意义(P0.05);两者的平均住院时间[(8.2±0.8)d比(7.8±0.7)d)]相比较,差异无统计学意义(P0.05)。结论非手术治疗PDGU是安全有效的,期间如果有腹腔积液,可选择腹腔穿刺引流。     

中西医结合非手术治疗消化性溃疡急性穿孔的体会

目的总结中西医结合非手术治疗消化性溃疡急性穿孔的体会。方法在常规西医保守治疗(半卧位、禁食水、持续胃肠减压、使用抑酸和抑制消化液分泌药物等)的同时,采用针刺、中药灌肠和局部热敷。对患者的临床资料进行回顾性分析。结果全组患者腹痛在治疗后4～16 h减轻或缓解,平均为7.8 h。在治疗后12～44 h,平均28 h,腹膜炎体征完全消失。白细胞计数和体温在3 d内恢复正常。随诊20例中,2例因溃疡出血而行胃大部切除术。结论应用中西医结合方法非手术治疗消化性溃疡急性穿孔,疗效显著,并发症少。     

消化性溃疡穿孔保守治疗的定量指标探讨

目的 探讨消化性溃疡穿孔保守治疗的定量指标。方法 回顾性分析1990－1999年收治的溃疡病穿孔321例的临床资料，按腹痛范围，是否空腹，腹穿情况，穿孔时间，年龄，发热，腹脸游离气体评分。结果 保守治疗2分以内85例，治愈81例（95．2％），3分22例，治愈16例（72．7％）；4分8例，治愈2例（25．0％）。差异有显著性（P＜0．05）。结论 对≤2分病例应叟承保守治疗，3分病例可先行保守治疗24h，如病情好转，可继续保过治疗，病情加重应及时中转手术。≥4分病人不宜保守治疗，宜及早手术。     

Definitive Surgery for Perforated Peptic Ulcer in Malaysia1

Seventy-three cases of perforated peptic ulcer (51 duodenal and 22 gastric) are reviewed. The condition is common in the Chinese, but rare in Malays, Indians, Pakistanis and Ceylonese. Simple closure is followed by a high recurrence rate. Emergency definitive surgery is safe. Difficulties with follow-up of patients favour a wider use of emergency definitive surgery for perforated peptic ulcer in Malaysia.     

Trends in Diagnosis and Surgical Management of Patients with Perforated Peptic Ulcer

Introduction

While the laparoscopic treatment of perforated peptic ulcers (PPU) has been shown to be feasible and safe, its implementation into routine clinical practice has been slow. Only a few studies have evaluated its overall utility. The aim of this study was to investigate changes in surgical management of PPU and associated outcomes.

Material and Methods

The study was a retrospective, single institution, population-based review of all patients undergoing surgery for PPU between 2003 and 2009. Patient demographics, diagnostic evaluation, management, and outcomes were evaluated.

Results

Included were 114 patients with a median age of 67 years (range, 20?C100). Women comprised 59% and were older (p?<?0.001), had more comorbidities (p?=?0.002), and had a higher Boey risk score (p?=?0.036) compared to men. Perforation location was gastric/pyloric in 72% and duodenal in 28% of patients. Pneumoperitoneum was diagnosed by plain abdominal x-ray in 30 of 41 patients (75%) and by abdominal computerized tomography (CT) in 76 of 77 patients (98%; p?<?0.001).Laparoscopic treatment was initiated in 48 patients (42%) and completed in 36 patients (75% of attempted cases). Laparoscopic treatment rate increased from 7% to 46% during the study period (p?=?0.02). Median operation time was shorter in patients treated via laparotomy (70 min) compared to laparoscopy (82 min) and those converted from laparoscopy to laparotomy (105 min; p?=?0.017). Postoperative complications occurred in 56 patients (49%). Overall 30-day postoperative mortality was 16%. No statistically significant differences were found in morbidity and mortality between open versus laparoscopic repair.

Conclusion

This study demonstrates an increased use of CT as the primary diagnostic tool for PPU and of laparoscopic repair in its surgical treatment. These changes in management are not associated with altered outcomes.     

Laparoscopic Repair for Perforated Peptic Ulcer: A Retrospective Study

Backgrounds

The incidence of patients presenting with perforated peptic ulcers (PPU) has decreased during the last decades. At the same time, a laparoscopic approach to this condition has been adopted by increased number of surgeons. The aim of this study was to evaluate the early postoperative results of the laparoscopic treatment of perforated peptic ulcer performed in eight Romanian surgical centers with extensive experience in laparoscopic surgery.

Methods

Between 2009 and 2013, 297 patients with perforated peptic ulcer were operated in the eight centers participating in this retrospective study. The patients’ charts were reviewed for demographics, surgical procedure, complications and short-term outcomes.

Results

Boey score of 0 was found in 122 patients (41.1%), Boey 1 in 169 (56.9%), Boey 3 in 6 (2.0%). For 145 (48.8%) patients, primary suture repair was performed, in 146 (49.2%) primary suture repair with omentopexy. There were 6 (2.0%) conversions to open surgery. The operative time was between 25 and 120 min, with a mean of 68 min. Two (0.7%) deaths were noted. Mean hospital stay was 5.5 days, ranges 3–25 days. Postoperative complications included: 7 (2.4%) superficial surgical site infections, 5 (1.6%) cardiovascular, 3 (1.0%) pulmonary, 2 (0.7%) duodenal leakages, 3 (1.0%) deep space infections and 1 (0.3%) upper digestive hemorrhage.

Conclusions

This study shows that the laparoscopic approach for PPU is feasible; the procedure is safe, with no increased risk of duodenal fistulae or residual intraperitoneal abscesses. We now consider the laparoscopic approach for PPU as the “gold standard” in patients with Boey score 0 or 1.

     

Current Status of Indications for Surgery in Peptic Ulcer Disease

The eradication of Helicobacter pylori in patients with peptic ulcer disease has greatly diminished the need for antiulcer surgery. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out. If the required expertise is available, it can be undertaken laparoscopically. The advent of endoscopic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic ulcer disease. Once again, however, when such therapy fails surgery is still indicated. Even with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nonoperative management of perforation is indicated in fit patients if the diagnosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extremely ill either because of co-morbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is established to be unsealed, particularly after a trial of conservative management, and in all patients who are otherwise fit.     

Mortality in Perforated Peptic Ulcer Patients After Selective Management of Stratified Poor Risk Cases

Introduction Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. Methods In our study, two series were retrospectively reviewed: group A patients (n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients (n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B (n = 785) treated at Khulna Medical College Hospital during the 1990s. Results In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Conclusions Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.     

Meta-analysis of Laparoscopic Versus Open Repair of Perforated Peptic Ulcer

Background and Objectives:

Laparoscopic treatment of perforated peptic ulcer (PPU) has been introduced as an alternative procedure to open surgery. It has been postulated that the minimally invasive approach involves less operative stress and results in decreased morbidity and mortality.

Methods:

We conducted a meta-analysis of randomized trials to test this hypothesis. Medline, EMBASE, and the Cochrane Central Register of Randomized Trials databases were searched, with no date or language restrictions.

Results:

Our literature search identified 4 randomized trials, with a cumulative number of 289 patients, that compared the laparoscopic approach with open sutured repair of perforated ulcer. Analysis of outcomes did not favor either approach in terms of morbidity, mortality, and reoperation rate, although odds ratios seemed to consistently support the laparoscopic approach. Results did not determine the comparative efficiency and safety of laparoscopic or open approach for PPU.

Conclusion:

In view of an increased interest in the laparoscopic approach, further randomized trials are considered essential to determine the relative effectiveness of laparoscopic and open repair of PPU.