采用格雷厄姆补片手术闭合十二指肠穿孔后导致再漏的因素。

Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham's Patch.

作者信息

Kumar K, Pai D, Srinivasan K, Jagdish S, Ananthakrishnan N

机构信息

Dept. of General Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry-6.

出版信息

Trop Gastroenterol. 2002 Oct-Dec;23(4):190-2.

PMID:12833709

Abstract

BACKGROUND

Perforated duodenal ulcer is one of the common surgical emergencies. Releak after duodenal ulcer perforation closure is an important cause of mortality. This study was planned to analyse risk factors if any, which could predict releak following duodenal ulcer perforation closure and to ascertain the contribution of releak towards ultimate outcome.

METHODS

A prospective study was undertaken between September 1997 and August 1999 including all patients undergoing surgery for perforated duodenal ulcer. All patients (119) underwent a Graham's patch closure and were put on parenteral H2 antagonists and antibiotics postoperatively. Patients with releak were included in case group (9), and those without releak were included in control group (110). Factors considered for comparison among the two groups were age, pulse rate, systolic blood pressure at presentation, anthropometeric parameters, haemoglobin, serum total protein/albumin, total lymphocyte count and operative findings including size of perforation, evidence of chronicity of ulcer, quantity and nature of peritoneal fluid.

RESULTS

Age greater than 60 years (p-0.0470, CI-0.76-31.54), pulse rate greater than 110/minute (p-0.0217, CI-1.04-34.48), systolic blood pressure less than 90 mm Hg (p-0.0016, CI-2.04-71.9), haemoglobin level less than 10 g/dl (p-0.0009, CI-2.25-135.02), serum albumin less than 2.5 grams/dl (p-0.0145, CI-1.21-38.31), total lymphocyte count less than 1800 cells/mm-3 (p-0.0003, CI-8.9-42.2), size of perforation greater than 5 mm (p-0.0011, CI-1.09-36.13) were identified as risk factors for releak. Serum albumin, hemoglobin and size of perforation were independent risk factors for prediction of releak on multivariate analysis. The anthropometric parameters namely mean triceps skin fold thickness, mean mid arm circumference and mean body mass index were all significantly less in cases as compared to controls. Releak was found to be a significant cause of death in patients with perforated duodenal ulcer. A total of 8 patients died in both the groups. The mortality rate in the releak group was 55.6% (5 out of 9 patients) compared to 2.7% (3 out of 110 patients) in the control group [p-0.0001].

CONCLUSION

Releak was a significant factor influencing mortality rate after omental patch closure of perforated duodenal ulcer.

摘要

背景

十二指肠溃疡穿孔是常见的外科急症之一。十二指肠溃疡穿孔闭合术后再渗漏是导致死亡的重要原因。本研究旨在分析可能预测十二指肠溃疡穿孔闭合术后再渗漏的危险因素，并确定再渗漏对最终结局的影响。

方法

1997年9月至1999年8月进行了一项前瞻性研究，纳入所有接受十二指肠溃疡穿孔手术的患者。所有119例患者均接受了格雷厄姆补片闭合术，并在术后接受肠外H2拮抗剂和抗生素治疗。发生再渗漏的患者纳入病例组（9例），未发生再渗漏的患者纳入对照组（110例）。两组间进行比较的因素包括年龄、脉搏率、就诊时收缩压、人体测量参数、血红蛋白、血清总蛋白/白蛋白、总淋巴细胞计数以及手术所见，包括穿孔大小、溃疡慢性化证据、腹腔积液量及性质。

结果

年龄大于60岁（p = 0.0470，CI = 0.76 - 31.54）、脉搏率大于110次/分钟（p = 0.0217，CI = 1.04 - 34.48）、收缩压低于90 mmHg（p = 0.0016，CI = 2.04 - 71.9）、血红蛋白水平低于10 g/dl（p = 0.0009，CI = 2.25 - 135.02）、血清白蛋白低于2.5克/ dl（p = 0.0145，CI = 1.21 - 38.31）、总淋巴细胞计数低于1800个细胞/mm³（p = 0.0003，CI = 8.9 - 42.2）、穿孔大小大于5 mm（p = 0.0011，CI = 1.09 - 36.13）被确定为再渗漏的危险因素。多因素分析显示，血清白蛋白、血红蛋白和穿孔大小是预测再渗漏的独立危险因素。与对照组相比，病例组的人体测量参数，即肱三头肌皮褶厚度均值、上臂中部周长均值和体重指数均值均显著降低。发现再渗漏是十二指肠溃疡穿孔患者死亡的重要原因。两组共有8例患者死亡。再渗漏组的死亡率为55.6%（9例患者中有5例），而对照组为2.7%（110例患者中有3例）[p = 0.0001]。