Plummer J M, McFarlane M E C
Department of Surgery, Radiology, Anaesthesia and Intensive Care, Section of Surgery, The University of the West Indies, Kingston 7, Jamaica, West Indies.
West Indian Med J. 2004 Dec;53(6):378-81.
To determine the management of perforated duodenal ulcer at the University Hospital of the West Indies (UHWI) in this era of Helicobacter pylori, the medical records of all patients seen at the UHWI during the period July 1997 to June 2002 with an intra-operative diagnosis of perforated peptic ulcer were reviewed The records were analyzed for the following: age, gender, duration of symptoms, non-steroidal anti-inflammatory drug (NSAID) use, smoking status, operative repair duration of hospitalization, Helicobacter pylori status and medical therapy, peri-operative complications, mortality and recurrence. Ninety per cent of the cases were males. All females in whom perforation occurred were age 50 years and older compared to males where 58% of cases presented before age 50 years. Perforations in acute ulcers occurred in 80% of cases. The majority of patients were male smokers. Non-steroidal anti-inflammatory drug use was also an important risk factor in elderly females. Simple surgical closure and standard triple therapy antibiotics to eradicate Helicobacter pylori was the most common treatment offered. Mortality was one per cent and follow-up poor but 11% of patients had documented recurrent peptic ulceration. In this study population, perforated duodenal ulcer occured overwhelmingly in males less than 50 years of age. There is a trend towards exclusive simple surgical closure and H pylori eradication at the UHWI for patients with perforated duodenal ulcer but this needs to be supported by documentation of H pylori prevalence in the population of patients presenting with perforated peptic ulcers.
为了确定在幽门螺杆菌感染这个时代，西印度群岛大学医院（UHWI）对十二指肠溃疡穿孔的治疗方法，我们回顾了1997年7月至2002年6月期间在UHWI接受治疗的所有术中诊断为消化性溃疡穿孔患者的病历。对这些病历进行了以下分析：年龄、性别、症状持续时间、非甾体抗炎药（NSAID）使用情况、吸烟状况、手术修复、住院时间、幽门螺杆菌感染状况和药物治疗、围手术期并发症、死亡率和复发情况。90%的病例为男性。所有发生穿孔的女性年龄均在50岁及以上，而男性中58%的病例在50岁之前发病。80%的病例为急性溃疡穿孔。大多数患者为男性吸烟者。非甾体抗炎药的使用也是老年女性的一个重要危险因素。单纯手术缝合和使用标准三联疗法抗生素根除幽门螺杆菌是最常用的治疗方法。死亡率为1%，随访情况不佳，但11%的患者有记录显示复发性消化性溃疡。在这个研究人群中，十二指肠溃疡穿孔绝大多数发生在50岁以下的男性。在UHWI，对于十二指肠溃疡穿孔患者有单纯手术缝合和根除幽门螺杆菌的趋势，但这需要通过对消化性溃疡穿孔患者人群中幽门螺杆菌感染率的记录来支持。
