Rabinovici R, Manny J
Department of Surgery A, Hadassah University Hospital, Jerusalem, Israel.
Eur J Surg. 1991 Feb;157(2):121-5.
In a 10-year retrospective review of 41 patients aged greater than or equal to 65 years and treated for perforated duodenal ulcer, an attempt was made to characterize the clinical and laboratory profile and evaluate treatment policy for this surgical emergency in the elderly. In 1/3 of the series no accurate history was obtainable. Peroperative findings were sometimes discordant with laboratory data. Vagotomy and drainage were performed in ten low-risk patients and simple closure with omentopexy in 26. Conservative treatment was employed in four patients, three of whom recovered while one later required closure. Gastroenterostomy was performed in one case. A patient with severe mesenteric thrombosis had no perforation-related surgery. Vagotomy and drainage were associated with significantly fewer complications and shorter hospital stay than simple closure, no mortality (vs. 8%) in closure) and only one recurrence during follow-up averaging 37 months. This small, non-randomized series does not permit conclusive recommendations, but the data advocate definitive surgery in properly selected cases and stress the importance of associated pathology for decisions on treatment.
在一项对41例年龄大于或等于65岁且接受过十二指肠溃疡穿孔治疗的患者进行的10年回顾性研究中，我们试图描述其临床和实验室特征，并评估针对老年人这种外科急症的治疗策略。在该系列的1/3病例中，无法获得准确的病史。术中发现有时与实验室数据不一致。10例低风险患者接受了迷走神经切断术和引流术，26例患者接受了单纯缝合加网膜固定术。4例患者采用了保守治疗，其中3例康复，1例后来需要缝合。1例患者进行了胃肠造口术。1例患有严重肠系膜血栓形成的患者未接受与穿孔相关的手术。与单纯缝合相比，迷走神经切断术和引流术的并发症明显更少，住院时间更短，无死亡病例（单纯缝合的死亡率为8%），且在平均37个月的随访期间仅1例复发。这个小型的、非随机的系列研究不允许得出确定性的建议，但数据支持在适当选择的病例中进行确定性手术，并强调相关病理学对于治疗决策的重要性。
