Dascalescu Cristina, Andriescu Lidia, Bulat C, Danila R, Dodu L, Acornicesei M, Radulescu C
Third General Surgery Unit, University of Medicine and Pharmacy Gr.T.Popa Iasi, Romania.
Hepatogastroenterology. 2006 Jul-Aug;53(70):543-6.
BACKGROUND/AIMS: In the context of actual trends towards an efficient and less aggressive therapy of peptic ulcer, it seems that Taylor's method, in selected cases of perforated gastroduodenal ulcers (PGDU), comes again into attention. The aim of this study was to present our 16 years' experience with Taylor's treatment as an efficient option for sealed perforated ulcers, and to highlight the indications and advantages of this method.
A retrospective study, and prospective since 1990, was carried out on a series of 64 patients out of 592 (10%) diagnosed with PGDU between 1987 and 2003. The patients were carefully evaluated, particularly looking for clinical, laboratory and imaging diagnosis factors, indicating potential candidates for conservative approach: short history, hydropneumoperitoneum in small amount on admission. Two thirds of the patients presented in the Emergency Unit less than 12 hours from the onset of the symptoms. The diagnosis of PGDU was established by corroborating the obvious symptoms and abdominal signs with erect chest X-ray and ultrasonography (US) of the abdomen. The efficiency of Taylor's method, consisting of nasogastric aspiration, fluids resuscitation, parenteral broad spectrum antibiotics and antisecretory drugs, was assessed by meticulous repeated physical examinations, dynamics of WBC (white blood cell) and US. In case of failure, this method remained as a part of preoperative treatment.
The method was successful in 57 out of 64 (89%) cases of perforated peptic ulcer disease, selected from the 592 cases admitted with perforated peptic ulcer following the clinical and imaging criteria previously mentioned. The presence of pneumoperitoneum certifies the diagnosis of PGDU, but the amount of peritoneal fluid assessed by US predicts the success of the procedure. Seven patients developed complications (10.9%), mainly intraabdominal abscesses and only four of them needed surgical drainage. The mortality was nil. After discharge all patients were referred to gastroenterologists for monitoring the medical treatment and no recurrence was encountered.
The Taylor's method is a reliable alternative in selected cases of perforated gastroduodenal ulcers, the main advantage being the avoidance of anesthetic and surgical stress with their potential morbidity and mortality.
背景/目的：在消化性溃疡治疗趋向高效且侵袭性更小的实际趋势背景下，在十二指肠溃疡穿孔（PGDU）的特定病例中，泰勒方法似乎再次受到关注。本研究的目的是介绍我们16年来使用泰勒治疗法治疗闭合性溃疡穿孔的经验，并强调该方法的适应症和优势。
对1987年至2003年间诊断为PGDU的592例患者中的64例（10%）进行了一项回顾性研究，自1990年起为前瞻性研究。对患者进行了仔细评估，特别寻找临床、实验室和影像学诊断因素，以确定保守治疗的潜在候选者：病史短、入院时少量气腹。三分之二的患者在症状出现后不到12小时就被送到了急诊科。通过结合明显的症状、腹部体征以及胸部立位X线和腹部超声（US）来确诊PGDU。通过细致的反复体格检查、白细胞（WBC）动态变化和超声评估由鼻胃吸引、液体复苏、肠外广谱抗生素和抑酸药物组成的泰勒方法的疗效。若治疗失败，该方法则作为术前治疗的一部分。
按照上述临床和影像学标准，从592例因消化性溃疡穿孔入院的患者中选出的64例消化性溃疡穿孔病例中，该方法在57例（89%）中取得成功。气腹的存在证实了PGDU的诊断，但通过超声评估的腹水量可预测该手术的成功与否。7例患者出现并发症（10.9%），主要是腹腔内脓肿，其中只有4例需要手术引流。死亡率为零。出院后，所有患者均被转介给胃肠病学家进行药物治疗监测，未出现复发情况。
在十二指肠溃疡穿孔的特定病例中，泰勒方法是一种可靠的替代方法，其主要优点是避免了麻醉和手术应激及其潜在的发病率和死亡率。
