Di Quinzio C, Phang P T
Department of Surgery, University of British Columbia, Vancouver.
Can J Surg. 1992 Feb;35(1):94-7.
The authors compared the outcome in 40 high-risk patients who had a perforated benign gastric ulcer with respect to management by omental patch closure (OPC) or partial gastrectomy (PG). The patients were considered to be at high risk because of the presence of one or more of the following factors: age more than 70 years; initial hypotension; delay from presentation to operation of more than 12 hours; and significant premorbid illness. OPC was performed in 22 patients and PG in 10; the other 8 patients were initially managed nonoperatively (NonOp). Death rates were 40% overall--36% for patients in the OPC group, 30% for those in the PG group and 63% for those in the NonOp group. The hospital stay was more than 12 days for 57% of the OPC group, 86% of the PG group and 67% of the NonOp group. Sixty-eight percent of patients in the OPC group, 90% in the PG group and 89% in the NonOp group had complications. There was no significant difference in death rates between those treated with OPC and PG. There was a trend to lower death rates in patients over 70 years of age who underwent PG (1 of 6) compared with those who underwent OPC (7 of 12). The authors concluded that partial gastrectomy, a definitive surgical treatment for gastric ulcer disease, is not contraindicated in high-risk patients who have a perforated benign gastric ulcer.
作者比较了40例高危良性胃溃疡穿孔患者采用网膜修补术（OPC）或胃部分切除术（PG）的治疗结果。由于存在以下一个或多个因素，这些患者被视为高危患者：年龄超过70岁；初始低血压；从就诊到手术延迟超过12小时；以及有严重的基础疾病。22例患者接受了OPC，10例接受了PG；另外8例患者最初采用非手术治疗（NonOp）。总体死亡率为40%——OPC组患者为36%，PG组为30%，NonOp组为63%。OPC组57%的患者住院时间超过12天，PG组为86%，NonOp组为67%。OPC组68%的患者、PG组90%的患者和NonOp组89%的患者出现并发症。OPC和PG治疗患者的死亡率没有显著差异。70岁以上接受PG治疗的患者（6例中的1例）与接受OPC治疗的患者（12例中的7例）相比，有死亡率降低的趋势。作者得出结论，胃部分切除术作为胃溃疡疾病的一种确定性手术治疗方法，对于有良性胃溃疡穿孔的高危患者并非禁忌。
