Schuster Kevin M, Feuer William J, Barquist Erik S
Division of Trauma, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, USA.
J Gastrointest Surg. 2007 Nov;11(11):1560-3. doi: 10.1007/s11605-007-0257-1. Epub 2007 Aug 15.
Crack cocaine has been associated with acute gastric perforation. The appropriate surgical treatment and long-term outcomes remain unclear. A retrospective chart review of all gastroduodenal perforations associated with crack cocaine use was performed. Data abstracted included details of short- and long-term outcomes. Kaplan-Meier methods were used to evaluate surgical outcomes. Over the 14-year period ending December 2005, 16 cases of crack-induced gastric perforations were identified. Most (75%) were treated with an omental patch. The other patients underwent a formal antiulcer operation, including one vagotomy and pyloroplasty (V&P), one vagotomy and antrectomy, one subtotal gastrectomy, and one ulcer excision and V&P. All patients after antiulcer procedures were followed for a median of 63 months (range 27-120) with no recurrences. Follow-up data were available in 75% of the omental patch patients. Recurrence of disease was observed in 56% of these omental patch patients at a median of 20 months (range 11-39). Those without recurrence were followed for a median of 67 months (range 12-96). The recurrence rate was borderline lower in the antiulcer group (P = 0.072). Omental patch closure results in a recurrence rate over 50% compared with no recurrence for formal antiulcer procedures.
快克可卡因与急性胃穿孔有关。适当的手术治疗及长期预后仍不明确。我们对所有与快克可卡因使用相关的胃十二指肠穿孔病例进行了回顾性图表分析。提取的数据包括短期和长期预后的详细信息。采用Kaplan-Meier方法评估手术结果。在截至2005年12月的14年期间，共识别出16例由快克可卡因导致的胃穿孔病例。大多数病例（75%）采用网膜修补术治疗。其他患者接受了正规的抗溃疡手术，包括1例迷走神经切断术和幽门成形术（V&P）、1例迷走神经切断术和胃窦切除术、1例胃大部切除术以及1例溃疡切除术和V&P。所有接受抗溃疡手术的患者术后中位随访63个月（范围27 - 120个月），无复发。75%接受网膜修补术的患者有随访数据。这些接受网膜修补术的患者中，56%在中位时间20个月（范围11 - 39个月）出现疾病复发。未复发的患者中位随访时间为67个月（范围12 - 96个月）。抗溃疡手术组的复发率略低（P = 0.072）。与正规抗溃疡手术无复发相比，网膜修补术的复发率超过50%。
