Department of Surgery, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania.
Department of Internal Medicine, Weill-Bugando University College of Health Sciences, Mwanza, Tanzania.
World J Emerg Surg. 2011 Aug 26;6:31. doi: 10.1186/1749-7922-6-31.
Perforated peptic ulcer is a serious complication of peptic ulcers with potential risk of grave complications. There is paucity of published reports on perforated peptic ulcer disease in our local environment. This study was conducted to evaluate the clinical presentation, management and outcome of patients with peptic ulcer perforation in our setting and to identify predictors of outcome of these patients.
This was a combined retrospective and prospective study of patients who were operated for perforated peptic ulcers at Bugando Medical Centre between April 2006 and March 2011. Data were collected using a pre-tested and coded questionnaire and analyzed using SPSS computer software version 15.0. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study.
A total of 84 patients were studied. Males outnumbered females by a ratio of 1.3: 1. Their median age was 28 years and the modal age group was 21-30 years. The median duration of illness was 5.8 days. The majority of patients (69.0%) had no previous history of treatment for peptic ulcer disease. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking was reported in 10.7%, 85.7% and 64.3% respectively. Eight (9.5%) patients were HIV positive with a median CD4 count of 220 cells/μl. Most perforations were located on the duodenum {90.4%) with the duodenal to gastric ulcers ratio of 12.7: 1. Graham's omental patch (Graham's omentopexy) of the perforations was performed in 83.3% of cases. Complication and mortality rates were 29.8% and 10.7% respectively. The factors significantly related to complications were premorbid illness, HIV status, CD 4 count < 200 cells/μl, treatment delay and acute perforation (P < 0.001). Mortality rate was high in patients who had age ≥ 40 years, delayed presentation (>24 hrs), shock at admission (systolic BP < 90 mmHg), HIV positivity, low CD4 count (<200 cells/μl), gastric ulcers, concomitant diseases and presence of complications (P < 0.001). The median overall length of hospital stay was 14 days. Excellent results using Visick's grading system were obtained in 82.6% of surviving patients.
Perforation of peptic ulcer remains a frequent clinical problem in our environment predominantly affecting young males not known to suffer from PUD. Simple closure with omental patch followed by Helicobacter pylori eradication was effective with excellent results in majority of survivors despite patients' late presentation in our center.
消化性溃疡穿孔是消化性溃疡的严重并发症，可能导致严重的并发症。在我们当地环境中，关于消化性溃疡穿孔的报道很少。本研究旨在评估我们环境中消化性溃疡穿孔患者的临床表现、治疗方法和预后，并确定这些患者预后的预测因素。
这是一项对 2006 年 4 月至 2011 年 3 月在布甘达医疗中心接受消化性溃疡穿孔手术的患者进行的回顾性和前瞻性研究。使用经过预测试和编码的问卷收集数据，并使用 SPSS 计算机软件版本 15.0 进行分析。在研究开始前，已获得相关当局的研究伦理批准。
共研究了 84 名患者。男性患者人数多于女性，比例为 1.3:1。他们的中位年龄为 28 岁，模态年龄组为 21-30 岁。中位病程为 5.8 天。大多数患者（69.0%）没有消化性溃疡病治疗的既往史。分别有 10.7%、85.7%和 64.3%的患者报告使用非甾体抗炎药、酒精和吸烟。8 名（9.5%）患者 HIV 阳性，中位 CD4 计数为 220 个细胞/μl。大多数穿孔位于十二指肠{90.4%），十二指肠溃疡与胃溃疡的比例为 12.7:1。83.3%的病例采用 Graham's 网膜补丁（Graham's omentopexy）修补穿孔。并发症和死亡率分别为 29.8%和 10.7%。与并发症相关的因素有：合并症、HIV 状态、CD4 计数<200 个细胞/μl、治疗延迟和急性穿孔（P<0.001）。年龄≥40 岁、就诊延迟（>24 小时）、入院时休克（收缩压<90mmHg）、HIV 阳性、CD4 计数低（<200 个细胞/μl）、胃溃疡、合并症和并发症的患者死亡率较高（P<0.001）。患者的中位总住院时间为 14 天。采用 Visick 分级系统，82.6%的存活患者获得了良好的效果。
消化性溃疡穿孔在我们的环境中仍然是一个常见的临床问题，主要影响年轻男性，这些患者并不患有 PUD。尽管我们中心的患者就诊较晚，但大多数患者仍采用简单的网膜补丁闭合联合幽门螺杆菌根除治疗，效果良好，预后极佳。
