Jaka Hyasinta, Mchembe Mabula D, Rambau Peter F, Chalya Phillipo L
Department of Surgery, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania.
BMC Surg. 2013 Sep 25;13:41. doi: 10.1186/1471-2482-13-41.
Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. There is a paucity of published data on this subject in our setting. This study was undertaken to highlight the etiological spectrum and treatment outcome of gastric outlet obstruction in our setting and to identify prognostic factors for morbidity and mortality.
This was a descriptive prospective study which was conducted at Bugando Medical Centre between March 2009 and February 2013. All patients with a clinical diagnosis of gastric outlet obstruction were, after informed consent for the study, consecutively enrolled into the study. Statistical data analysis was done using SPSS computer software version 17.0.
A total of 184 patients were studied. More than two-third of patients were males. Patients with malignant gastric outlet obstruction were older than those of benign type. This difference was statistically significant (p < 0.001). Gastric cancer was the commonest malignant cause of gastric outlet obstruction where as peptic ulcer disease was the commonest benign cause. In children, the commonest cause of gastric outlet obstruction was congenital pyloric stenosis (13.0%). Non-bilious vomiting (100%) and weight loss (93.5%) were the most frequent symptoms. Eighteen (9.8%) patients were HIV positive with the median CD 4+ count of 282 cells/μl. A total of 168 (91.3%) patients underwent surgery. Of these, gastro-jejunostomy (61.9%) was the most common surgical procedure performed. The complication rate was 32.1 % mainly surgical site infections (38.2%). The median hospital stay and mortality rate were 14 days and 18.5% respectively. The presence of postoperative complication was the main predictor of hospital stay (p = 0.002), whereas the age > 60 years, co-existing medical illness, malignant cause, HIV positivity, low CD 4 count (<200 cells/μl), high ASA class and presence of surgical site infection significantly predicted mortality ( p< 0.001). The follow up of patients was generally poor as more than 60% of patients were lost to follow up.
Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant. The majority of patients present late with poor general condition. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided.
胃出口梗阻给在资源有限国家执业的普通外科医生带来了诊断和治疗方面的挑战。在我们的环境中，关于这个主题的已发表数据很少。本研究旨在突出我们环境中胃出口梗阻的病因谱和治疗结果，并确定发病率和死亡率的预后因素。
这是一项描述性前瞻性研究，于2009年3月至2013年2月在布甘多医疗中心进行。所有临床诊断为胃出口梗阻的患者，在获得研究知情同意后，连续纳入研究。使用SPSS计算机软件版本17.0进行统计数据分析。
共研究了184例患者。超过三分之二的患者为男性。恶性胃出口梗阻患者比良性患者年龄大。这种差异具有统计学意义（p < 0.001）。胃癌是胃出口梗阻最常见的恶性原因，而消化性溃疡病是最常见的良性原因。在儿童中，胃出口梗阻最常见的原因是先天性幽门狭窄（13.0%）。非胆汁性呕吐（100%）和体重减轻（93.5%）是最常见的症状。18例（9.8%）患者HIV阳性，CD4 +细胞计数中位数为282个/μl。共有168例（91.3%）患者接受了手术。其中，胃空肠吻合术（61.9%）是最常见的手术方式。并发症发生率为32.1%，主要是手术部位感染（38.2%）。中位住院时间和死亡率分别为14天和18.5%。术后并发症的存在是住院时间的主要预测因素（p = 0.002），而年龄>60岁、并存内科疾病、恶性病因、HIV阳性、低CD4计数（<200个/μl）、高ASA分级和手术部位感染的存在显著预测死亡率（p<0.001）。患者的随访情况普遍较差，超过60%的患者失访。
在我们的环境中，胃出口梗阻在男性中更为普遍，病因大多为恶性。大多数患者就诊时病情较晚且全身状况较差。如果要避免与胃出口梗阻相关的发病率和死亡率，早期识别诊断、积极复苏和早期进行手术治疗至关重要。
