Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Int J Surg. 2015 Feb;14:38-44. doi: 10.1016/j.ijsu.2014.12.022. Epub 2015 Jan 2.
Emergency surgery for perforated peptic ulcer (PPU) is associated with significant morbidity and mortality. Accurate and early risk stratification is important. The primary aim of this study is to validate the various existing MRPMs and secondary aim is to audit our experience of managing PPU.
332 patients who underwent emergency surgery for PPU at a single intuition from January 2008 to December 2012 were studied. Clinical and operative details were collected. Four MRPMs: American Society of Anesthesiology (ASA) score, Boey's score, Mannheim peritonitis index (MPI) and Peptic ulcer perforation (PULP) score were validated.
Median age was 54.7 years (range 17-109 years) with male predominance (82.5%). 61.7% presented within 24 h of onset of abdominal pain. Median length of stay was 7 days (range 2-137 days). Intra-abdominal collection, leakage, re-operation and 30-day mortality rates were 8.1%, 2.1%, 1.2% and 7.2% respectively. All the four MRPMs predicted intra-abdominal collection and mortality; however, only MPI predicted leak (p = 0.01) and re-operation (p = 0.02) rates. The area under curve for predicting mortality was 75%, 72%, 77.2% and 75% for ASA score, Boey's score, MPI and PULP score respectively.
Emergency surgery for PPU has low morbidity and mortality in our experience. MPI is the only scoring system which predicts all - intra-abdominal collection, leak, reoperation and mortality. All four MRPMs had a similar and fair accuracy to predict mortality, however due to geographic and demographic diversity and inherent weaknesses of exiting MRPMs, quest for development of an ideal model should continue.
穿孔性消化性溃疡（PPU）的急诊手术与较高的发病率和死亡率相关。准确且早期的风险分层很重要。本研究的主要目的是验证各种现有的 MRPM，并次要目的是审核我们对 PPU 的管理经验。
研究了 2008 年 1 月至 2012 年 12 月期间在一家医院接受 PPU 急诊手术的 332 名患者。收集了临床和手术细节。对四种 MRPM 进行了验证：美国麻醉医师协会（ASA）评分、Boey 评分、曼海姆腹膜炎指数（MPI）和消化性溃疡穿孔（PULP）评分。
中位年龄为 54.7 岁（范围 17-109 岁），男性居多（82.5%）。61.7%的患者在腹痛发作后 24 小时内就诊。中位住院时间为 7 天（范围 2-137 天）。腹腔内积液、漏液、再次手术和 30 天死亡率分别为 8.1%、2.1%、1.2%和 7.2%。所有四种 MRPM 均预测了腹腔内积液和死亡率；然而，只有 MPI 预测了漏液（p=0.01）和再次手术（p=0.02）的发生率。预测死亡率的曲线下面积分别为 ASA 评分、Boey 评分、MPI 和 PULP 评分的 75%、72%、77.2%和 75%。
在我们的经验中，PPU 的急诊手术发病率和死亡率较低。MPI 是唯一可预测所有指标（腹腔内积液、漏液、再次手术和死亡率）的评分系统。所有四种 MRPM 预测死亡率的准确性相当，但由于地理和人口统计学的多样性以及现有 MRPM 的固有弱点，应该继续寻求开发理想的模型。
