Berne T V, Donovan A J
Department of Surgery, University of Southern California School of Medicine, Los Angeles 90033.
Arch Surg. 1989 Jul;124(7):830-2. doi: 10.1001/archsurg.1989.01410070084017.
This report concerns 35 adult patients in whom perforation of a duodenal or prepyloric ulcer was treated nonoperatively between July 1979 and April 1988 at the Los Angeles County--University of Southern California Medical Center, Los Angeles. Each patient had pneumoperitoneum with clinical evidence of peritonitis, and a gastroduodenogram documented a sealed perforation. The ulcer was believed to be acute in 27 patients and chronic in 8. These 35 cases represent 12% of 294 cases of duodenal and prepyloric peptic ulcers with perforation treated during the same period. An intra-abdominal abscess developed in 1 of the 35 patients. Reperforation did not occur. The mortality rate for the 259 cases treated operatively during this period was 6.2%; the mortality rate of the 35 cases treated nonoperatively was 3%. Duodenal ulcer can be safely treated nonoperatively when a gastroduodenogram documents self-sealing.
本报告涉及1979年7月至1988年4月间在洛杉矶南加州大学洛杉矶县医疗中心接受非手术治疗的35例十二指肠或幽门管溃疡穿孔的成年患者。每位患者均有气腹及腹膜炎的临床证据，胃十二指肠造影显示穿孔已封闭。27例患者的溃疡被认为是急性的，8例为慢性的。这35例占同期治疗的294例十二指肠和幽门管消化性溃疡穿孔病例的12%。35例患者中有1例发生腹腔内脓肿。未发生再穿孔。同期接受手术治疗的259例患者的死亡率为6.2%；35例非手术治疗患者的死亡率为3%。当胃十二指肠造影显示溃疡已自行封闭时，十二指肠溃疡可安全地进行非手术治疗。
