Institute for Surgical Advancement, Florida Hospital Orlando, 2415 N Orange Ave, #400, Orlando, FL, 32804, USA.
University of Central Florida College of Medicine, Orlando, FL, USA.
Surg Endosc. 2018 Jan;32(1):400-404. doi: 10.1007/s00464-017-5695-6. Epub 2017 Jun 29.
There are no guidelines on the routine or selective use of contrast upper gastrointestinal series (UGI) after omental patch repair (OPR) of a gastric (GP) or duodenal perforation (DP). This study aims to elucidate whether the use of selective versus routine contrast study will lead to worse clinical outcomes.
A retrospective analysis of 115 (n = 115) patients with OPR of GP or DP was performed. Data were obtained from seven Florida Hospital campuses. Patients aged 18 and older from 2006 to 2016 were identified by ICD9 billing information. Patients were divided into two groups: UGI and no UGI. The UGI group was subdivided into selective versus routine. A selective UGI was defined as one or more of the following after post-operative day 3: WBC >12,000, peritonitis, fever >100.4 F, tachycardia >110 bpm on three or more assessments, and any UGI performed after POD 7. Perioperative symptoms, perforation location, size, abdominal contamination, laparoscopic or open, leak detection, length of stay, mortality, and reoperation within 2 weeks were also examined.
No differences between the UGI group and non-UGI group relating to preoperative symptoms, leak detection, death, and reoperation rate were revealed. Differences in length of stay were found to be statistically significant with the UGI group and non-UGI at a median of 15.5 and 8 days, respectively. In the UGI subgroup, 20 of the 29 patients received selective studies. There were no statistical differences identified in leak detection, death, and reoperation.
Rates of leak detection, reoperation, and death in patients with GP or DP repaired with omental patch utilizing an UGI study were not statistically significant. An increased length of stay was observed within the UGI group. There was no advantage demonstrated between a selective versus routine UGI; therefore, the use of selective UGI should be based upon clinical indications.
胃（GP）或十二指肠穿孔（DP）修补术后常规或选择性使用对比上消化道系列（UGI）检查尚无指南。本研究旨在阐明使用选择性对比检查与常规对比检查是否会导致更差的临床结果。
对 115 例（n=115）胃或十二指肠穿孔修补术后网膜补丁修复（OPR）的患者进行回顾性分析。数据来自佛罗里达医院的七个院区。通过 ICD9 计费信息确定 2006 年至 2016 年间年龄在 18 岁及以上的患者。将患者分为 UGI 组和非 UGI 组。UGI 组进一步分为选择性 UGI 组和常规 UGI 组。术后第 3 天出现以下任何一种情况的患者被定义为行选择性 UGI：白细胞计数>12,000/mm³、腹膜炎、体温>100.4°F、三次或多次评估时心动过速>110 bpm、以及术后第 7 天以后进行的任何 UGI。还检查了围手术期症状、穿孔位置、大小、腹部污染、腹腔镜或开放、漏诊、住院时间、死亡率以及术后 2 周内的再次手术。
UGI 组与非 UGI 组在术前症状、漏诊、死亡和再手术率方面没有差异。UGI 组和非 UGI 组的住院时间中位数分别为 15.5 天和 8 天，差异有统计学意义。在 UGI 亚组中，29 例患者中有 20 例接受了选择性检查。在漏诊、死亡和再手术方面没有发现统计学差异。
GP 或 DP 修补术后行 UGI 检查的患者漏诊率、再手术率和死亡率无统计学意义。UGI 组的住院时间延长。选择性 UGI 与常规 UGI 之间没有显示出优势；因此，选择性 UGI 的使用应基于临床指征。
