穿孔和出血性消化性溃疡：WSES 指南。
Perforated and bleeding peptic ulcer: WSES guidelines.
机构信息
1Emergency Surgery Department, Parma University Hospital, Parma, Italy.
2General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.
出版信息
World J Emerg Surg. 2020 Jan 7;15:3. doi: 10.1186/s13017-019-0283-9. eCollection 2020.
BACKGROUND
Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment.
METHODS
The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached.
CONCLUSIONS
The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
背景
消化性溃疡病较为常见，普通人群终生患病率为 5-10%，年发病率为 0.1-0.3%。尽管在过去 30 年中，该病的发病率和住院率及死亡率急剧下降，但在这些患者中仍有 10-20%会出现并发症。消化性溃疡病仍然是一个重大的医疗保健问题，会消耗大量的财政资源。其管理可能涉及多个专科，包括外科医生、胃肠病学家和放射科医生。成功管理复杂消化性溃疡（CPU）患者需要及时识别、必要时复苏、适当的抗生素治疗以及及时的手术/放射治疗。
方法
本指南是根据 GRADE 方法制定的。为制定这些指南，WSES 委员会设计并任命了一个专家组，负责对现有文献进行系统评价，并提供具有直接实际应用的循证声明。所有声明都在第 5 届 WSES 大会上进行了陈述和讨论，对于每个声明，WSES 专家组都达成了共识。
结论
这些指南中考虑的人群是疑似患有复杂消化性溃疡病的成年患者。本指南提供了有关复杂消化性溃疡管理的循证国际共识声明，是由专家组合作完成的，旨在提高世界各地医生对这一特定主题的认识和了解。我们将工作分为出血和穿孔性消化性溃疡两个主要主题，并将其分为六个主要主题，涵盖了从 ED 到达时的诊断到出院后的抗菌治疗整个患者管理过程，提供了一个最新的、易于使用的工具，以帮助医生和外科医生在决策过程中。
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