Khripun A I, Alimov A N, Asratyan S A, Sazhin I V, Churkin A A
Pirogov Russian National Research Medical University, Moscow, Russia.
Buyanov Municipal Clinical Hospital, Moscow, Russia.
Khirurgiia (Mosk). 2020(12):22-26. doi: 10.17116/hirurgia202012122.
To study the outcomes of fast-track recovery in patients with perforated duodenal ulcer (PDU).
There were 138 patients with PDU who underwent surgical treatment for the period from January 1, 2015 to December 31, 2019. Patients were divided into 3 groups: main group, control group 1 (CG-1) and control group 2 (CG-2). The main group (fast-track group, FT-group) included 51 patients who underwent laparoscopic suturing of PDU followed by enhanced recovery (fast-track). CG-1 comprised 44 patients who underwent open suturing of PDU and conventional perioperative treatment. CG-2 consisted of 43 patients who underwent laparoscopic suturing and conventional perioperative treatment. Complications were assessed using Clavien-Dindo grading system.
In the FT group, postoperative complications were observed in 2 patients (3.92%). Anemia of mixed genesis (Clavien-Dindo grade II) was diagnosed in 1 patient and left-sided lower lobe pneumonia in another one (grade II). There were no deaths. Mean length of hospital-stay was 3.86 days. In the 1 control group, the largest number of complications was observed (=12, 27.27%) including 9 extra-abdominal complications (pulmonary disorders (II) - 7 patients (15.9%); sepsis (IVB) - 1 (2.27%), delirium (IVA) - 1 patient (2.27%), postoperative wound seroma (IIIA) - 1 (2.27%) patient). Intra-abdominal complications consisted of compensated pyloroduodenal stenosis (II) in 1 (2.27%) case, recurrent bleeding from acute gastric and duodenal ulcers (IIIB) in 1 (2.27%) patient. Mortality rate was 4.54% (=2) in this group (progressive multiple organ failure). Mean length of hospital-stay was 7.56 days. In the 2 control group, postoperative complications included extra-abdominal (pulmonary disorders (II) - pneumonia in 4 (9.3%) cases, spontaneous pneumothorax (IIIA) in 1 (2.32%) case) and intra-abdominal events (duodenitis (II) in 1 (2.32%) patient and compensated pyloroduodenal stenosis (II) in another 1 (2.32%) patient). There were no lethal outcomes in this group. Mean length of hospital-stay was 6.7 days.
Treatment outcomes in patients with perforated duodenal ulcer confirmed an effectiveness of laparoscopic suturing and complete abdominal sanitation. These measures create the prerequisites for fast track recovery in urgent surgical practice. FT-protocol of inpatient management is followed by reduced hospital-stay and less incidence of postoperative complications. Moreover, this approach promotes early and safe discharge of patients.
研究十二指肠溃疡穿孔（PDU）患者的快速康复结局。
选取2015年1月1日至2019年12月31日期间接受手术治疗的138例PDU患者。患者分为3组：主要组、对照组1（CG - 1）和对照组2（CG - 2）。主要组（快速康复组，FT组）包括51例行PDU腹腔镜缝合术并进行强化康复（快速康复）的患者。CG - 1组由44例行PDU开放缝合术及传统围手术期治疗的患者组成。CG - 2组由43例行腹腔镜缝合术及传统围手术期治疗的患者组成。采用Clavien - Dindo分级系统评估并发症。
FT组有2例患者（3.92%）出现术后并发症。1例患者被诊断为混合性贫血（Clavien - Dindo II级），另1例为左下叶肺炎（II级）。无死亡病例。平均住院时间为3.86天。在第1对照组中，观察到的并发症数量最多（=12例，27.27%），包括9例腹部外并发症（肺部疾病（II级） - 7例患者（15.9%）；脓毒症（IVB级） - 1例（2.27%），谵妄（IVA级） - 1例患者（2.27%），术后伤口血清肿（IIIA级） - 1例（2.27%）患者）。腹部内并发症包括1例（2.27%）代偿性幽门十二指肠狭窄（II级），1例（2.27%）患者急性胃和十二指肠溃疡复发出血（IIIB级）。该组死亡率为4.54%（=2例）（进行性多器官功能衰竭）。平均住院时间为7.56天。在第2对照组中，术后并发症包括腹部外（肺部疾病（II级） - 4例（9.3%）肺炎，1例（2.32%）自发性气胸（IIIA级））和腹部内事件（1例（2.32%）患者十二指肠炎症（II级）和另1例（2.32%）患者代偿性幽门十二指肠狭窄（II级））。该组无致死病例。平均住院时间为6.7天。
十二指肠溃疡穿孔患者的治疗结局证实了腹腔镜缝合术及彻底的腹腔清洁的有效性。这些措施为紧急外科手术实践中的快速康复创造了前提条件。遵循FT住院管理方案可缩短住院时间并降低术后并发症发生率。此外，这种方法有助于患者早期安全出院。
