Department of Surgery, JN Medical College, AMU, Aligarh, UP, 202002, India.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):81-86. doi: 10.1007/s00068-020-01597-6. Epub 2021 Feb 15.
Perforated peptic ulcer (PPU) has been associated with substantially high incidence of morbidity and mortality. The aim of this study was to analyze the factors affecting the outcome of patients having perforated peptic ulcer undergoing surgical intervention.
Medical records of 112 patients with PPU who underwent emergency laparotomy between December 2014 and November 2016 were prospectively analyzed. Primary suture of the perforation and pedicled omentoplasty was done in all the patients. Data regarding patients was collected and correlated with the postoperative outcome.
The overall postoperative morbidity and mortality were 62.5% and 30.4%, respectively. On univariate analysis advanced age (≥ 60 years) [(p = 0.005), (OR = 3.6), (95% CI = 1.5-8.8)], pre-operative shock [(p < 0.001), (OR = 7.4), (95% CI = 2.6-21.0)], delayed presentation (> 24 h) [(p = 0.007), (OR = 4.0), (95% CI = 1.5-11.2)] and raised serum creatinine [(p < 0.001), (OR = 7.7), (95% CI = 3.1-19.0)] were found to be significantly associated with the post-operative morbidity. For mortality, advanced age (≥ 60 year) [(p < 0.001), (OR = 5.02), (95% CI = 2.1-11.9)], pre-operative shock [(p < 0.001), (OR = 19.3), (95% CI = 6.9-53.6)], comorbidity [(p = 0.03), (OR = 6.6), (95% CI = 1.2-35.7)] and raised serum creatinine [(p < 0.001), (OR = 13.1), (95% CI = 4.5-37.8)] were statistically significant factors. Multivariate analysis showed advanced age (≥ 60 years) (p = 0.05) and raised serum creatinine (p = 0.004) as significant factors for increased risk of post-operative morbidity. Advanced age (≥ 60 years), pre-operative shock and raised serum creatinine were found to be independent risk factors influencing post-operative mortality (p < 0.05).
A thorough clinical evaluation, adequate resuscitation, sepsis control, addressing comorbidities and early access to hospital can reduce the risk morbidity and mortality in patients with PPU.
穿孔性消化性溃疡（PPU）与发病率和死亡率的显著升高有关。本研究的目的是分析影响接受手术干预的穿孔性消化性溃疡患者结局的因素。
对 2014 年 12 月至 2016 年 11 月期间接受急诊剖腹手术的 112 例 PPU 患者的病历进行前瞻性分析。所有患者均行穿孔的一期缝合和带蒂大网膜覆盖术。收集患者的数据并与术后结果相关联。
总的术后发病率和死亡率分别为 62.5%和 30.4%。单因素分析显示，年龄较大（≥60 岁）（p=0.005）（OR=3.6）（95%CI=1.5-8.8）、术前休克（p<0.001）（OR=7.4）（95%CI=2.6-21.0）、延迟就诊（>24 小时）（p=0.007）（OR=4.0）（95%CI=1.5-11.2）和血清肌酐升高（p<0.001）（OR=7.7）（95%CI=3.1-19.0）与术后发病率显著相关。对于死亡率，年龄较大（≥60 岁）（p<0.001）（OR=5.02）（95%CI=2.1-11.9）、术前休克（p<0.001）（OR=19.3）（95%CI=6.9-53.6）、合并症（p=0.03）（OR=6.6）（95%CI=1.2-35.7）和血清肌酐升高（p<0.001）（OR=13.1）（95%CI=4.5-37.8）是统计学上显著的因素。多因素分析显示，年龄较大（≥60 岁）（p=0.05）和血清肌酐升高（p=0.004）是术后发病率增加的显著因素。年龄较大（≥60 岁）、术前休克和血清肌酐升高是影响术后死亡率的独立危险因素（p<0.05）。
彻底的临床评估、充分的复苏、控制脓毒症、处理合并症和尽早入院可以降低 PPU 患者的发病率和死亡率。
