Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan.
Surg Today. 2021 Sep;51(9):1446-1455. doi: 10.1007/s00595-021-02247-z. Epub 2021 Feb 20.
The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.
This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).
All patients initially received either conservative therapy (n = 7) or surgery (n = 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II-V (n = 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0-I (n = 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.
Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.
上消化道穿孔仍然存在较高的并发症发生率和死亡率。本研究旨在评估该疾病的最佳治疗方法及治疗后并发症。
这是一项回顾性单中心研究，时间为 2010 年至 2019 年。我们分析了 50 例因消化性溃疡（44 例）或癌症（6 例）导致腹腔游离气体的患者。
所有患者最初均接受保守治疗（n=7）或手术治疗（n=43）。非手术治愈患者明显更年轻，腹膜炎较轻，住院时间也较短。2 例患者因症状加重而转为手术治疗，其中 1 例为老年患者，穿孔至治疗时间较长。术后并发症方面，Grade II-V 级（n=21）患者明显较年长，身体状况较差，穿孔至手术时间较长，术前 CRP 和乳酸水平较高，而 Grade 0-I 级（n=24）患者则相反。多变量分析发现术前乳酸升高是术后并发症的独立危险因素。非手术治疗的进展期胃癌穿孔患者均在术后 1 年内死亡。
对于老年和延迟治疗的患者，应考虑非手术适应证，对于术前乳酸水平升高的患者，应关注其术后结局。
