Seyoum Nebyou, Ethicha Daba, Assefa Zelalem, Nega Berhanu
Cardiothoracic Unit, Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia.
Ethiop J Health Sci. 2020 Jul 1;30(4):549-558. doi: 10.4314/ejhs.v30i4.10.
This study was done to identify risk factors that affect the morbidity and mortality of patients operated for a perforated peptic ulcer in a resource-limited setting.
A two years (January 1, 2016 -December 30, 2018) retrospective cross-sectional study was done on patients admitted and operated for PPU at Yekatit 12 Hospital, Addis Ababa, Ethiopia.
A total of 93 patients were operated. The median age affected was 29 years (Range 15-75 years). Male to female ratio was 7.5:1. Chewing chat, smoking and alcohol use were seen in 22 (23.6%), 35(37.6%), and 34(36.5%), cases respectively. Only 23.6% gave previous history of dyspepsia. The median duration of illness was 48hours and the duodenal to gastric ulcer perforation ratio was 6.5:1. In majority of the cases (63.3%) the perforation diameter was =10mm (63.3%). Cellan-Jones repair of the perforations was done in 92.5% of cases. A total of 47 complications were seen in 25 cases. The total complications and mortality rates were 25(26.8%) and 6(6.5%) respectively. The most common postoperative complication was pneumonia (13.97%) followed by superficial surgical site infection (10.8%). Mortality rate was highest among patients >50yrs [AOR (95%CI) =2.4(230)]. Delayed presentation of >24 hours [AOR (95%CI) =4.3(1.4-13.5)] and a SBP =90mmhg [AOR (95%CI) =4.8(1-24)] were found to be significantly related with higher complication rate.
Patients who presented early and immediate corrective measures were instituted had better outcomes while those seen late developed unfavorable out-come with significantly higher complications. Therefore, early detection and treatment of PPU is essential.
本研究旨在确定在资源有限的环境中，影响接受穿孔性消化性溃疡手术患者发病率和死亡率的危险因素。
对埃塞俄比亚亚的斯亚贝巴耶卡蒂特12医院收治并接受穿孔性消化性溃疡手术的患者进行了一项为期两年（2016年1月1日至2018年12月30日）的回顾性横断面研究。
共有93例患者接受了手术。受影响患者的中位年龄为29岁（范围15 - 75岁）。男女比例为7.5:1。分别有22例（23.6%）、35例（37.6%）和34例（36.5%）患者有咀嚼恰特草、吸烟和饮酒习惯。只有23.6%的患者有消化不良病史。中位病程为48小时，十二指肠溃疡穿孔与胃溃疡穿孔的比例为6.5:1。大多数病例（63.3%）穿孔直径≤10mm（63.3%）。92.5%的病例采用了塞兰 - 琼斯穿孔修补术。25例患者共出现47种并发症。总并发症发生率和死亡率分别为25例（26.8%）和6例（6.5%）。最常见的术后并发症是肺炎（13.97%），其次是浅表手术部位感染（10.8%）。50岁以上患者的死亡率最高[AOR（95%CI）=2.4（2 - 3.0）]。发现就诊延迟超过24小时[AOR（95%CI）=4.3（1.4 - 13.5）]和收缩压≤90mmHg[AOR（95%CI）=4.8（1 - 24）]与较高的并发症发生率显著相关。
早期就诊并立即采取纠正措施的患者预后较好，而就诊较晚的患者预后不佳，并发症明显更多。因此，早期发现和治疗穿孔性消化性溃疡至关重要。
