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三级护理医院治疗胃肠道穿孔继发腹膜炎一年的经验:一项回顾性分析

One Year of Experience Managing Peritonitis Secondary to Gastrointestinal Perforation at a Tertiary Care Hospital: A Retrospective Analysis.

作者信息

Shahid Muhammad Hasaan, Khan Faisal I, Askri Zain, Asad Arslan, Alam M Azhar, Ali Danish, Saeed Rabia, Jamal Aun, Fatima Tauseef, Afzal M Farooq

机构信息

General Surgery, Lahore General Hospital, Lahore, PAK.

General Surgery, Mansoorah Teaching Hospital, Lahore, PAK.

出版信息

Cureus. 2022 Apr 8;14(4):e23966. doi: 10.7759/cureus.23966. eCollection 2022 Apr.

Abstract

Introduction Peritonitis secondary to gastrointestinal perforation causes high morbidity and mortality rates in the emergency department with an immediate need for surgical intervention. Despite improved surgical management procedures, patients are still suffering from gastrointestinal leak causing peritonitis that demands surgical management by highly skilled surgeons in high-quality surgical units. Material and methods This paper presents one year of experience in the surgical treatment of gastrointestinal perforation-related peritonitis by surgeons in Lahore General Hospital, Lahore, Pakistan. Data was retrospectively collected from patient records and quantitatively analyzed. Involved patients developed peritonitis secondary to gastrointestinal perforation requiring surgical exploration and interventions in the emergency department between November 2020 and October 2021. Results One hundred and fifty-eight patients were involved; the mean age was 43.46 years. The number of males was 87 (55.06%). The patients mostly presented with generalized abdominal pain (57.6%). All the patients had perforation-related peritonitis, which was most prevalent in the ileum (62%). The most performed surgical intervention was loop ileostomy (36.71%). Compared to other published reports, the incidence rate of wound dehiscence in the hospital was relatively higher. Postoperatively, wound infection was low if the skin was left open (23.62%) compared to closed skin (38.7%). Patient outcomes were acceptable as the death rate was low (3.2%, 5/158). Conclusion Peritonitis caused by gastrointestinal perforation is associated with a high risk of morbidity that necessitates surgical exploration. Leaving skin wound open after the surgical intervention is recommended to decrease the incidence of wound infection and dehiscence.

摘要

引言 继发于胃肠道穿孔的腹膜炎在急诊科会导致高发病率和死亡率,急需手术干预。尽管手术管理程序有所改进,但患者仍会因胃肠道渗漏引发腹膜炎,这需要经验丰富的外科医生在高质量的手术科室进行手术治疗。

材料与方法 本文介绍了巴基斯坦拉合尔拉合尔综合医院的外科医生对胃肠道穿孔相关性腹膜炎进行手术治疗的一年经验。数据从患者记录中回顾性收集并进行定量分析。纳入的患者在2020年11月至2021年10月期间因胃肠道穿孔继发腹膜炎,需要在急诊科进行手术探查和干预。

结果 共纳入158例患者;平均年龄为43.46岁。男性87例(55.06%)。患者大多表现为全腹痛(57.6%)。所有患者均患有穿孔相关性腹膜炎,最常见于回肠(62%)。最常进行的手术干预是回肠袢式造口术(36.71%)。与其他已发表的报告相比,该医院伤口裂开的发生率相对较高。术后,皮肤敞开时伤口感染率较低(23.62%),而皮肤缝合时为38.7%。患者的预后尚可,死亡率较低(3.2%,5/158)。

结论 胃肠道穿孔引起的腹膜炎发病率高,需要进行手术探查。建议手术干预后让皮肤伤口敞开,以降低伤口感染和裂开的发生率。

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本文引用的文献

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Gastrointestinal perforation and the acute abdomen.胃肠道穿孔与急腹症。
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