Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Sur Hospital, Ministry of Health, Muscat, Oman.
World J Emerg Surg. 2022 May 24;17(1):24. doi: 10.1186/s13017-022-00429-9.
Peptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.
This is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management.
One hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1-2) days in EG, while in SG was 7 (range 6-8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively).
Combined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.
消化性溃疡穿孔是一种常见的危及生命的外科急症。Graham 大网膜补丁用于堵塞穿孔性消化性溃疡。许多内镜方法已被用于治疗急性穿孔性消化性溃疡，如内镜下夹闭、标准内镜夹闭、内镜缝合和金属支架。内镜治疗急性穿孔性消化性溃疡的主要思想是通过介入放射引流早期清除污染和减少脓毒症。
这是一项前瞻性随机对照临床试验。本研究纳入 2019 年 12 月至 2021 年 8 月期间我院收治的急性穿孔性消化性溃疡表现的患者。样本量为 100 例患者，分为两组。内镜组（EG）：包括 50 例接受内镜治疗的患者。手术组（SG）：包括 50 例接受手术治疗的患者。
100 例患者随机分为两组：SG（50 例）和 EG（50 例）。SG 和 EG 患者的中位年龄分别为 36 岁（范围 27：54）和 47 岁（范围 41：50）。男性分别占 SG 和 EG 的 72%和 66%。EG 患者的术后住院时间中位数为 1 天（范围：1-2 天），而 SG 为 7 天（范围 6-8 天）。SG 患者的术后并发症发生率为 58%，表现为发热、肺炎、漏、腹腔脓肿、肾衰竭和切口疝（11%、5%、5%、3%、2%和 3%）。EG 患者的术后并发症发生率为 24%，表现为发热、肺炎、漏、腹腔脓肿、肾衰竭和切口疝（10%、0%、2%、0%、0%和 0%）。
联合内镜和介入放射引流可有效治疗急性穿孔性消化性溃疡，无需全身麻醉，手术时间短，适用于高危手术患者，发病率和死亡率低。
