Hamby L S, Zweng T N, Strodel W E
Division of General Surgery, University of Kentucky Medical Center, Lexington.
Am Surg. 1993 May;59(5):319-23; discussion 323-4.
A review of patients treated operatively for perforated ulcer was undertaken to determine factors that independently predict mortality and morbidity. From 1980 to 1989 84 patients were treated with operative mortality and morbidity rates of 18 and 37 per cent, respectively. Patients with gastric ulcer were significantly older and were more likely to have concomitant medical problems, to use steroids, and be hospitalized at time of their perforation. They also had a higher perioperative mortality rate when compared to patients with gastroduodenal ulcers (P < 0.05 for each). Patients treated with definitive operation (n = 51) had a significantly lower recurrent ulcer rate when compared to an equivalent group treated with simple closure (n = 33) (mean follow-up, 47 months). Multivariate analysis confirmed a patient's likelihood of complication or death could be predicted using three variables (P < 0.03); age greater than 42 years, hospitalization at time of perforation, concomitant medical illness. While the relative distribution of these three factors in patients with gastric versus peptic ulcers appears to account for the difference in outcome between these two groups, the distribution of these factors between patients treated with patch closure and definitive operation was not significantly different. Patient outcome from operation for perforated ulcer is dependent on preoperative conditions and appears to be independent of surgical procedure performed. There was no benefit to simple closure of a perforated ulcer. Definitive procedures of perforated ulcers are associated with lower ulcer recurrence and therefore are advocated to treat perforation.
对接受手术治疗的穿孔性溃疡患者进行了一项回顾性研究，以确定独立预测死亡率和发病率的因素。1980年至1989年期间，84例患者接受了手术治疗，手术死亡率和发病率分别为18%和37%。胃溃疡患者年龄明显更大，更有可能伴有其他疾病、使用类固醇药物，且在穿孔时住院。与胃十二指肠溃疡患者相比，他们的围手术期死亡率也更高（每项P<0.05）。与接受单纯缝合的同等组（n = 33）相比，接受确定性手术（n = 51）的患者复发性溃疡率明显更低（平均随访47个月）。多变量分析证实，使用三个变量可以预测患者发生并发症或死亡的可能性（P<0.03）；年龄大于42岁、穿孔时住院、伴有其他疾病。虽然这三个因素在胃溃疡和消化性溃疡患者中的相对分布似乎解释了这两组患者预后的差异，但接受补片缝合和确定性手术的患者之间这些因素的分布没有显著差异。穿孔性溃疡手术患者的预后取决于术前状况，似乎与所施行的手术方式无关。单纯缝合穿孔性溃疡没有益处。穿孔性溃疡的确定性手术与较低的溃疡复发率相关，因此提倡用于治疗穿孔。
