Abbasakoor F, Attwood S E, McGrath J P, Stephens R B
St. James's Hospital, Dublin, Ireland.
Ir Med J. 1995 Nov-Dec;88(6):207-10.
There is controversy over the optimum treatment of perforated peptic ulcer. Non-operative management is associated with a high incidence of subsequent operation while immediate definitive surgery is associated with a high initial peri-operative mortality. We have a policy of simple closure and follow up H2-receptor antagonists. This study reviews 100 consecutive patients to identify immediate survival and subsequent symptomatic results of this surgical policy. The mean age was 49 years with 24 patients over 70 years. Sixteen were taking H2-receptor antagonists and 20 taking non-steroidal anti-inflammatory drugs on admission. Simple closure was performed in 94 and six had definitive surgery as their first procedure. The 30 day mortality was 6% (1% for < 70 yrs n = 76, 20% for > 70 yrs n = 24). Complete follow up was achieved in 90%, (range 2-80 months). Seventy-four percent were asymptomatic, 13% intermittently symptomatic and 7% had continuous symptoms. Only five patients (6%) required subsequent definitive surgery. The policy of simple closure and follow up H2 receptor antagonists for perforated peptic ulcer is safe and effective in the long term.
对于穿孔性消化性溃疡的最佳治疗方法存在争议。非手术治疗与后续手术的高发生率相关，而立即进行确定性手术则与较高的初始围手术期死亡率相关。我们采用简单缝合并后续使用H2受体拮抗剂的治疗策略。本研究回顾了100例连续患者，以确定该手术策略的即时生存率和后续症状结果。平均年龄为49岁，其中24例患者年龄超过70岁。16例患者入院时正在服用H2受体拮抗剂，20例正在服用非甾体类抗炎药。94例患者进行了简单缝合，6例首次手术即进行了确定性手术。30天死亡率为6%（年龄<70岁的患者中1%，n = 76；年龄>70岁的患者中20%，n = 24）。90%的患者获得了完整随访（范围为2 - 80个月）。74%的患者无症状，13%的患者间歇性有症状，7%的患者有持续症状。只有5例患者（6%）需要后续进行确定性手术。对于穿孔性消化性溃疡，简单缝合并后续使用H2受体拮抗剂的治疗策略长期来看是安全有效的。
