Alizadeh N, Bühler L, Huber O, Morel P
Département de chirurgie, Hôpitaux universitaires de Genève.
Schweiz Med Wochenschr Suppl. 1997;89:17S-19S.
Surgery is the conventional form of treatment for perforated peptic ulcer. Conservative treatment has however been described, and is still used in rare situations. The present study analyzes the indications and results of conservative therapy in our hospital. Between 1978 and 1995, 332 patients were admitted for perforated peptic ulcer. Twelve (3.5%), with a mean age of 85 (67-93) years, underwent conservative treatment (gastric suction, H2-blockers and broad-spectrum antibiotics). The diagnosis was established on the basis of epigastric pain and the finding of a pleuriperitoneum on the plain film of the abdomen. The indication for conservative treatment was a prohibitive anesthesiological risk in 11 patients and absence of peritoneal sign in one. The evolution was favourable only in 4 patients, who were discharged after a median stay of 18 days. Mortality was 8/12 patients. In one of these, autopsy showed ischemic colonic perforation. Conservative treatment of perforated peptic ulcer is associated with very high mortality. The results suggest that frequent and careful clinical monitoring is essential during the first 24 hours. In the event of deterioration, surgery must be reconsidered. In addition, the diagnosis should be confirmed by ruling out perforation of another abdominal organ.
手术是消化性溃疡穿孔的传统治疗方式。然而，保守治疗也有相关报道，且仍在极少数情况下使用。本研究分析了我院保守治疗的适应症及结果。1978年至1995年间，332例患者因消化性溃疡穿孔入院。其中12例（3.5%）平均年龄85岁（67 - 93岁），接受了保守治疗（胃肠减压、H2受体阻滞剂及广谱抗生素）。诊断依据上腹部疼痛及腹部平片发现膈下有游离气体。保守治疗的适应症为11例患者存在极高的麻醉风险，1例患者无腹膜刺激征。仅4例患者病情好转，中位住院18天后出院。12例患者中有8例死亡。其中1例尸检显示为缺血性结肠穿孔。消化性溃疡穿孔的保守治疗死亡率极高。结果表明，在最初24小时内进行频繁且仔细的临床监测至关重要。一旦病情恶化，必须重新考虑手术。此外，应通过排除其他腹部器官穿孔来确诊。
