Evans J P, Smith R
Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Aust N Z J Surg. 1997 Nov;67(11):792-5. doi: 10.1111/j.1445-2197.1997.tb04582.x.
Despite modern medications for peptic ulcers, patients frequently require emergency surgery for complications of ulcer disease. Many of these patients have coexisting medical problems which not only predispose to perforated ulcer disease, but also influence the clinical outcome. This study reviews the outcome of a group of patients with perforated ulcer disease and examines the influence of a range of comorbidity factors on the outcome.
A retrospective chart review of all cases of perforated peptic occurring over a period of 9 years.
One hundred and forty-nine perforated peptic ulcers in 147 patients were diagnosed between 1987 and 1996. Coexisting malignancy, use of immunosuppressives or corticosteroids, pre-operative shock and admission to intensive care were all significantly associated with reperforation by univariate analysis. However, logistic regression analysis indicated that none of these factors independently predicted reperforation which, therefore, occurs as a multifactorial event with all the above factors contributing. Death from perforated ulcer disease was related to pre-operative shock, malignancy, admission to intensive care and reperforation when examined by univariate analysis. Furthermore, logistic regression analysis showed that coexisting malignancy and reperforation were significant predictors of mortality.
Perforated peptic ulcer disease remains a frequent clinical problem in patients with short dyspeptic histories, who may or may not have been using ulcerogenic medications. It is a significant cause of morbidity and mortality among an often aged and otherwise unwell group of patients. Patients with underlying malignant disease, who may be immunosuppressed with corticosteroids or cytotoxics, are at increased risk of dying from perforated ulcer disease. Reperforation of an ulcer, following simple closure or conservative treatment, is also highly predictive of increased mortality.
尽管有治疗消化性溃疡的现代药物，但患者仍常因溃疡病并发症而需要紧急手术。这些患者中许多人存在并存的内科问题，这些问题不仅易导致溃疡穿孔疾病，还会影响临床结局。本研究回顾了一组溃疡穿孔疾病患者的结局，并探讨了一系列合并症因素对结局的影响。
对9年间所有消化性溃疡穿孔病例进行回顾性病历审查。
1987年至1996年间，147例患者中诊断出149例消化性溃疡穿孔。单因素分析显示，并存恶性肿瘤、使用免疫抑制剂或皮质类固醇、术前休克以及入住重症监护病房均与再次穿孔显著相关。然而，逻辑回归分析表明，这些因素均不能独立预测再次穿孔，因此，再次穿孔是一个多因素事件，上述所有因素均有促成作用。单因素分析显示，溃疡穿孔疾病导致的死亡与术前休克、恶性肿瘤、入住重症监护病房和再次穿孔有关。此外，逻辑回归分析表明，并存恶性肿瘤和再次穿孔是死亡率的重要预测因素。
消化性溃疡穿孔疾病在消化不良病史较短的患者中仍然是一个常见的临床问题，这些患者可能使用过或未使用过致溃疡药物。在一组往往年龄较大且身体状况不佳的患者中，它是发病和死亡的重要原因。患有潜在恶性疾病且可能因皮质类固醇或细胞毒性药物而免疫抑制的患者，死于溃疡穿孔疾病的风险增加。在简单缝合或保守治疗后溃疡再次穿孔，也高度预示死亡率增加。
