The aim of this study was to evaluate of logical program for the management of patients with perforated peptic ulcers. The case records of 75 consecutive patients were reviewed. The average age of the patients was 52 years. Ten patients were older than 80. The logical program was based on preoperative risk factors (concurrent medical illness, preoperative shock, and longstanding perforation more than 48 hours), history of chronic ulcer symptoms, and in selected cases, spontaneous seal on X-Ray gastroduodenogram with a water soluble contrast medium. The program was applied in 75% of cases and not applied in 25%. Out of 9 post-operative deaths (12%), 3 had a surgical cause: leakage of the suture with dehiscence in two cases. The mortality increased progressively with increasing of number of risk factors: 0%, 10% and 55% in patients with no, one, and two or three risk factors respectively. These findings constitute a validation of the predictive factors of death proposed by Boey et al. A logical program for the management of patients based on results of such multifactorial studies on risk factors, and on results of randomized prospective controlled studies may be applied in almost all patients. Our results also suggest that the quality of the perforation suture, and of the abdominal closure, especially in old and obese patients, are the most important factors to decrease the mortality.

译文

这项研究的目的是评估用于治疗消化性溃疡穿孔患者的逻辑程序。回顾了75例连续患者的病历。患者的平均年龄为52岁。10名患者年龄在80岁以上。逻辑程序基于术前危险因素 (并发内科疾病,术前休克和超过48小时的长期穿孔),慢性溃疡症状史,以及在选定的病例中,使用水溶性造影剂在x射线胃十二指肠造影上自发密封。该程序适用于75% 情况,而不适用于25% 情况。在9例术后死亡 (12% 例) 中,有3例是手术原因: 两例缝合线渗漏和裂开。死亡率随着危险因素数量的增加而逐渐增加: 分别没有,一个和两个或三个危险因素的患者的0%,10% 和55%。这些发现构成了对Boey等人提出的死亡预测因素的验证。基于风险因素的多因素研究结果和随机前瞻性对照研究结果的患者管理逻辑程序可能适用于几乎所有患者。我们的结果还表明,穿孔缝合线和腹部闭合的质量,尤其是在老年和肥胖患者中,是降低死亡率的最重要因素。

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