Indications of Non-Operative Management for Perforated Peptic Ulcer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FANG Yu , LI Fei , CAO Feng , LI Ang , ZHANG Yupeng , LIU Dongbin , SUN Jiabang , WANG Yajun.

General Surgical Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;

Corresponding author：

Keywords：

Peptic ulcer; Surgical indications; Perforation; Treatment; Non-operative treatment

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset time lt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （P gt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.

Citation： FANG Yu,LI Fei,CAO Feng,LI Ang,ZHANG Yupeng,LIU Dongbin,SUN Jiabang,WANG Yajun.. Indications of Non-Operative Management for Perforated Peptic Ulcer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(6): 629-634. doi: Copy

1.	Wangensteen OH. Non operative treatment of localized perforations of the duodenum [J]. Minn Med, 1935; 18: 477480.
2.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
3.	王吉甫. 胃十二指肠溃疡并发症//王吉甫. 胃肠外科学 [M]. 北京: 人民卫生出版社, 2000: 248260.
4.	Crofts TJ, Park KG, Steele RJ, et al. A randomized trial of nonoperative treatment for perforated peptic ulcer [J]. N Engl J Med, 1989, 320(15): 970973.
5.	俞世安, 张家敏, 许龙堂, 等. 重新评估非手术治疗十二指肠溃疡穿孔的地位 [J]. 中华胃肠外科杂志, 2003, 6(5): 311313.
6.	Rahman MM, Ahsan HN, Hossain MD. Nonoperative management of perforated peptic ulcer [J]. Par J Med Sci, 2003, 19(2): 101105.
7.	Kulkarni SV, Naik AS, Subramanian N Jr. APACHE Ⅱ scoring system in perforative peritonitis [J]. Am J Surg, 2007, 194(4): 549552.
8.	Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors [J]. Ann Surg, 1987, 205(1): 2226.
9.	费贤彬, 吴少亮. 老年人溃疡病急性穿孔外科治疗19例体会 [J]. 中国普外基础与临床杂志, 1999, 6(2): 125.
10.	张国虎，龚加庆，王培红，等. Ｂ超引导下穿刺引流治疗老年胃十二指肠溃疡急性穿孔患者的疗效评价 [J]. 中国普外基础与临床杂志, 2010, 17(11): 11861189.
11.	庄丹, 许国平, 刘金炎, 等. 胃癌穿孔手术时机及术式探讨 [J]. 中国普外基础与临床杂志, 2002, 9(3): 205206.

1. Wangensteen OH. Non operative treatment of localized perforations of the duodenum [J]. Minn Med, 1935; 18: 477480.
2. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321336.
3. 王吉甫. 胃十二指肠溃疡并发症//王吉甫. 胃肠外科学 [M]. 北京: 人民卫生出版社, 2000: 248260.
4. Crofts TJ, Park KG, Steele RJ, et al. A randomized trial of nonoperative treatment for perforated peptic ulcer [J]. N Engl J Med, 1989, 320(15): 970973.
5. 俞世安, 张家敏, 许龙堂, 等. 重新评估非手术治疗十二指肠溃疡穿孔的地位 [J]. 中华胃肠外科杂志, 2003, 6(5): 311313.
6. Rahman MM, Ahsan HN, Hossain MD. Nonoperative management of perforated peptic ulcer [J]. Par J Med Sci, 2003, 19(2): 101105.
7. Kulkarni SV, Naik AS, Subramanian N Jr. APACHE Ⅱ scoring system in perforative peritonitis [J]. Am J Surg, 2007, 194(4): 549552.
8. Boey J, Choi SK, Poon A, et al. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors [J]. Ann Surg, 1987, 205(1): 2226.
9. 费贤彬, 吴少亮. 老年人溃疡病急性穿孔外科治疗19例体会 [J]. 中国普外基础与临床杂志, 1999, 6(2): 125.
10. 张国虎，龚加庆，王培红，等. Ｂ超引导下穿刺引流治疗老年胃十二指肠溃疡急性穿孔患者的疗效评价 [J]. 中国普外基础与临床杂志, 2010, 17(11): 11861189.
11. 庄丹, 许国平, 刘金炎, 等. 胃癌穿孔手术时机及术式探讨 [J]. 中国普外基础与临床杂志, 2002, 9(3): 205206.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Indications of Non-Operative Management for Perforated Peptic Ulcer

Abstract Full text Figures/Tables Video References Cited by

Format

Content