Prognostic Factors in Duodenal Ulcer Perforation.
- Author:
Jae Hwan SEO
1
;
Heung Kyu PARK
;
Yeon Ho PARK
;
Hoon Kyu LEE
;
Woon Ghi LEE
;
Seung Yeon CHO
;
Jeong Nam LEE
;
Young Don LEE
Author Information
1. Department of Surgery, Gachon Medical School Gil Medical Center, Inchon, Korea.
- Publication Type:Original Article
- Keywords:
Perforated duodenal ulcer;
Prognostic factors;
Postoperaive mortality
- MeSH:
APACHE;
Duodenal Ulcer*;
Humans;
Mortality;
Peptic Ulcer;
Peptic Ulcer Perforation;
Peritonitis;
Retrospective Studies;
Risk Factors;
Surgical Procedures, Operative;
Ulcer
- From:Journal of the Korean Surgical Society
2001;60(4):425-431
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: There has been controversy over an adequate operative method for peptic ulcer perforation, but currently there is general agreement in the surgical literature that perforated duodenal ulcers in patients who constitute excessive surgical risk should be managed by the simplest possible procedure and in the absence of surgical risk, definitive operations are advocated. However, an accurate description of the degree of severity of concurrent medical disease and surgical risk factor is not available and the question as to whether the postoperative mortality is influenced by the magnitude of the procedure or determined only by the patient's risk remains unanswered. METHODS: This retrospective study reviewed the case histories of all patients who underwent operations for perforated duodenal ulcer at Gil Medical Center from January 1993 through 1998 and evaluates the influences of prognostic factors, APACHE II, SAPS, age, duration of peritonitis, concurrent major medical disease and ulcer size, and operative procedures on postoperative mortality in high risk and low risk groups. RESULTS: Large APACHE II score (> or =15) and SPSS (> or =10), delayed operation, large ulcer (> or =2 cm), age (> or =60), and major medical illness that severely compromised cardiorespiratory, hepatic, renal, and immunologic function were associated significantly with mortality in patients with a perforated peptic ulcer. CONCLUSION: Age, duration of peritonitis, major medical disease, APACHE II score, and ulcer size should be pre-sumed to be important prognostic factors. Although further study is necessary in a larger number of patients, it appears that operative procedures have no influence on postoperative mortality.
