对需要急诊手术治疗消化道溃疡出血的患者行迷走神经切断术/引流优于局部吻合

对需要急诊手术治疗消化道溃疡出血的患者行迷走神经切断术/引流优于局部吻合
摘要
目的：比较不同急诊手术治疗胃肠道溃疡出血或穿孔后患者的术后早期转归。
背景：尽管确定性降酸手术在急诊溃疡手术中的使用已经越来越少，但少有已发表数据支持这一临床实践改变。
方法：对美国外科医师协会国家手术质量促进项目数据库中2005年至2011年间接受急诊手术以治疗消化道溃疡出血或穿孔的患者的数据进行回顾性分析，研究手术方式（仅局部手术，迷走神经切断术/引流，和迷走神经切断术/胃切除）和术后30天内患者转归间的关联。使用多元回归分析校正患者自身相关因素。
结果：共有3611名急诊溃疡手术患者（775名出血，2374名穿孔）纳入研究分析。与仅接受局部手术的患者相比，迷走神经切断术/胃切除治疗溃疡穿孔或出血的术后发病率显著增高。对于溃疡穿孔的患者，迷走神经切断术/引流治疗的转归与局部手术患者的预后相似，但前者的术后住院时间显著延长。相反地，对于溃疡出血的患者，与局部溃疡缝合相比，迷走神经切断术/引流的术后死亡率显著降低。
结论：简单修复是治疗需要急诊手术治疗胃肠道溃疡穿孔患者时的一个选择。对于需要急诊手术治疗难治性溃疡出血的患者，迷走神经切断术/引流与简单溃疡缝合相比，前者术后死亡率更低。


英文原文：

Vagotomy/Drainage Is Superior to Local Oversew in Patients Who Require Emergency Surgery for Bleeding Peptic Ulcers

Abstract

Objective: To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers.
Background: Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice.
Methods: A retrospective analysis of data for patients from the 2005–2011 American College of Surgeons National Surgical Quality Improvement Program database who underwent emergency operation for bleeding or perforated peptic ulcer disease was performed to determine the association between surgical approach (local procedure alone, vagotomy/drainage, or vagotomy/gastric resection) and 30-day postoperative outcomes. Multivariable regression analysis was used to adjust for a number of patient-related factors.
Results: A total of 3611 patients undergoing emergency ulcer surgery (775 for bleeding, 2374 for perforation) were included for data analysis. Compared with patients undergoing local procedures alone, vagotomy/gastric resection was associated with significantly greater postoperative morbidity when performed for either ulcer perforation or bleeding. For patients with perforated ulcers, vagotomy/drainage produced similar outcomes as local procedures but required a significantly greater length of postoperative hospitalization. Conversely, vagotomy/drainage was associated with a significantly lower postoperative mortality rate than local ulcer oversew when performed for bleeding ulcers.
Conclusions: Simple repair is the procedure of choice for patients requiring emergency surgery for perforated peptic ulcer disease. For patients requiring emergency operation for intractable ulcer bleeding, vagotomy/drainage is associated with lower postoperative mortality than with simple ulcer oversew.

很有价值

果真如此

学习了。

学习了，感谢分享

感谢分享那么好的经验

学习了

学习了

学习了

学习了，感谢分享