頁籤選單縮合
題 名 | 高齡消化性潰瘍穿孔病患之手術危險性 |
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作 者 | 吳誠中; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 19:3 1986.07[民75.07] |
頁 次 | 頁223-229 |
分類號 | 416.24 |
關鍵詞 | 高齡消化性潰瘍穿孔; 手術危險性; |
語 文 | 中文(Chinese) |
中文摘要 | 消化性潰瘍併發穿孔(PPU)發生在高齡患者身上仍是一相當棘手的問題。隨著國人平均壽命延長,高齡PPU患者也有增多的趨勢。 台中榮總一般外科在過去3年間,共有57例PPU患者年齡超過65歲,占所有199例PPU患者的28.6%;經手術治療後,有9例死亡,死亡率高達15.8%。茲分析此病人之死亡原因,我們發現高峰PPU患者之幾項危險因素:(1)年齡較大者。(2)發生穿孔至施行手術之時間耽擱愈長者。(3)術前呈現休克症狀者。(4)術前伴有急性或慢性貧血者。(5)穿孔愈大者。(6)手術時發現腹腔內膿汁及滲出物愈多者。合於上述危險因素愈多,程度愈厲害者,其預後似乎愈差。而此等病患之性別,過去史中是否伴有內科類疾病,潰瘍病史之長短,潰瘍發生之位置及腹水細菌培養之陽性率則與其預後無關。 57例中有36例因全身狀況不住或腹腔內極度污染,只能以單純縫合治療。有13例發生各種併發症,有9例死亡。另21例則施以各種確定之消化性潰瘍根治手術,有1例發生併發症,無死亡例。 對於高齡PPU患者,在病人情況許可時,衡量上述之危險因素,作確定之手術仍是可行的。 |
英文摘要 | Perforated peptic ulcer (PPU) in geriatric patients remains a difficult management problem, at the same time that there is a rise in the incidence of PPU as this group has steadily increased numerically because of prolonge life span here. One hundred and ninety-nine PPU patients were treated by the General Surgical Section of VGH-Taichung in the past three years. Among them, 57 patients (28.6%) were older than 65 years, and 9 of them died after operation, yielding a mortality rate of 15.8%. A statistical analysis of the clinical data for the geriatric patients who thus succumbed has singled out some risk factors: (1) older age, (2) longer time span between perforation and operation, (3) presentation of shock, (4) presentation of acute or chronic anemia, (5) especially larger perforation, (6) larger than usual amount of intraabdominal exudate during operation. The more risk factors involved, the severe the symptoms presented, the poorer the prognosis. There is no significant difference between the prognosis and such factofs as sex, collectable medical disease in personal history, duration of ulcer pain, site of perforation or positive bacterial culture of ascites. Simple closure with omental patch was performed in 36 patients who were in poor general condition or had severe peritoneal contamination. Among them, 9 died (morality rate 25%) and 13 (36.1%) had complications. Various definitive surgical procedures carried out in the other 21 patients of better condition yielded only 1 complication (complication rate 4.7%) and no death. The conclusion was that (1) simple closure of a perforated ulcer in the aged patient is a logical policy when multiple risks are evidently presented, and (2) definitive ulcer surgery is still permissible when the patient is in a good condition. |
本系統中英文摘要資訊取自各篇刊載內容。