Assessment of risk factors for leakage after repair of perforated peptic ulcer with omental patch. Retrospective study / Evaluación de factores de riesgo de fuga después de la reparación de una úlcera péptica perforada con parche de epiplón. Estudio retrospectivo

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage

Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.

Impact of the coronavirus disease 2019 pandemic on the management of acute peptic ulcer perforation: to be reconsidered(?)

SUMMARY OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation.

Brief introduction of the application status, causes and countermeasures of laparoscopy repair of perforated peptic ulcer / 国际外科学杂志

Perforated peptic ulcer is a common acute abdominal disease and requires emergency surgical treatment. Laparoscopic repair PPU was started early but progressed slowly. Compared with the popularization of minimally invasive concept of laparoscopic cholecystectomy, laparoscopic repair is still under the situation of disputation, low overall application rate and extremely unbalanced development in different regions and organizations. With the embodiment of minimally invasive advantages of laparoscopy and the technology progress, as well as the updating of surgeons′ ideas and the emergence of higher quality RCT studies, the proportion of PPU in laparoscopic treatment is gradually increasing. In order to make full use of the minimally invasive value and differential diagnostic value of laparoscopy, the laparoscopy-first approach can be adopted as a routine for appropriate PPU patients. The key to case selection and the physicians experience and proficiency. Laparoscopy should be actively adopted but should not be easily expanded. If necessary, the patients should be converted to open operation. If not the advantages of laparoscopy will be drowned.

Síndrome de Valentino: una causa no común de abdomen agudo. Reporte de un caso / Valentino Syndrome: an uncommon cause of acute abdomen. Case Report.

INTRODUCCIÓN: El síndrome de Valentino es la perforación de una úlcera péptica a nivel gástrico o duodenal, en donde el paciente se presenta de forma atípica, con un cuadro clínico sugerente de apendicitis aguda, asociado a peritonitis localizada. Al ser una entidad con escasos reportes a nivel mundial y con ningún caso documentado en el Ecuador, es fundamental difundir el presente caso clínico para conocimiento de la comunidad médico-científica. CASO CLÍNICO: Paciente masculino de 63 años, acudió a servicio de emergencia con dolor abdominal de 12 horas de evolución localizado en fosa iliaca derecha asociado a signos de irritación peritoneal y descompensación hemodinámica, sugestivo de peritonitis. Se realizó laparotomía exploratoria. EVOLUCIÓN: En el procedimiento quirúrgico no se evidenciaron cambios inflamatorios en el apéndice y tras la exploración de la cavidad abdominal se encontró una úlcera gástrica perforada; se realizó rafia primaria en dos planos, apendicectomía incidental, más lavado de cavidad abdominal. Paciente con recuperación exitosa, se indicó alta médica al séptimo día de hospitalización. CONCLUSIÓN: La perforación de una úlcera péptica puede generar un cuadro clínico de dolor en fosa ilíaca derecha, que puede confundirse con una apendicitis aguda debido a su similitud clínica. El equipo médico debe considerar al Síndrome de Valentino como un diagnóstico diferencial importante durante la evaluación del paciente que llega a la emergencia con cuadro clínico de dolor abdominal sugestivo de apendicitis aguda.

BACKGROUND: Valentino's syndrome is secondary to a perforated peptic ulcer, which could be located in the stomach or the duodenum, patients present with clinical features that suggest acute appendicitis, with localized peritonitis. There are few case reports about this syndrome worldwide and no one submitted in Ecuador. It is essential to transmit this clinical case for the knowledge of the medical- scientific community. CASE REPORT: A 63-year-old male patient came to the emergency department with abdominal pain, located in the right iliac fossa, that began 12 hours ago, associated to peritoneal irritation signs and hemodynamic decompensation; suggestive of peritonitis. An exploratory laparotomy was performed. EVOLUTION: During exploratory laparotomy, no inflammatory changes were identified in the appendix. After abdominal cavity exploration, a perforated gastric ulcer was found. Primary raffia was stitched in two planes, incidental appendectomy and lavage of the abdominal cavity were performed. The patient had a successful recovery; and was discharged after 7 days at hospitalization. CONCLUSION: The perforation of a peptic ulcer can generate right iliac fossa pain, simulating acute appendicitis due to its clinical similarity. The medical team should consider Valentino's Syndrome as an important differential diagnosis during the evaluation of a patient that arrives to the emergency room with abdominal pain, suggestive of appendicitis.

A study on surgical complications of peptic ulcer disease: a prospective study at a tertiary care center

Background: Peptic ulcer was defined as a disruption of the mucosal integrity of the abdominal esophagus, stomach, duodenum leading to local defect or excavation due to active inflammation. Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy & low tachyphylaxis associated with those drugs. This study aims to evaluate the surgical complications of peptic ulcer disease and tested the hypothesis that despite the decrease in hospitalization for PUD, the incidence of elective surgery for PUD during the recent three decades tends to decrease and in contrast, the frequency of emergency surgical interventions for complications of the PUD has remained consistent.Methods: A total of 60 patients operated for complications of PUD, admitted to PES Institute of Medical Sciences, Kuppam, from January 2018 to September 2019. All data that may be potential predictors concerning complications of PUD were prospectively analyzed.Results: In the present study, the most common complication was perforated peptic ulcer (78.3%) followed by Gastric outlet obstruction (15%) and rest bleeding peptic ulcer.Conclusions: Despite the efficacy of modern medical therapy, decreasing the overall PUD hospitalizations, the volume of procedures to treat complications of PUD has not declined.

Endoscopic assessment and Helicobacter pylori status evaluation in operated cases of peptic ulcer perforation

Background: Helicobacter pylori’s role in delaying ulcer healing after surgical repair for peptic ulcer perforation causing ulcer persistence hasn’t been definitively established as it has been for uncomplicated ulcers.Methods: Authors performed an endoscopy and H. pylori status evaluation in 30 patients at an average of 6.2 weeks after simple omental patch closure for perforated peptic ulcer.Results: A positive H. pylori status was found in 12 patients (40%) of which 9 had active ulcers. None in the negative group had an active ulcer. H. pylori infection was the only factor found to be responsible for ulcer persistence after surgery.Conclusions: A reasonable approach would thus be to perform an endoscopy 6 weeks after surgery to assess ulcer healing and H. pylori status. H. pylori eradication therapy should then be selectively initialled for patients with an active ulcer or positive H. pylori status.

Perforated Gastric Ulcer Masquerading as Anterior Abdominal Wall Necrotizing Fasciitis

@#Necrotizing fasciitis (NF) is a deadly soft tissue infection causing a significant morbidity and mortality. Abdominal and chest wall NF are unusual. We describe a 49-year-old male with anterior abdominal wall NF secondary to perforated gastric ulcer (PGU). He was admitted in septic shock presenting an abdominal wall NF with severe metabolic acidosis requiring dialysis and admission to the intensive care unit. There was a patch of gangrene with surrounding skin discoloration at lower quadrant of the abdominal wall. Local debridement was done without a preoperative computed tomography that was performed after surgery. Adequate source control was not achieved after the second surgery and the patient had worsened resulting to death. We describe this rare presentation of NF and discuss the issues learnt from this unfortunate event.

A Stitch in Time Saves Nine - A Novel Treatment of Duodenal Perforation Closure

Introduction: There are many techniques for closure ofperforation and there is continuing debate in the literatureregarding the preferred surgical procedure for the patientwith a perforated peptic ulcer. Our objective is to comparethe efficacy and safety of figure of eight suturing techniquecoupled with pedicled omental graft repair versus conventionalomentopexy. In this study we proposed to either prove orreject the null-hypothesisMaterial and methods: The proposed study was conductedin Department of Surgery JJM medical college and BapujiHospital, Davangere. 50 patients included in the study weredivided into two groups after randomization; the groupsbeing patients undergoing figure of eight suturing coupledwith pedicled omental graft repair technique for pepticulcer perforation (SG) and patients undergoing conventionalomentopexy technique for peptic ulcer perforation (CG).Results: Majority of patients in this study were of group 15-30 years and 88% were males. Majority of cases had 2cmperforation (36 cases 72%) and most of the perforations werein first part of duodenum (58%). Complications were seenin 72% of patients, most common being wound infection(40%) and 4 patients in control group had bile leak (8%). Oralfeeding was started earlier in the study group as compared tocontrol group. The intra-operative time taken in study groupwas lesser than control group. The hospital stay was lesser instudy group.Conclusion: In conclusion, the present study is superior thanstandard omentopexy in terms of intra-operative time taken,bile leak, duration of hospital stay, commencement of oral feedand mortality. It can be used as a safe alternative to standardomentopexy. As with figure of eight suturing technique, lessertendency to cut through because the pressure at one point isdivided into two directions, and the pressure is exerted on fourpoints instead of two points

Laparoscopic Single Figure of Eight Suturing Omentopexy for the Treatment of a Perforated Duodenal Ulcer

PURPOSE: Safe and effective surgical treatment of peptic ulcer perforations is fundamental to achieve favorable outcomes. We present laparoscopic single figure of eight suturing omentopexy for perforated duodenal ulcer and review associated clinical outcomes. This is a new formulaic surgical technique for laparoscopic omentopexy. METHODS: Laparoscopic single figure of eight suturing omentopexies for perforated duodenal ulcer were completed in 15 consecutive patients between April 2008 and November 2017 at Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Using prospectively collected data, we performed an observational study on an intention-to-treat basis. RESULTS: The mean age of the 15 patients who underwent laparoscopic repair was 41.7±13.9 years. The perforation site was the anterior duodenal bulb in all patients. The median perforation size was 5 mm (range: 3~8 mm). The mean operation time was 66.7±19.6 minutes. There was no evidence of leakage from the omentopexy site clinically or in the postoperative upper gastrointestinal series. One patient (6.7%) experienced the postoperative complication of pneumothorax. There were no cases of postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of regular diet was 6 (range: 4~9) days. The median postoperative hospital stay was 7 days (range: 5~11 days). CONCLUSION: Laparoscopic single figure of eight suturing omentopexy can be a viable option in the surgical management of perforated duodenal ulcer in selected patients without surgical risk factors. Laparoscopic single figure of eight suturing omentopexy is safe and easy to perform, and may therefore reduce operation time.

Comparative study of laparoscopic and open repair of gastroduodenal ulcer perforation / 国际外科学杂志

Objective@#To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.@*Methods@#Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test.@*Results@#All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h, (14.55±3.44) ×109/L vs (16.02±4.12) ×109/L, P=0.020; 72 h, (10.25±2.32) ×109/L vs (14.22±3.29) ×109/L, P<0.001; 120 h, (8.12±3.11)×109/L vs (11.58±2.33) ×109/L, P<0.001. CRP: 24 h, (50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001; 72 h, (29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001; 120 h, (17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05).@*Conclusion@#Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.

Comparative study of laparoscopic and open repair of gastroduodenal ulcer perforation / 国际外科学杂志

Objective To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation.Methods Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018,including 86 males and 31 females.The average age was 35.56 years with a range from 17 to 68 years.Patients were divided into two groups according to different surgical methods:laparoscopic group (n =56) and open group (n =61).Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer,while patients in the open group received open repair for perforated gastroduodenal ulcer.Comparison of two groups of patients with operation time,intraoperative blood loss,postoperative first anal exhaust time,analgesic utilization rate,length of hospital stay,the body's inflammatory response [preoperative and 24 h,72 h,120 h of postoperative peripheral white blood cell (WBC)],C-reactive protein level (CRP),postoperative complications (postoperative incision infection,incision dehiscence,gastric duodenal fistula,abdominal abscess,adhesion intestinal obstruction and lung infection).Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data were compared by Chi-square test.Results All the patients in the two groups successfully completed the operation,and there were no cases transferred to laparotomy in the laparoscopic group.Intraoperative blood loss [(15.3 ± 9.5) ml vs (30.5 ±11.3) ml,P ＜ 0.001],time of first anal exhaust [(56.5 ± 9.8) h vs (83.8 ± 15.6) h,P ＜ 0.001],analygesic utilization rate (10.71％ vs 52.46％,P ＜ 0.005),and length of hospital stay [(7.5 ± 1.5) d vs (10.0 ±3.4) d,P ＜ 0.001] of the laparoscopic group were significantly better in the open group,the differences were statistically significant.The WBC and CRP at 24 h,72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC:24 h,(14.55 ± 3.44) × 109/L vs (16.02 ± 4.12) × 109/ L,P =0.020;72 h,(10.25 ± 2.32) × 109/L vs (14.22 ± 3.29) × 109/L,P ＜ 0.001;120 h,(8.12 ±3.11) ×109/Lvs (11.58 ±2.33) × 109/L,P ＜0.001.CRP:24 h,(50.35 ± 13.73) mg/L vs (80.11 ±13.56) mg/L,P＜0.001;72 h,(29.37 ±7.81) mg/Lvs (53.57 ±8.05)mg/L,P＜0.001;120h,(17.71 ±7.01) mg/L vs (34.35 ± 7.72) mg/L,P ＜ 0.001],the differences were statistically significant.There was no significant difference in operation time and postoperative complications between the two groups (P ＞ 0.05).Conclusion Compared with open gastroduodenal ulcer perforation repair,laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller,and the body's inflammatory response are lighter,postoperative complications is no statistical significance,but will look from actual data,the cases of complications is less,is now a better surgical treatment of gastroduodenal ulcer perforation.

Predictive Value of Nutritional Risk Assessment for Postoperative Complication in Elderly Patients With Gastroduodenal Ulcer Perforation / 胃肠病学

There is a high risk of postoperative complication of ulcer perforation in senile patients, and there is no effective predictive method previously. Nutritional risk assessment improves clinical outcome and reduces the incidence of complication by receiving nutritional support treatment for patients at risk of nutrition. Aims: To investigate the predictive value of nutritional risk assessment for postoperative complication in elderly patients with gastroduodenal ulcer perforation. Methods: A total of 100 patients with perforation of gastroduodenal ulcer from January 2015 to December 2017 at Heyuan People's Hospital Affiliated to Jinan University were enrolled. NRS-2002 score and SGA score were used for nutritional risk assessment. The occurrence of postoperative complication was recorded, and risk factors of postoperative complication were analyzed by multivariate Logistic regression analysis. Results: NRS-2002 score showed that no nutritional risk in 37 patients, 63 patients with nutritional risk. SGA score showed that no malnutrition was found in 41 patients, moderate malnutrition in 32 patients, and severe malnutrition in 27 patients. There was no significant difference in the proportion of no malnutrition/nutritional risk between the two groups (P>0.05). Different degrees of complication occurred in 21 patients. NRS-2002 score and SGA score were correlated with the incidence of serious complication and infectious complication (P<0.05). Multivariate Logistic regression analysis showed that NRS-2002 score and SGA score were independent risk factors for postoperative complication of gastroduodenal ulcer perforation (P<0.05). Conclusions: NRS-2002 score and SGA score can be used to assess malnutrition in elderly patients with perforation of gastroduodenal ulcer. NRS-2002 score, SGA score are closely related to postoperative complication, and can be used to predict the risk of postoperative complication.

Covered Self-expandable Metallic Stent Insertion as a Rescue Procedure for Postoperative Leakage after Primary Repair of Perforated Duodenal Ulcer / 대한소화기학회지

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

Effect of laparoscopic neoplasty in treatment of gastric and duodenal ulcer perforation and its influence on immune function / 新乡医学院学报

Objective To investigate the effect of laparoscopic neoplasty in the treatment of gastric and duodenal ulcer perforation and its influence on immune function. Methods A total of 98 patients with gastric and duodenal ulcer perforation were selected from February 2010 to February 2017 in the Second People's Hospital of Zhengzhou City. The patients were di-vided into observation group and control group according to operative method,49 cases in each group. The operation time,intra-operative bleeding volume,anal exhaust time and hospitalization time were recorded in the two groups. The postoperative pain of all patients were evaluated by visual analogue scales(VAS)on the 1st ,2nd and 7th day after operation. The levels of serum pro-calcitonin(PCT),CD 3+,CD 4+,CD 8+ and natural killer(NK)cell were detected at the time points of 30 min before operation and the 1st ,2nd and 7th day after operation respectively. Results The intraoperative bleeding volume in the observation group was significantly less than that in the control group(P < 0. 05),the anus exhaust time and the hospitalization time in the obser-vation group were significantly shorter than those in the control group(P < 0. 05),and the operation time in the observation group was significantly longer than that in the control group(P < 0. 05). The VAS score in the observation group was signifi-cantly lower than those in the control group on the 1st ,2nd and 7th day after operation(P < 0. 05). The incidence of postopera-tive complication in the observation group and the control group was 6. 12％(3 / 49)and 26. 53％(13 / 49)respectively,the in-cidence of postoperative complication in the observation group was significantly lower than that in the control group(χ2 =13. 652,P < 0. 05). There was no significant difference in serum CD 3+,CD 4+,CD 8+,NK cell and PCT levels between the two groups before operation(P > 0. 05). The levels of serum CD 3+,CD 4+,CD 8+ and NK cell on the 1st and 2nd day after operation were significantly lower than those before operation,and the PCT level on the 1st and 2nd day after operation was significantly higher than that before operation in the control group(P < 0. 05). The levels of serum CD 3+,CD 8+ and NK cell on the 7th day after operation were significantly lower than those before operation in the control group(P < 0. 05). There was no significant difference in the levels of serum CD4 + and PCT between the 7th day after operation and before operation in the control group (P > 0. 05). The levels of serum CD 3+,CD 4+,CD 8+ and NK cell on the 1st day after operation were significantly lower than those before operation,and the PCT level on the 1st day after operation was significantly higher than that before operation in the observation group(P < 0. 05). There was no significant difference in serum CD 3+,CD 4+,CD 8+,NK cell and PCT levels be-tween the 2nd ,7th day after operation and before operation in the observation group(P > 0. 05). The levels of serum CD 3+,CD4 +,CD 8+ and NK cell in the observation group were significantly higher than those in the control group on the 1st ,2nd and 7th day after operation(P < 0. 05). The serum PCT level in the observation group was significantly lower than that in the control group on the 1st and 2nd day after operation(P < 0. 05). There was no significant difference in serum PCT level between the two groups on the 7th day after operation(P > 0. 05). Conclusion Laparoscopic neoplasty for gastric and duodenal ulcer perfora-tion has less traumatic and less influence on the immune function of patients. It is beneficial to the recovery of postoperative body function,and can reduce postoperative complications. The laparoscopic repair is effective in the treatment of perforation of gastric and duodenal ulcer. It is beneficial to the recovery of reduce postoperative complications.Objective To investigate the effect of laparoscopic neoplasty in the treatment of gastric and duodenal ulcer perforation and its influence on immune function. Methods A total of 98 patients with gastric and duodenal ulcer perforation were selected from February 2010 to February 2017 in the Second People's Hospital of Zhengzhou City. The patients were di-vided into observation group and control group according to operative method,49 cases in each group. The operation time,intra-operative bleeding volume,anal exhaust time and hospitalization time were recorded in the two groups. The postoperative pain of all patients were evaluated by visual analogue scales(VAS)on the 1st ,2nd and 7th day after operation. The levels of serum pro-calcitonin(PCT),CD 3+,CD 4+,CD 8+ and natural killer(NK)cell were detected at the time points of 30 min before operation and the 1st ,2nd and 7th day after operation respectively. Results The intraoperative bleeding volume in the observation group was significantly less than that in the control group(P < 0. 05),the anus exhaust time and the hospitalization time in the obser-vation group were significantly shorter than those in the control group(P < 0. 05),and the operation time in the observation group was significantly longer than that in the control group(P < 0. 05). The VAS score in the observation group was signifi-cantly lower than those in the control group on the 1st ,2nd and 7th day after operation(P < 0. 05). The incidence of postopera-tive complication in the observation group and the control group was 6. 12％(3 / 49)and 26. 53％(13 / 49)respectively,the in-cidence of postoperative complication in the observation group was significantly lower than that in the control group(χ2 =13. 652,P < 0. 05). There was no significant difference in serum CD 3+,CD 4+,CD 8+,NK cell and PCT levels between the two groups before operation(P > 0. 05). The levels of serum CD 3+,CD 4+,CD 8+ and NK cell on the 1st and 2nd day after operation were significantly lower than those before operation,and the PCT level on the 1st and 2nd day after operation was significantly higher than that before operation in the control group(P < 0. 05). The levels of serum CD 3+,CD 8+ and NK cell on the 7th day after operation were significantly lower than those before operation in the control group(P < 0. 05). There was no significant difference in the levels of serum CD4 + and PCT between the 7th day after operation and before operation in the control group (P > 0. 05). The levels of serum CD 3+,CD 4+,CD 8+ and NK cell on the 1st day after operation were significantly lower than those before operation,and the PCT level on the 1st day after operation was significantly higher than that before operation in the observation group(P < 0. 05). There was no significant difference in serum CD 3+,CD 4+,CD 8+,NK cell and PCT levels be-tween the 2nd ,7th day after operation and before operation in the observation group(P > 0. 05). The levels of serum CD 3+,CD4 +,CD 8+ and NK cell in the observation group were significantly higher than those in the control group on the 1st ,2nd and 7th day after operation(P < 0. 05). The serum PCT level in the observation group was significantly lower than that in the control group on the 1st and 2nd day after operation(P < 0. 05). There was no significant difference in serum PCT level between the two groups on the 7th day after operation(P > 0. 05). Conclusion Laparoscopic neoplasty for gastric and duodenal ulcer perfora-tion has less traumatic and less influence on the immune function of patients. It is beneficial to the recovery of postoperative body function,and can reduce postoperative complications. The laparoscopic repair is effective in the treatment of perforation of gastric and duodenal ulcer. It is beneficial to the recovery of reduce postoperative complications.

Comparison of the curative effect of laparoscopy and laparotomy in surgical repair of gastric perforation / 中国基层医药

Objective To compare the the curative effect of laparoscopy and open operation in surgical repair of gastric perforation.Methods The clinical data of 68 patients with gastric perforation were analyzed.According to different operation method,the patients were diviede into laparoscopic group and laparotomy group,34 cases in each group.The patients in the two groups were given laparoscopy or laparotomy,respectively.ResultsThe operation time between the two groups had no statistically significant difference (P＞0.05).The intraoperative blood loss,postoperative exhaust time,length of hospital stay in the laparoscopic group were (24.9±7.3)mL,(31.9±10.5)h,(7.4±2.9)d,respectively,which were significantly less than those in the laparotomy group,the differences were statistically significant (t=9.953,5.226,7.441,all P＜0.05).The incidence rate of postoperative complications of the laparotomy group was 32.35％,which was significantly higher than 8.82％ of the laparoscopic group,the difference was statistically significant(χ2=5.757,P=0.016).Conclusion The curative effect of laparoscopic downward gastric perforation repair is superior to laparotomy,patients have rapid recovery,less complications,it is worthy of clinical popularization and application.

Early gastroscopy after closure of gastroduodenal perforation by conservative treatment / 中华普通外科杂志

Objective To evaluate early diagnosis by gastroscopy for the causes of gastroduodenal perforation after successful non-surgical treatment.Method Gastroduodenal perforation patients suspected of benign ulcer in origin on hospital admission undergoing successful non-surgical treatment were examined by gastroscopy within days after the closure.Results Among 284 patients undergoing gastroscopy,277 cases (97.5％) were diagnosed as gastroduodenal ulcer,3 cases (1.1％) as gastric carcinoma,1 case (0.4％) of duodenal diverticulum.There were not major complications developing after gastroscopy.Conclusion Early gastroscopy performed after closure by non-surgical treatment in gastroduodenal perforation patients is safe,helping make definite diagnosis for the cause of perforation.

A comparative study of laparoscopic neoplasty and open neoplasty on levels of procalcitonin and cell-mediated immunity in elderly patients with upper digestive tract ulcer perforation / 天津医药

Objective To study the effect of laparoscopic neoplasty and changes of procalcitonin (PCT) and cell-mediated immunity in elderly patients with duodenal ulcer perforation. Methods Forty-four elderly patients with duodenal ulcer perforation were divided into laparoscopic neoplasty group (n=20) and open neoplasty group (n=24).The level of PCT was assayed by colloid immunization. Blood levels of CD3+, CD4+, CD8+and natural killer (NK) cells were detected by flow cytometry before operation and at 0.5 h, 24 h, 48 h and the 7th day after operation.Surgical complications and postoperative hospital stay were observed in two groups. Results There was no significant difference in the activity of PCT before operation between two groups. There were no significant differences in CD3+, CD4+, CD8+ and NK cells 0.5 h before operation between two groups. The level of PCT was significantly lower at 24 h and 48 h after operation in laparoscopic group than that in open operation group (P<0.05). There were significant differences in the serum levels of CD3+, CD4+, CD8+and NK cells with time changes in two groups (P<0.05). There were significant decreases in CD3+, CD4+and CD8+at 24 h after operation than those before operation in two groups, which were significantly lower in open operation group than those of laparoscopic group except for CD8+. The levels of CD3+, CD4+and CD8+recovered to the levels before operation at 48 h after operation in laparoscopic group. In open operation group CD3+did not return to the level before operation at 7 d after operation. The levels of NK cells were decreased at 24 h after operation in two groups, but there was no significant difference in the level of NK cells between two groups. The level of NK cells returned to preoperative levels at 48 h after operation in laparoscopic group, while there was no significant difference in the level of NK cells before and after operation in open neoplasty group. Compared with the open neoplasty group, there were fewer complications and shorter hospital stay in laparoscopic group. Conclusion The laparoscopic repair operation for gastric and duodenal ulcer perforation has a fewer effects on the stress response and immune function in elderly patients, and has the advantages in the protection of immune function.

Non-operative Treatment of Gastric Ulcer Perforation with Contrast Leakage in an Elderly Patient / 대한내과학회지

Peptic ulcer remains an important public health concern due to an aging society and the increasing use of non steroidal anti-inflammatory drugs (NSAIDs). Perforated peptic ulcer is a major life-threatening complication of peptic ulcer. While the preferred treatment is surgery, conservative treatment does not result in significantly different outcomes in young, hemodynamically stable patients. However, conservative treatment of perforated peptic ulcer is associated with high failure rates in elderly patients. We report a case of an 87-year-old patient with a perforated peptic ulcer with contrast agent leakage. The patient was treated conservatively without complications; the treatment included non per os (NPO), insertion of a Levin tube, intravenous antibiotics, and a proton pump inhibitor.

Observation on the influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation / 中国基层医药

Objective To observe and investigate the influence degree of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation.Methods 76 patients with gastric and duodenal ulcer perforation were selected as study subjects,and they were divided into control group(conventional open operation group)and observation group(laparoscopic operation group)according to the random number table,38 cases in each group.The serum body stress hormones and antiinflammatory,proinflammatory related indexes of the two groups at first day before operation and at first,third,seventh day after operation were respectively detected and compared.Results The serum IL -2 levels of the observation group at first,third and seventh day after operation were (3.53 ±0.24)μg/mL,(3.25 ±0.22)μg/mL and (4.37 ±0.33)μg/mL,which were higher than those of the control group(F =5.876,P <0.05),while other serum body stress hormones and antiin-flammatory,proinflammatory related indexes were all obviously lower than those of the control group (all P <0.05), there were significant differences between those postoperative evaluation results of the two groups.Conclusion The influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation is relatively small,and it shows that the bad body stress degree caused by the operation is relatively smaller.