A clinical evaluation and follow up results on 172 patients with perforated peptic ulcer who were treated surgically at the Department of General Surgery, Taegu Fatima Hospital from January 1986 to December, 1990, have been analyzed.
@ES The results were as follows;
@EN 1) Among these 172 patients, the perforated duodenal ulcer were in 165 cases(95.9%), the perforated gastric ulcer 7 cases(4.1%). The ratio of perforated duodenal ulcer and gastric ulcer was 24 : 1.
2) In sex distrbution, 164 cases were male(95.3%) and 8 cases female(4.7%) with the ratio of 21 : 1. In perforated duodenal ulcer, the ratio was 20 : 1 and in gastric ulcer, all were male.
3) In age distribution, the peak incidence was in the 3rd decade with 45 cases(26.2%) and next orders were below the 3rd decade with 30 cases(17.4%), the 6th decade with 29 cases(16.9%) and in the 5th decade with 27 cases(15.7%).
4) In seasonal distribution, autumn showed the highest incidence with 56 cases(32.6%) and winter the lowest incidence ith 23 cases(13.3%).
5) The duration of past history prior to perforation was most common for over 3 years with 66 cases(38.4%), 1 to 3 years with 51 cases(29.7%) but 29 cases(16.9%) had no previous ulcer symptoms.
6) The duration from perforation to operation was 12 to 24 hours with 58 cases(33.7%), 6 to 12 hours with 52 cases(30.2%), over 24 hours with 35 cases(20.4%) and within 6 hours with 27 cases(15.7%).
7) In radiologic study, subdiaphragmatic free air shadow was positive in 144 cases(83.7%). In duodenal ulcer perforation, was found in 139 cases(84.2%) and gastric ulcer perforation in 5 cases(71.4%).
8) The majority of perforation were developed in the lst portion of the duodenum with 148 cases (86.0%) and among 150 cases of perforated duodenal ulcer, the anterior wall was the most prevalent site with 146 cases(97.3%).
9) The size of the perforated hole ranged from 5 mm to 10 mm in diameter in 88 cases(51.2%) and over 10 mm in diameter in 12 cases(7.0%).
10) As to the operative procedure, the truncal vagotomy with pyloroplasty was performed in 122 cases(70.9%), simple closure in 11 cases(6.4%), gastrectomy in 11 cases(6.4%), truncal vagotomy with antrectomy in 10 cases(5.8%), highly selective
vagotomy
with omental patch closure in 9 cases(5.2%), and simple closure and vagotomy with gastrojejunostomy in 9 cases(5.2%).
11) Postoperative early complications were as follows;
Wound infection was the most common with 13 cases(7.6%), ileus with 11 cases(6.4%), and pulmonary complications with 5 cases(2.9%), etc.
12) Postoperative delayed complications were as follows; In truncal vagotomy with pyloroplasty, intractable diarrhea in 25 cases(20.5%), recurred ulcer in 2 cases(1.6%). In truncal vagotomy with antrectomy, diarrhea in 3 cases(33.3%), dumping
syndrome
and anemia in 2 cases(18.2%), recurred ulcer and alkaline reflux gastritis in 1 case(9.0%).
13) Clinical results were evaluated by Modified Visick classification.
The results were follows;
Truncal vagotomy with antrectomy shows 85.7% of satisfaction (Visick criteria I. II), gastrectomy 83.3%, truncal vagotomy with pyloroplasty 82.5%, simple closure 42.9%, and highly selective vagotomy 88.9%.
|