十二指腸潰瘍穿孔に対する治療法の適応についての検討

Background: Although conservative therapy has been acceptable as the first-line therapy for duodenal ulcer (DU) perforations, surgical therapies are known to have certain advantages. We investigated the indications for laparoscopic (LS) or open surgery (OS) or conservative therapy (CoT) among 56 DU perforation cases over 5 years. Methods: 31 LSs, 22 OSs and 5 CoTs were analyzed for patient's physical and surgical factors and clinical course. Results: Mean age was 51.6. Male/female ratio was 49/9. Survival ratio was 98%. Although the hospital stay (10.9 vs 19.5 days) and analgesic administrations (1.9 vs 4.6 days) were significantly shorter in LS than OS, almost all OS patients were in serious condition as evidenced by longer waiting time before treatment, stronger pain, bigger hole of perforation, more ascites accumulation and higher morbidity of complications. Two cases of multisurgery were experienced in both LS and OS groups due to leakage of seam, abscess formation, relapsed ulcer or idiopathic intestinal perforation. LS is a therapy more widely usable and more beneficial than the other two. Conclusion: LS, a minimally invasive surgery for DU perforation, should be considered as a first-line standard therapy because of significant advantages such as shorter hospital stay. OS or CoT may be selected when appropriate.

原著 (Original Paper)