Early Identification of Patients with Potential Failure of Nonoperative Management for Gastroduodenal Peptic Ulcer Perforation.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2023-11-25 DOI:10.1159/000535520

Toshimichi Kobayashi, Satoshi Tabuchi, Itsuki Koganezawa, Masashi Nakagawa, Kei Yokozuka, Shigeto Ochiai, Takahiro Gunji, Yosuke Ozawa, Toru Sano, Koichi Tomita, Naokazu Chiba, Eiji Hidaka, Shigeyuki Kawachi

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引用次数: 0

Abstract

Introduction: We aimed to identify objective factors associated with failure of nonoperative management (NOM) of gastroduodenal peptic ulcer perforation (GDUP) and establish a scoring model for early identification of patients in whom NOM of GDUP may fail.

Methods: A total of 71 patients with GDUP were divided into NOM (cases of NOM success) and operation groups (cases requiring emergency operation or conversion from NOM to operation). Using logistic regression analysis, a scoring model was established based on the independent factors. The patients were stratified into low-risk and high-risk groups according to the scores.

Results: Of the 71 patients, 18 and 53 were in the NOM and operation groups, respectively. Ascites in the pelvic cavity on computed tomography (CT) and sequential organ failure assessment (SOFA) score at admission were identified as independent factors for NOM failure. The scoring model was established based on the presence of ascites in the pelvic cavity on CT and SOFA score ≥2 at admission. The operation rates for GDUP were 28.6% and 86.0% in the low-risk (score, 0) and high-risk groups (scores, 2 and 4), respectively.

Conclusion: Our scoring model may help determine NOM failure or success in patients with GDUP and make decisions regarding initial treatment.

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胃十二指肠消化性溃疡穿孔非手术治疗失败患者的早期识别。

前言:我们旨在确定与胃十二指肠消化性溃疡穿孔(GDUP)非手术治疗失败(NOM)相关的客观因素，并建立一个评分模型，用于早期识别GDUP非手术治疗失败的患者。方法:将71例GDUP患者分为NOM组(NOM成功病例)和手术组(需要紧急手术或由NOM转为手术病例)。采用logistic回归分析，建立了基于独立因素的评分模型。根据评分将患者分为低危组和高危组。结果:71例患者中，NOM组18例，手术组53例。入院时计算机断层扫描(CT)盆腔腹水和顺序器官衰竭评估(SOFA)评分被确定为NOM失败的独立因素。以入院时CT显示盆腔腹水及SOFA评分≥2为评分标准建立评分模型。低危组(评分0分)和高危组(评分2分和4分)GDUP手术率分别为28.6%和86.0%。结论:我们的评分模型可以帮助确定GDUP患者的NOM失败或成功，并决定初始治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.