INDICATIONS OF THERAPIES FOR PERFORATED DUODENAL ULCER

Abstract

A retrospective study was made of 40 cases of perforated duodenal ulcer experienced at the hospital from July 1991 to March 1997 to evaluate indications of therapies for the disease. There were 2 cases of conservative therapy, 13 cases of laparoscopic simple closure (LSC), 9 cases of open simple closure (OSC) and 16 cases of subtotal gastrectomy (SG). Durations from the onset of the disease until the operation were 7.3 hours in LSC, 34.2 hours for OSC and 27.5 hours in SG. The opration times were 1.4 hours in LSC, 1.2 hours in OSC and 2.8 hours in SG. The hospital stay amounted to 13.7 days in LSC, 18.8 days in OSC and 29.3 days in SG, whereas over 30 days in conservative theray. As to the medical cost on the health insurance, LSC amounted to 67, 326, OSC to 90, 434, the conservative method to 91, 492, SG to 116, 222 points Recurence of duodenal ulcer appeared in 38.5% of patients undergoing simple closure more than one year after the operation, but all such patients were treated by medication.
From these findings, we think that the conservative therapy should be indicated for aged patients or inoperable patients with poor risk; and LSC is indicated first if there are no shock findings, then SG is indicated if duodenal stenosis is confirmed, and finally OSC should be selected if shock state or severe complications are confirmed.