THE TREATMENT AND REAL STATE OF MEDICAL EXPENSES FOR PERFORATION OF DUODENAL ULCER-EVALUATION BY AGES AND THERAPEUTIC METHODS

Abstract

In this study, we examined the treatments and medical expenses for cases of perforation of duodenal ulcer. As to therapeutic methods, we selected conservative therapy as a rule, but employed ultrasonographyguided puncture drainage or laparoscopic procedure if a large volume of ascites was noted. Emergency operation was performed for patients who did not respond to conservative therapy, those associated with hematological disease, those with perforation of gastric ulcer, and those misdiagnosed. Elective surgery after sucessful conservative therapy was carried out for cases associated with malignant disease and those of frequently recurred ulcer. Each points for hospital stay, medication, treatment, surgical anesthesia, test, imaging diagnosis, as well as total points became larger in aged patients group. There was a tendency for patients who well responded to conservative therapy to decrease the expenses, but all patients who did not respond to conservative therapy were associated with some postoperative complication to became more expensive. Conservative therapy was liable to be excellent for juvenile patients, but it often ineffective for aged patients who also had complications in the clinical course in a high rate. It is indicated that early decision-making for conservative therapy in aged and severe patients and prevention of complications during clinical course may contribute to the saving of medical expenses.