소화성 궤양 천공 환자에서 응급 수술 후 사망률에 영향을 미치는
Risk Factors Associated with Mortality in Emergency Surgery for Perforated Peptic Ulcer
고정원, 홍수정, 반주영, 김종흥,
소속 상세정보
고정원 ( Ko Jeong-Won )
국립의료원 외과
홍수정 ( Hong Soo-Jung )
국립의료원 외과
반주영 ( Ban Joo-Young )
국립의료원 외과
김종흥 ( Kim Jong-Heung )
국립의료원 외과
KMID : 0371320040670050373
Abstract
Purpose: Despite modern medication, peptic ulcer, patients often require emergency surgery for complications of peptic ulcer disease, and the mortality due to a perforated peptic ulcer still remains high. This retrospective study was conducted to evaluate the risk factors associated with mortality in patients undergoing surgery for a perforated peptic ulcer.
Methods: Two hundred and four consecutive patients (mean age: 45.8 years; range: 15～90 years) who underwent emergency surgery for a perforated peptic ulcer at the National Medical Center, between January 1991 and December 2000, were reviewed.
Results: The overall mortality rate was 5.9%. A univariate analysis of multiple clinical variables revealed old age (≥65 years), duration of symptoms (≥24 hours), NSAIDs or steroid use, comorbid disease, shock on admission, low hemoglobin (＜10 g/dl), higher BUN (≥20 mg%), higher creatinine (≥1.5 mg%), gastric ulcer and simple closure to be significantly associated with mortality. However, a multivariate analysis showed that shock on admission, comorbid disease and old age (≥65 years) were independent predictors of mortality.
Conclusion: Shock on admission, comorbid disease and old age should be considered as significant prognostic factors of emergency surgery for a perforated peptic ulcer, and a comorbid disease and age as non modifiable factors. For that reason, prompt resuscitation is considered as the most effective therapy for reducing the mortality due to peptic ulcer perforation. (J Korean Surg Soc 2004;67:373-378)
키워드
소화성 궤양 천공;수술 사망률;위험 인자;Perforated peptic ulcer;Postoperative mortality;Risk factors
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