CAJ | 학술논문

目的：探讨消化性溃疡穿孔非手术治疗的适应证和禁忌证。方法回顾性分析2010年1月至2013年6月连续237例消化性溃疡穿孔患者治疗的临床结果，计算非手术治疗成功率，分析非手术治疗失败的相关因素。结果本组237例非手术治疗成功率为88.4%（167/189），除外其中17例高龄和合并内科疾病或免疫抑制状态的患者，非手术治疗成功率可达97.1%（167/172）；非手术治疗失败的相关因素包括年龄≥70岁、入院时休克、既往其他部位恶性肿瘤史以及合并糖尿病和肝硬化（χ2＝7.631～42.38，P＜0.01）。结论只要严格掌握适应证和禁忌证，消化性溃疡穿孔的非手术治疗是安全、可行的；患者年龄≥70岁、入院时休克、合并糖尿病、肝硬化或其他部位恶性肿瘤史等免疫抑制状态，是非手术治疗的禁忌证。
목적：탐토소화성궤양천공비수술치료적괄응증화금기증。방법회고성분석2010년1월지2013년6월련속237례소화성궤양천공환자치료적림상결과，계산비수술치료성공솔，분석비수술치료실패적상관인소。결과본조237례비수술치료성공솔위88.4%（167/189），제외기중17례고령화합병내과질병혹면역억제상태적환자，비수술치료성공솔가체97.1%（167/172）；비수술치료실패적상관인소포괄년령≥70세、입원시휴극、기왕기타부위악성종류사이급합병당뇨병화간경화（χ2＝7.631～42.38，P＜0.01）。결론지요엄격장악괄응증화금기증，소화성궤양천공적비수술치료시안전、가행적；환자년령≥70세、입원시휴극、합병당뇨병、간경화혹기타부위악성종류사등면역억제상태，시비수술치료적금기증。
Objective To investigate the indications and contraindications of non-surgical treatment for patients with perforated peptic ulcer. Methods Between January 2010 and June 2013, the clinical outcomes of 237 consecutive patients with perforated peptic ulcer were analyzed retrospectively. The success rate of conservative treatment was calculated, and the risk facts of unsuccessful non-operative management were analyzed. Results The success rate of conservative treatment was 88.4%(167/189), but a success rate as high as 97.1%(167/172) after 17 cases with an older age or medical comorbidities or immunity suppression were excluded. An age≥70 years, shock on admission, previous other malignancy, diabetes mellitus and cirrhosis were high risk factors for unsuccessful non-operative treatment (χ2=7.631-42.38, P<0.01). Conclusions As long as the indications and contraindications are controlled strictly, non-operative management for perforated peptic ulcer is safe and feasible. The presence of an age≥70 years, shock on admission, associated medical diseases such as diabetes mellitus and cirrhosis, previous other malignancy or immunity suppression are the contraindications of non-surgical treatment for perforated peptic ulcer.