Etki Eden FAKTÖRLER, Mehmet Akif ÜSTÜNER, Enver İLHAN, Abdullah ŞENLİKÇİ, Emrah DADALI, Uğur GÖKÇELLİ, Orhan ÜREYEN

PEPTİK ÜLSER PERFORASYONLARINDA MORBİDİTE VE MORTALİTEYE ETKİ EDEN FAKTÖRLER

Günümüzde H2-reseptör blokerleri ve proton pompa inhibitörlerinin kullanımı sonucu peptik ülser hastalığında elektif cerrahi gereksinimi azalmıştır. Ancak komplikasyonlara bağlı acil cerrahi sıklığında herhangi bir değişiklik olmamıştır. Perforasyon meydana gelen hastalarda morbidite ve mortalite halen büyük bir problemdir. İzmir Bozyaka Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde 2008-2013 yılları arasında peptik ülser perforasyonu nedeniyle ameliyat edilen hastaların dosya ve elektronik kayıtları retrospektif olarak incelendi. Toplam 50 hastanın 41 %82 'i erkek 9 %18 'u kadındı. Yaş ortalaması 48.9 idi. Ortalama hastanede kalış süresi 7.8 gündü. Peptik ülser perforasyonu en sık yaz mevsimi %32 ve Ağustos ayında %12 görüldü. Kasım ayında 5yıl boyunca perforasyon görülmedi.Perforasyon en sık, 31 %62 hastada olmak üzere duodenumda görüldü. Bunu 17 %34 hasta ile jukstapilorik ve 2 %4 hasta ile anastomoz hattı perforasyonları izledi. İki hasta tekrarlayan perforasyon nedeniyle ameliyat edildi. Tüm hastalara antibiyotik tedavisi yapıldı. Perforasyon deliği çapı 39 %78 hastada 1cm altı,7 %14 hastada 1-2 cm arası, 4 %8 hastada 2 cm ve üstü olarak bulundu. Ameliyat öncesi, 38 %72 hastada lökositoz, dokuz %18 hastada kreatin yüksekliği ve 11 %22 hastada amilaz yüksekliği tespit edildi. Ameliyat sonrası üç hastada yara yeri infeksiyonu, iki hastada pnömoni, bir hastada deliriyum tablosu, dört hastada akut böbrek yetmezliği, bir hastada sepsis ve bir hastada evisserasyon gelişti. Toplam 4 %8 hasta eks oldu. Morbidite ve mortalite gelişen hastaların çoğu ileri yaş grubunda olup yandaş hastalıklara sahiptiler. Yandaş hastalığa sahip, ileri yaş ve gecikmiş perforasyonu olan hastalarda morbidite ve mortalite oranı artmaktadır. Ameliyat öncesi lökositoz, yüksek amilaz değeri ve kreatin yüksekliği preoperatif dönemde morbidite ve mortalitenin tahmininde kullanılabilinir

Anahtar Kelimeler:

Peptik ülser perforasyonu, morbidite, peptik ülser hastalığı

FACTORS AFFECTING THE MORBIDITY AND MORTALITY IN PERFORATED PEPTIC ULSER DISEASE

Today, as a result of the use of H2-receptor blockers and proton pump inhibitors in peptic ulcer disease has decreased the need for elective surgery. However, there is no change in the frequency emergency surgery due to complications. Morbidity and mortality in patients with perforation occurring is still a major problem. We reviewed retrospectively the patients who underwent surgery for peptic ulcer perforation with files and computer records between 2008- 2013 in İzmir Bozyaka Training and Research Hospital General Surgery Department. Total of 50 patients, 41 82% were male and 9 18% were women. The mean age was 48.9 years. Average hospital stay was 7.8 days. Peptic ulcer perforations were seen most common in summer season and August. There was no perforation for 5 years in November. Perforations were seen most common in duodenum in 31 62% patients. That followed by the perforations of juxtapyloric in 17 34% patients and anastomosis in 2 4% patients. Two patients were operated due to recurrent perforation. All patients were treated with antibiotics. Perforation hole diameter were found in 39 78% patients below 1 cm, in 7 14% patients between 1-2 cm and 4 8% patients 2 cm and above. There was leukocytosis in 38 72% patients, increased creatinine in 9 18% patients and increased amylase in 11 22% patients. There was wound infection in three patients, pneumonia in two patients, delirium in one patient, acute renal failure in four patients, sepsis in one patient, evisceration in one patient after surgery. Total 4 8% patients had died. Most of the patients with morbidity and mortality in the elderly group had concomitant diseases. Morbidity and mortality is increasing in patients with co-morbid disease, advanced age and delayed perforation. Preoperative leukocytosis, increased amylase and increased creatinine can be used to predict morbidity and mortality

Keywords:

Peptic ulcus perforation, morbidity, peptic ulcus disease,

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