Investigation of the Indications for Conservative Therapy to Treat Perforated Gastroduodenal Ulcers

DOI Web Site 参考文献4件
  • Niwa Kazuya
    Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine
  • Mikami Shinya
    Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine
  • Enomoto Takeharu
    Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine
  • Otsubo Takehito
    Department of Gastrointestinal and General Surgery, St. Marianna University School of Medicine

この論文をさがす

抄録

<p>At our hospital, we have been using the criteria reported by Watanabe et al. to determine the treatment plan for patients with of perforated gastroduodenal ulcers to determine whether they should undergo surgery. Between April 2003 and March 2015, we evaluated 117 cases of perforation, and among these, we selected conservative treatment for 14 cases. One of these 14 cases required conversion to surgery. Although we selected surgical treatment in 103 cases, at surgery, the perforation was already covered in 19 cases. The Watanabe score was found to have a sensitivity of 0.99 and specificity of 0.41, and none of the cases judged using this scoring method had perforation as a cause of death. We have therefore determined the validity of the Watanabe score. However, we believe that we performed an excessive amount of surgery as we found some cases in which the perforation was already covered and therefore could have been managed conservatively. To avoid this, we have proposed the following new scoring system, which uses coefficients to provide weighting during logistic regression analysis for the four items found to have a significant difference in terms of their Watanabe scores. The formula is calculated as: 0.36 + 1.29 [if symptoms of peritoneal irritation are limited to the epigastrium] + 0.92 [if no severe concomitant disease] + 0.80 [if duration is less than 6 hours from the time of onset to initial examination] + 0.63 [if progression of ascites is limited to the epigastrium]. If the total score is 2.08 or greater, then conservative treatment is selected. This new scoring system not only decreases the number of items evaluated when compared to the Watanabe system, but with a sensitivity of 0.94 and specificity of 0.63, it may also provide a more definitive method for determining the treatment plan.</p>

収録刊行物

参考文献 (4)*注記

もっと見る

キーワード

詳細情報 詳細情報について

問題の指摘

ページトップへ