NGHIÊN CỨU ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ ĐÁNH GIÁ KẾT QUẢ SỚM PHẪU THUẬT NỘI SOI KHÂU LỖ THỦNG Ổ LOÉT DẠ DÀY - TÁ TRÀNG Ở NGƯỜI CAO TUỔI TẠI BỆNH VIỆN ĐA KHOA THÀNH PHỐ CẦN THƠ NĂM 2018 -2019

Abstract

 Background: Perforated peptic ulcer has high mortality, accounted for 1.3-20%. Laparoscopic surgery has several advantages. It is also an optimal method for perforated peptic ulcer closure treatment. Objectives: to identify the clinical and subclinical characteristics of perforated peptic ulcer and evaluate the early postoperative result of elderly patients undergoing laparoscopic closure in perforated peptic ulcer in Cantho General Hospital. Materials and method: Between 3/2018 and 7/2019, a consecutive series of 49 patients who were operated with laparoscopic surgery for closing perforated peptic ulcer. The questionnaires were used through this study to collect data including patients’ information, clinical and subclinical characteristics and treatment result. SPSS 18.0 software was used for analyzing data. Results: The study included 49 patients, the number of patients aged 60-69 was 44.9%, 24.5% of patients aged 70-79 and patients aged 80 and above accounted for 30.6%. Accounted for Males and Females were 77.6% and 22.4% respectively. There were 51% of patients had abdominal pain focus on upper abdomen. The proportion of pain on upper abdomen and right iliac region and abdominal rigidity and diffuse abdominal pain accounted for 22.4% and 26.5% respectively. Prevalence of comorbidities among patients were hypertension (12.2%). The figure of patients had high WBC count from 9000 and above was 81.6%. Free intraperitoneal gas was seen by X-ray investigation in 79.6% of patients. The treatment results were evaluated: There were 49.6% of patients with local peritonitis; 44.9% of patients had fluid and pseudomembrance spread throughout the abdomen; 8.2% of patients had diffuse fluid and adhesion of pseudomembrance which was hard to clean or it formed into cavities among loops of small bowel. Mean time to remove gastric drainage was 2.76±1.535 days. Mean hospital stay was 9.08 days. The group with diffuse peritonitis had a mean 10.15 days for postopertative treatment longer than the local peritonitis group with a mean 7.87 days, the difference between those groups were statistically significant. The rate of well surgical procedure was 93.9%. 54.3% of patients assessed the treatment was excellent overall, 43.5% rated was good, only 1 patient rated it was average. Conclusion: Laparoscopic surgery was an effective treatment with nice incision, shortening hospital stay length, and reducing postoperative complications for elder patients.