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Triple tube drainage for “difficult” gastroduodenal perforations:A prospective study

World Journal of Gastrointestinal Surgery 2017年第1期9卷 19-24页

作者： Nitin Agarwal Nishant Kumar Malviya Nikhil Gupta Iqbal Singh Sanjay Gupta Department of Surgery and Renal Transplant Postgraduate Institute of Medical Education and Research (PG-IMER) and Dr. Ram Manohar Lohia Hospital Depart-ment of Surgery University College of Medical Sciences and Guru Tegh Bahadur Hospital Department of Surgery Post Graduate Institute of Medical Education and Research (PGIMER) and Dr RML Hospital

AIMTo prospectively study the outcome of difficult gastroduodenal perforations (GDPs) treated by triple tube drainage (TTD) in order to standardize the *** presenting to a single surgical unit of a tertiary hospital with difficult GDPs (large, unfavourable local and systemic factors) were treated with TTD (gastrostomy, duodenostomy and feeding jejunostomy). Postoperative parameters were observed like time to return of bowel sounds, time to start enteral feeds, time to start oral feeds, daily output of all drains, time to clamping/removal of all drains, time for skin to heal, complications, hospital stay, and, mortality. Descriptive statistics were *** December 2013 and April 2015, 20 patients undergoing TTD for GDP were included, with mean age of 44.6 ± 19.8 years and male:female ratio of 17:3. Mean pre-operative APACHE II scores were 10.85 ± 3.55; most GDPs were prepyloric (9/20; 45%) or proximal duodenal (8/20; 40%) and mean size was 1.83 ± 0.59 cm (largest 2.5 cm). Median times of resumption of enteral feeding, removal of gastrostomy, removal of duodenostomy, removal of feeding jejunostomy and oral feeding were 4 d (4-5 IQR), 13 (12-16.5 IQR), 16 (16.25-22.25 IQR), 18 (16.5-24 IQR) and 12 d (10.75-18.5 IQR) respectively. Median hospital stay was 22 d (19-26 IQR) while mortality was 4/20 (20%).CONCLUSIONTTD for difficult GDP is feasible, easy in the emergency, and patients recover in two-three weeks. It obviates the need for technically demanding and riskier procedures.

关键词： Peptic ulcer Perforation peritonitis APACHE Triple tube drainage duodenostomy

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