Svanes C
Department of Thoracic Medicine, Haukeland Hospital, University of Bergen, 5021 Bergen, Norway.
World J Surg. 2000 Mar;24(3):277-83. doi: 10.1007/s002689910045.
After increasing steeply at the beginning of the twentieth century, ulcer perforation incidence during the last decades has declined in the young and in men, and it has risen among the elderly and in women. These changes can be attributed to a cohort phenomenon: Ulcer perforation risk is particularly common in the cohorts born after the turn of the twentieth century and is less common in previous and succeeding birth cohorts. A decline in total incidence is expected with the death of the high risk cohorts. Most ulcer perforations among subjects < 75 years of age can be attributed to smoking. Subjects with a history of ulcer perforation therefore have poorer long-term survival than the general population, most pronounced for younger generations. About one of four ulcer perforations can be attributed to the use of nonsteroidal antiinflammatory drugs, a risk factor of particular importance in the elderly. Ulcer perforation was frequently treated by gastric resection in former days, whereas suture, being the first method introduced in 1887, is the method of choice today. The introduction of antibiotics improved the prognosis of ulcer perforation surgery greatly. Postoperative lethality decreased until 1950 but has remained stable since then. Lethality is higher in the elderly and is higher after gastric than after duodenal perforation. The delay before surgical treatment is a strong determinant for lethality, complication rates, and hospital costs. Treatment delay seems to have increased during the last
在20世纪初急剧上升之后，过去几十年间溃疡穿孔的发病率在年轻人和男性中有所下降，而在老年人和女性中则有所上升。这些变化可归因于队列现象：溃疡穿孔风险在20世纪之交后出生的队列中尤为常见，而在之前和之后的出生队列中则较少见。随着高风险队列的死亡，预计总发病率会下降。75岁以下人群中的大多数溃疡穿孔可归因于吸烟。因此，有溃疡穿孔病史的患者长期生存率低于普通人群，在年轻一代中最为明显。约四分之一的溃疡穿孔可归因于使用非甾体抗炎药，这是老年人中一个特别重要的风险因素。过去溃疡穿孔常通过胃切除术治疗，而1887年首次引入的缝合术是如今的首选方法。抗生素的引入极大地改善了溃疡穿孔手术的预后。术后死亡率在1950年之前下降，但此后一直保持稳定。老年人的死亡率更高，胃穿孔后的死亡率高于十二指肠穿孔。手术治疗前的延迟是死亡率、并发症发生率和医院费用的一个重要决定因素。在过去，治疗延迟似乎有所增加。
