Penston J G, Boyd E J, Wormsley K G
Ninewells Hospital & Medical School, Dundee, Scotland, UK.
Gastroenterol Jpn. 1992 Feb;27(1):129-41. doi: 10.1007/BF02775076.
The present study is an attempt to assess the risks of the complications associated with recurrent ulcers in patients who have undergone gastric surgery and to determine whether these risks differ from those observed in patients receiving long term maintenance treatment with H2-receptor antagonists for ulcer disease. One hundred and thirty studies reported in the literature during the past three decades have been analysed to determine both the approximate rate of ulcer recurrence and the proportion of patients with recurrent ulcers who have presented with either haemorrhage or perforation following the various types of gastric surgery for ulcer disease. From these data, estimates of the risks of haemorrhage and of perforation during the years following gastric surgery have been calculated. Vagotomy and antrectomy is associated with a low risk of ulcer recurrence (less than 1%) and the risk of complications in later years is accordingly very small (less than 0.5%). Partial gastrectomy, although associated with low recurrence rates, has a higher risk of complications (1.3% for haemorrhage, 0.3% for perforation) because the proportion of recurrent ulcers that present with haemorrhage or perforation is high (33% and 8%, respectively). Truncal vagotomy plus drainage (TV + D) and highly selective vagotomy (HSV) are associated with recurrence rates of 9% and 12%, respectively, but ulcer recurrences following these operations are less frequently accompanied by complications then recurrences after gastric resection and, as a result, the risks of haemorrhage (1.7% for TV + D; 1.3% for HSV) are similar to the risks after gastric resection. During long term (five years or more) maintenance treatment with H2-receptor antagonists, the risks of haemorrhage and perforation are less than 2% and less than 0.5%, respectively. It appears, therefore, that the likelihood of developing haemorrhage or perforation following gastric surgery is of the same order as that during maintenance treatment with H2-receptor antagonists, at least during the first decade of follow-up.
本研究旨在评估接受胃手术患者复发性溃疡相关并发症的风险，并确定这些风险是否与接受H2受体拮抗剂长期维持治疗的溃疡病患者所观察到的风险不同。分析了过去三十年文献报道的130项研究，以确定溃疡复发的大致率以及复发性溃疡患者在接受各种类型的溃疡病胃手术后出现出血或穿孔的比例。根据这些数据，计算了胃手术后数年出血和穿孔的风险估计值。迷走神经切断术和胃窦切除术与溃疡复发风险较低（低于1%）相关，因此后期并发症风险非常小（低于0.5%）。胃部分切除术虽然复发率较低，但并发症风险较高（出血为1.3%，穿孔为0.3%），因为出现出血或穿孔的复发性溃疡比例较高（分别为33%和8%）。迷走神经干切断术加引流术（TV + D）和高选择性迷走神经切断术（HSV）的复发率分别为9%和12%，但这些手术后的溃疡复发较少伴有并发症，而胃切除术后复发则不然，因此出血风险（TV + D为1.7%；HSV为1.3%）与胃切除术后风险相似。在使用H2受体拮抗剂进行长期（五年或更长时间）维持治疗期间，出血和穿孔风险分别低于2%和低于0.5%。因此，至少在随访的第一个十年中，胃手术后发生出血或穿孔的可能性与使用H2受体拮抗剂维持治疗期间的可能性处于同一水平。
