Tersmette A C, Offerhaus G J, Giardiello F M, Brand R, Tersmette K W, Tytgat G N, Vandenbroucke J P
Department of Clinical Epidemiology, University Hospital, Leiden, The Netherlands.
Gastroenterology. 1991 Jul;101(1):148-53.
Decreased life expectancy may occur after remote peptic ulcer surgery, but the cause of shortened survival is unclear. A 50-year follow-up study of an Amsterdam cohort of postgastrectomy patients who underwent ulcer surgery between 1931 and 1960 showed a statistically significant decrease in survival after a postoperative interval of 12 years or more compared with the general population. The shortened life expectancy mainly reflected decreased survival in men. In women, no significant difference in survival compared with the general population was observed. The excess mortality in men was predominantly due to a statistically significant increase in cancer-related deaths. Carcinoma of the lung accounted for the majority of excess mortality. No time relationship between lung cancer death and interval since surgery was observed. Thus, smoking, primarily in men who had undergone surgery for gastric ulcers, seems an important factor contributing to excess mortality and shortened life expectancy. Excess mortality due to tobacco use has also been observed in postmarketing surveillance of H2-receptor antagonists. Therefore, smoking cessation may provide the greatest improvement in the long-term prognosis of peptic ulcer patients, regardless of the treatment.
远期消化性溃疡手术后可能出现预期寿命缩短的情况，但生存时间缩短的原因尚不清楚。一项对1931年至1960年间在阿姆斯特丹接受溃疡手术的胃切除术后患者队列进行的50年随访研究显示，与普通人群相比，术后12年或更长时间后，生存率在统计学上有显著下降。预期寿命缩短主要反映在男性生存率下降。在女性中，未观察到与普通人群相比生存率有显著差异。男性的额外死亡率主要是由于癌症相关死亡在统计学上显著增加。肺癌导致了大部分额外死亡率。未观察到肺癌死亡与术后间隔时间之间的时间关系。因此，吸烟，主要是接受过胃溃疡手术的男性吸烟，似乎是导致额外死亡率和预期寿命缩短的一个重要因素。在H2受体拮抗剂的上市后监测中也观察到了烟草使用导致的额外死亡率。因此，无论采用何种治疗方法，戒烟可能对消化性溃疡患者的长期预后有最大改善。
