Branicki F J, Boey J, Fok P J, Pritchett C J, Fan S T, Lai E C, Mok F P, Wong W S, Lam S K, Hui W M
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Ann Surg. 1990 Apr;211(4):411-8. doi: 10.1097/00000658-199004000-00006.
There were 12 hospital deaths in 433 patients (2.8%, 1.6% at 30 days) presenting with bleeding duodenal ulcer. Excluding patients who underwent immediate operation or early elective surgery, where ulcer size was measured at initial endoscopy rebleeding was evident in 40/288 patients (13.9%) and was associated with an increased mortality (0.4% v 12.5%) (p less than 0.0001). Rebleeding rates for ulcers less than or equal to 1 cm and greater than 1 cm were respectively 28/239 (11.7%) and 12/49 (24.5%) (p less than 0.02). Rebleeding occurred in 13/186 patients (7.0%) in whom endoscopic stigmata of recent haemorrhage were absent and in 27/102 (26.5%) with such stigmata (p less than 0.0001). The mortality rate for patients without stigmata was 3/186 (1.6%) whilst mortality figures for patients with ulcers less than or equal to 1 cm and greater than 1 cm in size were respectively 0/77 and 3/25 (12.0%) when stigmata were identified. Ulcers greater than 1 cm were more frequent in the greater than 60 year age group, more likely to have stigmata and carried an increased risk of rebleeding and mortality.
433例十二指肠溃疡出血患者中有12例院内死亡（2.8%，30天死亡率为1.6%）。排除立即手术或早期择期手术的患者，在初次内镜检查时测量溃疡大小，288例患者中有40例（13.9%）出现再出血，且再出血与死亡率增加相关（0.4%对12.5%）（p<0.0001）。溃疡直径小于或等于1 cm和大于1 cm的再出血率分别为28/239（11.7%）和12/49（24.5%）（p<0.02）。186例近期无出血内镜征象的患者中有13例（7.0%）发生再出血，102例有此类征象的患者中有27例（26.5%）发生再出血（p<0.0001）。无征象患者的死亡率为3/186（1.6%），而在发现征象时，溃疡直径小于或等于1 cm和大于1 cm的患者死亡率分别为0/77和3/25（12.0%）。大于1 cm的溃疡在60岁以上年龄组中更常见，更易出现征象，再出血和死亡风险增加。
