Heinz J, Kemps A, Baer U
Chirurgischen Abteilung, Wenckebach-Krankenhauses Berlin.
Zentralbl Chir. 1989;114(11):705-13.
Operations were performed on 131 patients for haemorrhagic peptic ulcer at Wenckebach Hospital, between 1977 and 1986. Roughly two thirds of all patients had never had ulcer before. Persistent haemorrhage was recorded from about 20 per cent of these cases by emergency gastroscopy. Immediate surgical action had to be taken on 23.7 per cent. Interval interventions were possible for 28.2 per cent, while almost 50 per cent had to be laparotomised for early recurrent bleeding. Mortality in the wake of immediate emergency operations and surgery for recurrent bleeding was nearly twice as high as that in the context of interval interventions. Resection was performed on 70 per cent, haemostasis only on 26 per cent, and additional vagotomy on 14 per cent. Overall mortality amounted to 27.5 per cent including 36.6 per cent for women and 22.8 per cent for men. Ulcer localisation had no impact on mortality. The highest mortality rate, 38.2 per cent, was recorded from patients on whom only haemostasis had been performed, while 16.7 per cent were recorded from those to whom additional vagotomy had been applied. Lethality in the context of resection amounted to 25.6 per cent. Twenty-three patients had to be relaparotomised (17.6 per cent), which pushed up the mortality rate to 43.5 per cent.
1977年至1986年间,温克巴赫医院对131例出血性消化性溃疡患者进行了手术。所有患者中约三分之二此前从未患过溃疡。通过急诊胃镜检查,约20%的此类病例出现持续性出血。23.7%的患者必须立即采取手术措施。28.2%的患者可行间隔期干预,而近50%的患者因早期复发性出血不得不接受剖腹手术。急诊手术和复发性出血手术的死亡率几乎是间隔期干预死亡率的两倍。70%的患者进行了切除术,仅26%的患者进行了止血,14%的患者进行了附加迷走神经切断术。总体死亡率为27.5%,其中女性为36.6%,男性为22.8%。溃疡部位对死亡率无影响。仅进行止血的患者死亡率最高,为38.2%,而接受附加迷走神经切断术的患者死亡率为16.7%。切除术的致死率为25.6%。23例患者不得不再次剖腹手术(17.6%),这使得死亡率升至43.5%。