Sonnenberg A
Br Med J (Clin Res Ed). 1985 Apr 20;290(6476):1185-7. doi: 10.1136/bmj.290.6476.1185.
A simple model of a Markov chain was used to study the long term outcome of different strategies for the treatment of duodenal ulcer. Maintenance treatment with H2 receptor antagonists surpassed intermittent drug treatment and proximal gastric vagotomy with respect to the relapse free interval and severe postoperative morbidity. With maintenance treatment the rate of complications and the number of deaths related to ulcer were slightly higher than after proximal gastric vagotomy. Nevertheless, because the few deaths from proximal gastric vagotomy occur at the initiation of treatment the loss of life years during maintenance treatment exceeded that of proximal gastric vagotomy only after 20 years. Despite its rarity, severe postoperative morbidity after proximal gastric vagotomy far exceeded that after the few emergency operations which would become necessary in the course of maintenance treatment. The superiority of maintenance treatment over proximal gastric vagotomy remained insensitive to changes in the assumptions underlying the recurrence rate with both treatments and the postoperative morbidity of proximal gastric vagotomy.
采用马尔可夫链的简单模型来研究十二指肠溃疡不同治疗策略的长期结果。就无复发间隔和严重术后发病率而言，使用H2受体拮抗剂进行维持治疗优于间歇性药物治疗和近端胃迷走神经切断术。维持治疗时，与溃疡相关的并发症发生率和死亡人数略高于近端胃迷走神经切断术后。然而，由于近端胃迷走神经切断术导致的少数死亡发生在治疗开始时，维持治疗期间的生命年损失仅在20年后才超过近端胃迷走神经切断术。尽管近端胃迷走神经切断术后严重术后发病率罕见，但远远超过维持治疗过程中可能需要的少数急诊手术后的发病率。维持治疗相对于近端胃迷走神经切断术的优势对两种治疗复发率以及近端胃迷走神经切断术术后发病率的假设变化不敏感。
