Winkeltau G, Arlt G, Truong S, Schumpelick V
Zentralbl Chir. 1986;111(23):1441-9.
Lethality of bleeding peptic ulcer has been reduced to about 15 per cent in recent years by therapeutic endoscopy in combination with differentiated surgical tactics. Intensity and activity of bleeding as well as additional criteria, such as localisation, recurrence of bleeding, and age of the patient, are some of the parameters for surgical indication which are used in decision-making, with due consideration of the spontaneous course. Endoscopic haemostasis should be intensively used to avoid emergency operations and action of early recurrence. Selective early surgery should be performed whenever possible. Surgical techniques should be chosen with two objectives in mind, localised haemostasis and definitive ulcer treatment. Extraluminal and intraluminal ligation and additional vagotomy should be the optional approach to bleeding peptic ulcer. Billroth's I operation should be applied to ventricular ulcer.
近年来，通过治疗性内镜检查结合差异化的手术策略，出血性消化性溃疡的致死率已降至约15%。出血的强度和活动性以及其他标准，如出血部位、出血复发情况和患者年龄，是用于决策的手术指征参数，同时要充分考虑自然病程。应积极采用内镜止血以避免急诊手术和早期复发。只要有可能，应进行选择性早期手术。选择手术技术时应牢记两个目标，即局部止血和溃疡的确定性治疗。腔外和腔内结扎以及附加迷走神经切断术应是治疗出血性消化性溃疡的可选方法。毕罗一式手术应用于胃小弯溃疡。
