Stabile B E, Hardy H J, Passaro E
Arch Surg. 1979 Oct;114(10):1153-6. doi: 10.1001/archsurg.1979.01370340059010.
Among 70 cases of perforated duodenal ulcers treated by plication, eight were complicated by massive postoperative hemorrhage from a syncronous posterior "kissing" duodenal ulcer. Critical analysis revealed that only signs of gastrointestinal (GI) bleeding preoperatively had predictive value for postoperative hemorrhage. Twenty-four patients had one or more predictive signs, and eight actually bled postoperatively. There was a 50% mortality and 75% additional complication rate for the bleeders. In contrast, the nonbleeders had a mortality and a complication rate of only 18% and 35%, respectively. There was no observed superiority of either surgical or medical treatment for postoperative hemorrhage. In perforated duodenal ulcer with evidence of GI blood loss, an intraoperative search for a posterior kissing ulcer is recommended. If a kissing ulcer is found, an acid-reducing operation and suture ligation of the ulcer is indicated.
在70例采用折叠术治疗的十二指肠溃疡穿孔病例中，有8例因同时存在的后壁“吻合性”十二指肠溃疡而并发术后大出血。批判性分析显示，术前只有胃肠道（GI）出血迹象对术后出血具有预测价值。24例患者有一项或多项预测体征，其中8例术后实际发生出血。出血患者的死亡率为50%，额外并发症发生率为75%。相比之下，未出血患者的死亡率和并发症发生率分别仅为18%和35%。对于术后出血，未观察到手术治疗或药物治疗有任何优势。对于有GI失血证据的十二指肠溃疡穿孔，建议术中探查后壁吻合性溃疡。如果发现吻合性溃疡，则应进行减酸手术并对溃疡进行缝合结扎。
