Hunt P S, Korman M G, Hansky J, Marshall R D, Peck G S, McCann W J
Br J Surg. 1979 Sep;66(9):633-5. doi: 10.1002/bjs.1800660911.
In a 6-year prospective study from 1972 to 1978 266 patients were admitted to a haematemesis and melaena unit with bleeding duodenal ulcer. There were 13 deaths, a mortality of 5 per cent. A comparison between the three consecutive 2-year periods of study showed an initial mortality of 6 per cent for the first 4 years falling to 2 per cent for the 93 admissions during the final 2 years of experience. Of the 120 patients treated surgically, 10 died in hospital, giving an operative mortality of 8 per cent. The trend in operative mortality was from 13 per cent for the initial 2-year period to 8 per cent for the second period and to 3 per cent for the final 2 years. The operative rate was consecutively 45, 50 and 34 per cent. There was 1 death in conservatively treated patients during each 2-year period of study. Three types of operation were performed: vagotomy, pyloroplasty and oversewing of the ulcer; Polya gastrectomy; and vagotomy and antrectomy. There was no difference in morbidity and mortality between these operations. At a mean follow-up of 3.1 years, 90 per cent of the patients had a good result from their operation. It is concluded that a prospective system of management with an active policy of early endoscopy, surgery and regular audit reduces the mortality from bleeding duodenal ulcer.
在1972年至1978年的一项为期6年的前瞻性研究中，266例因十二指肠溃疡出血而入住呕血与黑便科的患者。有13例死亡，死亡率为5%。对连续三个2年研究期的比较显示，最初4年的死亡率为6%，在最后2年的93例入院患者中降至2%。在120例接受手术治疗的患者中，10例在医院死亡，手术死亡率为8%。手术死亡率的趋势是从最初2年的13%降至第二个2年的8%，再降至最后2年的3%。手术率依次为45%、50%和34%。在研究的每个2年期间，保守治疗的患者中有1例死亡。进行了三种类型的手术：迷走神经切断术、幽门成形术和溃疡缝扎术；波利亚胃切除术；迷走神经切断术和胃窦切除术。这些手术在发病率和死亡率方面没有差异。平均随访3.1年时，90%的患者手术效果良好。结论是，采用早期内镜检查、手术和定期审计的积极政策的前瞻性管理系统可降低十二指肠溃疡出血的死亡率。
