Ti T K
Ann Acad Med Singap. 1983 Oct;12(4):564-9.
This paper reports a personal experience in the management of 45 patients with recurrent ulcer after gastric surgery. Inadequate acid reduction was the major cause of ulcer recurrence and treatment was by further acid reduction. Revisional surgery was performed in 23 patients (including a patient with a gastro-jejuno-colic fistula) with one mortality. Preliminary results of therapy with histamine H2-receptor antagonists have been encouraging and there appears to be a reduced need for re-operation in these patients in recent years. Less common causes of ulcer recurrence include retained suture material (2 cases) and the Zollinger-Ellison syndrome (2 cases). The incidence of post-surgical ulcer recurrence may be reduced by: improved surgical techniques, particularly in the performance of vagotomy, and avoidance of operations without acid reducing procedures e.g., gastro-jejunostomy without vagotomy; wider use of emergency ulcer curative surgery for perforated peptic ulcer. Experience at two local centres has been that this is a safe procedure in selected patients, there being no mortality in 58 cases. Routine screening of peptic ulcer patients for the Zollinger-Ellison Syndrome by measuring the serum gastrin level facilitates early diagnosis of the condition, thus forestalling gastric surgery and the inevitable recurrent ulceration.
本文报告了45例胃手术后复发性溃疡患者的治疗经验。胃酸分泌减少不足是溃疡复发的主要原因，治疗方法是进一步减少胃酸分泌。23例患者（包括1例胃空肠结肠瘘患者）接受了修正手术，1例死亡。组胺H2受体拮抗剂治疗的初步结果令人鼓舞，近年来这些患者再次手术的需求似乎有所减少。溃疡复发的少见原因包括残留缝线材料（2例）和佐林格-埃利森综合征（2例）。手术性溃疡复发的发生率可通过以下方法降低：改进手术技术，尤其是迷走神经切断术的操作，并避免不进行胃酸分泌减少程序的手术，如无迷走神经切断术的胃空肠吻合术；更广泛地使用急诊溃疡根治手术治疗穿孔性消化性溃疡。两个当地中心的经验表明，在选定的患者中这是一种安全的手术，58例患者无死亡病例。通过测量血清胃泌素水平对消化性溃疡患者进行佐林格-埃利森综合征的常规筛查有助于该病的早期诊断，从而避免胃手术及不可避免的溃疡复发。
