Hunt P S
Ann Surg. 1984 Jan;199(1):44-50. doi: 10.1097/00000658-198401000-00008.
Analysis of experience with chronic bleeding peptic ulcer in 504 patients, admitted from 1960 to 1971, shows a hospital mortality of 12%. This retrospective review suggested that early endoscopic diagnosis, adequate resuscitation and a policy of early selective surgery was necessary if mortality was to be reduced. With this policy, there were 37 deaths in 633 patients admitted during the period of prospective study from 1972 to 1982 (5.8%). There were 25 deaths after emergency surgery in 206 patients, 56% of postoperative deaths were related to technical factors and 44% to nontechnical complications. Comparison with the retrospective study from 1961 to 1970 showed, matching in terms of incidence of shock, sex distribution and number of patients over 60 years of age. During this period, 142 emergency operations were performed, with 25 postoperative deaths, an operative mortality of 17.6%. Thirty-five deaths occurred in conservatively treated patients (9.5%) compared with 12 deaths in conservatively treated patients from 1972 to 1982 (2.6%). Within the period of prospective study, there was a significant reduction in mortality from 8%, for the first 5 years, to 3.9% for the second 5 years of study. These two periods matched except for a significant increase in the proportion of patients 60 years and over. This was mainly due to a rise in incidence of aged patients with gastric ulcer. Also noted was a decrease in mortality in patients 60 years and over which reached significance, and a significant decrease in the number of deaths in shocked patients. A significant fall in technically related postoperative complications was noted, from 44 (11 causing death) to 12 (three causing death) during the second 5 years of prospective study. There were 444 patients admitted with bleeding duodenal ulcer with 20 deaths in hospital (4.5%), and 17 deaths in 189 patients admitted with bleeding gastric ulcer, a mortality of 9%. No single factor could be isolated as the reason for the improved results. Possibly the most significant reason is the application of a defined policy in a special unit where staff became familiar with all aspects of the problem of bleeding chronic peptic ulceration.
对1960年至1971年收治的504例慢性出血性消化性溃疡患者的经验分析显示，医院死亡率为12%。这项回顾性研究表明，若要降低死亡率，早期内镜诊断、充分复苏以及早期选择性手术策略是必要的。采用这一策略后，在1972年至1982年的前瞻性研究期间收治的633例患者中有37例死亡（5.8%）。206例患者接受急诊手术后有25例死亡，术后死亡的56%与技术因素有关，44%与非技术并发症有关。与1961年至1970年的回顾性研究相比，在休克发生率、性别分布以及60岁以上患者数量方面具有可比性。在此期间，进行了142例急诊手术，术后有25例死亡，手术死亡率为17.6%。保守治疗的患者中有35例死亡（9.5%），而1972年至1982年保守治疗的患者中有12例死亡（2.6%）。在前瞻性研究期间，死亡率从研究的前5年的8%显著降至后5年的3.9%。这两个时期除了60岁及以上患者的比例显著增加外具有可比性。这主要是由于老年胃溃疡患者的发病率上升。还注意到60岁及以上患者的死亡率下降且具有显著性，休克患者的死亡人数显著减少。在前瞻性研究的后5年期间，技术相关的术后并发症显著减少，从44例（11例导致死亡）降至12例（3例导致死亡）。444例十二指肠溃疡出血患者中有20例住院死亡（4.5%），189例胃溃疡出血患者中有17例死亡，死亡率为9%。没有单一因素可被确定为结果改善的原因。可能最重要的原因是在一个特殊科室应用了明确的策略，在那里工作人员熟悉慢性消化性溃疡出血问题的各个方面。
