The evidence in this contribution is based on the examination of 15 human antrectomy specimens removed for PPU , together with the evidence obtained from a comparison of the amount, degree, and distribution of chronic gastritis in an example of a typical DU, GU, and PPU . The evidence indicates that there is chronic gastritis in all PPUs , which is much less than that seen in GU, but is considerably greater than that seen in the stomach of a patient with a DU. In PPU the level of acid secretion may vary, and as a hypothesis it is suggested that PPU should be regarded as a mixed type of disease, in which both chronic gastritis and the effects of acid secretion are important. In individual instances either one or both of these components may be of particular importance, and in this way PPU is different from the more usual type of duodenal or gastric ulcer. For surgical management to be successful in PPU , both components should be treated. In PPU it appears that the higher the acid output, the nearer toward the duodenum the ulcer is likely to occur, with perhaps the greater curve ulcers showing a higher level of acid secretion than ulcers occurring on the lesser curvature. Whether or not the hypothesis is correct remains to be established, but it does have the single advantage that it explains most of the problems known to be associated with PPU , and perhaps even more important, it suggests a rational form of surgical management. When more information is available it may be possible to define which of the different factors are important in each instance and therefore to offer individual patients the surgical procedure appropriate to their specific needs.
本论文中的证据基于对15例因难治性溃疡（PPU）而切除的人胃窦标本的检查，以及从典型十二指肠溃疡（DU）、胃溃疡（GU）和难治性溃疡（PPU）患者的慢性胃炎数量、程度和分布比较中获得的证据。证据表明，所有难治性溃疡（PPU）均存在慢性胃炎，其程度远低于胃溃疡（GU），但远高于十二指肠溃疡（DU）患者的胃。在难治性溃疡（PPU）中，胃酸分泌水平可能有所不同，作为一种假设，有人提出难治性溃疡（PPU）应被视为一种混合型疾病，其中慢性胃炎和胃酸分泌的影响都很重要。在个别情况下，这些因素中的一个或两个可能特别重要，从这个意义上说，难治性溃疡（PPU）不同于更常见的十二指肠溃疡或胃溃疡类型。要使难治性溃疡（PPU）的手术治疗成功，这两个因素都应得到治疗。在难治性溃疡（PPU）中，似乎胃酸分泌越高，溃疡越有可能靠近十二指肠发生，也许大弯侧溃疡的胃酸分泌水平高于小弯侧溃疡。这个假设是否正确还有待证实，但它确实有一个优点，即它解释了大多数已知与难治性溃疡（PPU）相关的问题，也许更重要的是，它提出了一种合理的手术治疗方式。当有更多信息可用时，也许可以确定在每个病例中哪些不同因素是重要的，从而为个体患者提供适合其特定需求的手术方法。
