Wong J, Lam S K, Lee N W, Lai C L, Lam P, Ong G B
Aust N Z J Surg. 1980 Apr;50(2):150-4. doi: 10.1111/j.1445-2197.1980.tb06654.x.
A prospective trial of immediate operation was carried out on all 123 patients aged 50 years and over who presented with acute non-variceal bleeding as shown endoscopically. The mortality rate was 11.4%. Four hundred and sixty-seven similar patients treated by a conventional and more conservative approach, viz., surgery only for massive, continuous or recurrent bleeding, over an earlier period of three years, had a mortality rate of 6.4% during the acute bleeding episode. In the latter series, the mortality for the 161 patients with emergency surgery was 11.8%. The aggressive approach carries no advantage over the conservative approach and is not to be recommended. In both series surgery for haemorrhage with associated medical illness carried a similarly high mortality (27.3% and 26.3% respectively), indicating that the timing of surgery in such patients, whether it is done as early or as late as possible, does not influence the outcome. This mortality rate of immediate Billroth gastrectomy for gastric ulcer was low (4.8%), so that operation in such patients should not be delayed.
对123例年龄在50岁及以上、经内镜检查显示为急性非静脉曲张性出血的患者进行了即时手术的前瞻性试验。死亡率为11.4%。在三年前的较早时期，467例采用传统且更为保守方法治疗的类似患者，即仅对大量、持续性或复发性出血进行手术，在急性出血发作期间的死亡率为6.4%。在后一组中，161例接受急诊手术患者的死亡率为11.8%。积极的治疗方法相较于保守方法并无优势，因此不建议采用。在这两组中，伴有相关内科疾病的出血患者进行手术的死亡率同样很高（分别为27.3%和26.3%），这表明此类患者手术的时机，无论是尽早还是尽可能延迟进行，都不会影响结果。胃溃疡患者立即行毕罗（Billroth）式胃切除术的死亡率较低（4.8%），因此对此类患者的手术不应延迟。
