Schirmer B D, Meyers W C, Hanks J B, Kortz W J, Jones R S, Postlethwait R W
Ann Surg. 1982 May;195(5):653-61. doi: 10.1097/00000658-198205000-00015.
One hundred sixty-six patients with documented recurrent or marginal ulcers following previous ulcer operations were seen at Duke Medical Center and the Durham VA Hospital from 1950 through 1980. Patients with the diagnosis of gastrinoma were excluded from the series. Evaluation of initial operation for recurrent ulcer showed that the highest recurrence rate occurred following non-acid-reducing operations. Analysis of the symptom-free interval following initial ulcer operation showed a significantly longer interval prior to recurrent ulcer development following gastroenterostomy than other procedures, while resection and Billroth I reanastomosis showed a significantly shorter symptom-free interval than did other procedures. Endoscopy proved 85% sensitive in making the diagnosis of marginal ulcer, while upper GI series was 71% sensitive. Surgical treatment of 132 patients resulted in a 20.4% recurrence rate of second marginal ulcer, with a 2.3% mortality rate and a 10.6% morbidity rate. Second operation for recurrent ulcer in 24 patients yielded no deaths, a 12.5% morbidity rate, and a 29.2% recurrence rate. Average follow-up for the series was 12.3 years, and ultimate outcome of treatment showed, of patients not lost to follow-up, a 58.2% satisfactory to excellent rating, while 42.8% of patients had an unsatisfactory result of treatment.
1950年至1980年期间，在杜克医学中心和达勒姆退伍军人管理局医院共诊治了166例有既往溃疡手术史且确诊为复发性或边缘性溃疡的患者。本系列研究排除了胃泌素瘤患者。对复发性溃疡初次手术的评估显示，非抑酸手术的复发率最高。对初次溃疡手术后无症状期的分析表明，胃空肠吻合术后复发性溃疡出现前的无症状期明显长于其他手术，而切除术和毕罗一世再吻合术的无症状期明显短于其他手术。内镜检查诊断边缘性溃疡的敏感度为85%，而上消化道造影的敏感度为71%。132例患者接受手术治疗后，第二次边缘性溃疡的复发率为20.4%，死亡率为2.3%，发病率为10.6%。24例复发性溃疡患者接受二次手术，无死亡病例，发病率为12.5%，复发率为29.2%。本系列患者的平均随访时间为12.3年，治疗的最终结果显示，在未失访的患者中，58.2%的患者治疗结果为满意至优秀，而42.8%的患者治疗结果不满意。
