Ross A H, Smith M A, Anderson J R, Small W P
N Engl J Med. 1982 Aug 26;307(9):519-22. doi: 10.1056/NEJM198208263070902.
To examine the claim that life expectancy is reduced after curative peptic-ulcer surgery, we studied mortality and its causes in 779 men with peptic ulcer treated surgically between 1947 and 1965. The minimum follow-up period of survivors was 15 years. There was an excess mortality in the three major age groups (30 to 39, 40 to 49, and 50 to 59 years at operation), as compared with the general population (P less than 0.001), with a mean shift of 9.1 years in the survival curve. Surgery was not the direct cause of death. In particular, the eight deaths from carcinoma of the stomach were no more than expected. Excess mortality was due to smoking-associated disease, which accounted for 200 deaths. Eighty-three per cent of the patients were cigarette smokers. We conclude that substituting highly selective vagotomy for gastrectomy will not lead to improved survival, because 80 per cent of patients now having operations for ulcer are heavy cigarette smokers.
为了检验关于根治性消化性溃疡手术后预期寿命会缩短这一说法，我们研究了1947年至1965年间接受手术治疗的779例男性消化性溃疡患者的死亡率及其死因。存活者的最短随访期为15年。与普通人群相比，三个主要年龄组（手术时年龄为30至39岁、40至49岁和50至59岁）存在超额死亡率（P<0.001），生存曲线平均偏移9.1年。手术并非直接死因。特别是，8例胃癌死亡病例并未超过预期。超额死亡率归因于与吸烟相关的疾病，此类疾病导致200例死亡。83%的患者为吸烟者。我们得出结论，用高选择性迷走神经切断术替代胃切除术不会提高生存率，因为目前接受溃疡手术的患者中有80%是重度吸烟者。
