Ishikawa M, Ogata S, Harada M, Sakakihara Y
Department of Surgery, Ehime General Hospital, Japan.
Surg Today. 1995;25(4):318-23. doi: 10.1007/BF00311253.
A total of 902 surgical patients with peptic ulcer disease were evaluated to clarify the effects of H2-receptor antagonists and endoscopic hemostasis on surgical treatment. Following the introduction of these treatments to our institute in 1982, the number of operations performed annually decreased by 40%, or 36 cases per year. However, a remarkable increase in the frequency of surgical emergency intervention since 1982 was concurrently observed, with the ratio of emergency procedures to the total number of operated cases increasing to 72.5% in the last 5 years of the study. Moreover, intractability as an indication for surgery decreased to 34.1%, compared with an increase in the number of patients with bleeding and perforated ulcers requiring operation. There were 13 postoperative deaths recorded (1.4%). All of the deaths were in patients who had undergone emergency surgery in poor health. Of these 13 patients, 10 had bleeding ulcers. A study of bleeding ulcers for which endoscopic hemostasis had been unsuccessful revealed that shock on admission and a concomitant medical condition had been evident in all the patients who died, and in 52.2% and 30.4% of the survivors, respectively. The current study suggests that the frequency of high-risk patients requiring surgery is increasing since the introduction of H2-receptor antagonists and endoscopic hemostasis, and thus, prompt surgical treatment and intensive management for such patients is essential.
对902例消化性溃疡疾病的外科患者进行了评估，以阐明H2受体拮抗剂和内镜止血对手术治疗的影响。自1982年这些治疗方法引入我院后，每年的手术例数减少了40%，即每年减少36例。然而，自1982年以来，同时观察到外科急诊干预的频率显著增加，在研究的最后5年中，急诊手术与总手术例数的比例增至72.5%。此外，作为手术指征的难治性疾病降至34.1%，而需要手术的出血性溃疡和穿孔性溃疡患者数量有所增加。记录到13例术后死亡（1.4%）。所有死亡患者均为健康状况较差时接受急诊手术的患者。在这13例患者中，10例患有出血性溃疡。对内镜止血失败的出血性溃疡进行的一项研究表明，所有死亡患者入院时均出现休克且伴有其他疾病，而在幸存者中，分别有52.2%和30.4%的患者出现上述情况。当前研究表明，自引入H2受体拮抗剂和内镜止血后，需要手术的高危患者数量在增加，因此，对此类患者进行及时的手术治疗和强化管理至关重要。
