Lundegårdh G, Helmick C, Zack M, Adami H O
Department of Surgery, Luleå-Boden Hospitals, Sweden.
Dig Dis Sci. 1994 Feb;39(2):340-6. doi: 10.1007/BF02090206.
Partial gastrectomy for benign ulcer disease may influence future risk of death, eg, through changes in life-style or metabolism. To reveal such possible long-term effects, we analyzed a population-based cohort of 6459 patients operated on from 1950 through 1958 and followed through 1985. We found a lower overall mortality than in the general Swedish population (standardized mortality ratio = 0.94; 95% confidence interval 0.91-0.97). Mortality was decreased among those with duodenal ulcers, Billroth II operations, and older age at operation but increased as time passed after operation. Mortality was significantly (P < 0.05) increased from tuberculosis, alcoholism, emphysema, stomach ulcer, intestinal obstruction, gallbladder or biliary disease, suicide, and accidental falls but decreased from ischemic heart disease and cerebrovascular disease. Preoperative selection of healthy patients and the probable increased prevalence of risk factors for ulcer disease (smoking, alcoholism, and lower socioeconomic status) in this cohort explain most of these findings. Apart from intestinal obstruction, gallbladder or biliary tract diseases, and tuberculosis, the surgical procedure did not appear to increase mortality beyond one year after operation.
良性溃疡病的部分胃切除术可能会影响未来的死亡风险,例如通过生活方式或新陈代谢的改变。为了揭示这种可能的长期影响,我们分析了一组基于人群的队列,该队列由1950年至1958年接受手术并随访至1985年的6459例患者组成。我们发现总体死亡率低于瑞典普通人群(标准化死亡率=0.94;95%置信区间0.91-0.97)。十二指肠溃疡患者、毕罗Ⅱ式手术患者以及手术时年龄较大者的死亡率降低,但随着术后时间的推移死亡率升高。结核病、酒精中毒、肺气肿、胃溃疡、肠梗阻、胆囊或胆道疾病、自杀以及意外跌倒导致的死亡率显著(P<0.05)升高,但缺血性心脏病和脑血管疾病导致的死亡率降低。术前选择健康患者以及该队列中溃疡病危险因素(吸烟、酒精中毒和较低的社会经济地位)可能增加的患病率解释了这些发现中的大部分。除了肠梗阻、胆囊或胆道疾病以及结核病外,手术操作似乎在术后一年后并未增加死亡率。