Doberneck R C
University of New Mexico, School of Medicine, Albuquerque 87131.
Am Surg. 1993 Jul;59(7):472-4.
Twenty-four high risk patients underwent limited operation for bleeding (15) or perforated (9) gastric ulcers. Limited operation is defined as local ulcer management (oversewing or excision of bleeding ulcer and suture closure of perforated ulcer) with (8) or without (16) complementary vagotomy and pyloroplasty. Sixteen patients had serious coexistent disease and eight were physiologically unstable because of continued bleeding or peritonitis. Nine patients (38%) died; seven of 15 (47%) died after operation for bleeding and two of nine (22%) after operation for perforation. Only one patient rebled prior to death, and only two patients died of causes directly attributable to the operative procedure. The remaining six patients died as a result of coexistent disease. Limited operation for gastric ulcer is an option for treatment of highly selected, high risk patients requiring urgent operation for bleeding or perforated ulcer. The addition of complementary vagotomy and pyloroplasty appears to make little difference as to the immediate result but may influence late results. Limited operation does not reduce the mortality rate after operation on patients with bleeding or perforated ulcers.
24例高危患者因胃溃疡出血（15例）或穿孔（9例）接受了限制性手术。限制性手术定义为局部溃疡处理（缝扎或切除出血性溃疡以及缝合穿孔性溃疡），同时（8例）或不（16例）加做补充性迷走神经切断术和幽门成形术。16例患者并存严重疾病，8例因持续出血或腹膜炎而处于生理不稳定状态。9例患者（38%）死亡；15例出血性溃疡手术后7例（47%）死亡，9例穿孔性溃疡手术后2例（22%）死亡。仅1例患者在死亡前再次出血，仅2例患者死于直接与手术操作相关的原因。其余6例患者死于并存疾病。对于因出血或穿孔性溃疡而需要紧急手术的高度选择的高危患者，胃溃疡限制性手术是一种治疗选择。补充性迷走神经切断术和幽门成形术的加做似乎对近期结果影响不大，但可能影响远期结果。限制性手术并不能降低出血或穿孔性溃疡患者术后的死亡率。
