Kubba A K, Choudari C, Rajgopal C, Palmer K R
Gastro-intestinal Unit, Western General Hospital, Edinburgh, UK.
Eur J Gastroenterol Hepatol. 1996 Dec;8(12):1175-8. doi: 10.1097/00042737-199612000-00008.
To review the outcome of patients who underwent emergency surgery for major peptic ulcer haemorrhage after failed endoscopic therapy. To address whether 'conservative' or 'aggressive' surgery is best.
A retrospective analysis of emergency surgery for ulcer bleeding which could not be controlled by endoscopic therapy.
The four admitting units in the Lothian region of Scotland.
Sixty-seven patients who failed endoscopic therapy for bleeding peptic ulcer and underwent emergency surgery between December 1990 and December 1995. Simple underrunning or excision of ulcer alone was done in 31 patients whilst 36 had more radical surgery.
Rebleeding and 30-day mortality rates.
Rebleeding was significantly higher in patients treated by underrunning (7 versus 1, P < 0.013). There were fewer deaths in the radically treated group (5 versus 7, not significant).
Patients undergoing surgical operation for severe peptic ulcer haemorrhage after failed endoscopic therapy may be best served by a relatively aggressive approach.
回顾内镜治疗失败后接受急诊手术治疗的主要消化性溃疡出血患者的治疗结果。探讨“保守”手术还是“积极”手术效果最佳。
对内镜治疗无法控制的溃疡出血急诊手术进行回顾性分析。
苏格兰洛锡安地区的四个收治单位。
1990年12月至1995年12月期间，67例内镜治疗失败的消化性溃疡出血患者接受了急诊手术。31例患者仅进行了简单的溃疡底部缝扎或单纯溃疡切除，而36例患者接受了更激进的手术。
再出血率和30天死亡率。
采用溃疡底部缝扎治疗的患者再出血率显著更高（7例对1例，P<0.013）。接受激进手术治疗的组死亡人数较少（5例对7例，无显著差异）。
内镜治疗失败后因严重消化性溃疡出血接受手术治疗的患者，采用相对积极的手术方法可能效果最佳。
