Steiger Z, Nickel W O, Shannon G J, Nedwicki E G, Higgins R F
Am J Surg. 1976 Jun;131(6):668-71. doi: 10.1016/0002-9610(76)90174-4.
Reviewing the charts of tuberculosis patients during a span of seventeen years, we found a large number of gastrectomized patients. In our general hospital population, the incidence of tuberculosis was 3.2%. Among the gastrectomized patients, the percentage of tuberculosis was 6.3%. Of our tuberculosis patients 1.9% had gastrectomy, whereas of our general population 0.67% had gastrectomy. We were unable to arrive at any definite conclusions regarding the causative relationship between gastrectomy and tuberculosis. It is a retrospective study with all the fallacies, but the data does show an extremely significant difference between the incidence of gastrectomy in the general hospital population and the incidence of gastrectomy in histories of patients admitted with tuberculosis. It appears that a patient having gastrectomy runs a considerably greater risk of having tuberculosis in later life than a patient admitted for other reasons. Clinically, we were impressed with the widespread character of the disease in association with the poor nutritional status in the majority of the patients. We, therefore, could not avoid associating the loss of stomach substance with its nutritional function and the development of tuberculosis. As a consequence, we recommend a purified protein derivative test for all pateints undergoing gastric surgery. If the test proves to be positive, it is suggested the patient be given a course of isoniazid for one year. In the face of negative purified protein derivative test, we repeat the test at six month intervals. Should a conversion of the purified protein derivative occur, the patient is started on the course of isoniazid therapy. Our current belief is that more conservative methods of gastric surgery, that is, pyloroplasty, vagotomy, or antrectomy, should be substituted for gastrectomy in the treatment of duodenal ulcer disease to preserve a more normal gastric physiologic structure.
回顾十七年间肺结核患者的病历，我们发现大量患者接受了胃切除术。在我院的普通住院患者中，肺结核发病率为3.2%。在接受胃切除手术的患者中，肺结核发病率为6.3%。在我们的肺结核患者中，1.9%接受过胃切除术，而在普通人群中，这一比例为0.67%。我们无法就胃切除术与肺结核之间的因果关系得出任何明确结论。这是一项存在各种谬误的回顾性研究，但数据确实显示，综合医院普通住院患者的胃切除发病率与因肺结核入院患者病历中的胃切除发病率之间存在极其显著的差异。似乎接受胃切除术的患者在晚年患肺结核的风险比因其他原因入院的患者要高得多。临床上，我们对该病的广泛传播以及大多数患者营养不良的状况印象深刻。因此，我们不可避免地将胃实质的丧失与其营养功能以及肺结核的发展联系起来。因此，我们建议对所有接受胃部手术的患者进行结核菌素试验。如果试验结果呈阳性，建议患者接受为期一年的异烟肼治疗。如果结核菌素试验结果为阴性，我们每隔六个月重复进行一次试验。如果结核菌素试验结果出现转变，患者应开始接受异烟肼治疗。我们目前认为，在十二指肠溃疡疾病的治疗中，应采用更为保守的胃部手术方法，即幽门成形术、迷走神经切断术或胃窦切除术，以取代胃切除术，从而保留更正常的胃生理结构。
