Current status of indications for surgery in peptic ulcer disease

作     者：Jamieson, GG 

作者机构：Univ Adelaide Royal Adelaide Hosp Dept Surg Adelaide SA 5000 Australia 

出 版 物：《WORLD JOURNAL OF SURGERY》 (世界外科学杂志)

年 卷 期：2000年第24卷第3期

页      面：256-258页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：急诊处理 螺杆菌感染/并发症 幽门螺杆菌 腹腔镜检查 消化性溃疡/并发症 消化性溃疡/外科学 消化性溃疡出血/外科学 消化性溃疡穿孔/外科学 幽门狭窄/病因学 幽门狭窄/外科学 复发 人类 

摘      要：The eradication of Helicobacter pylori in patients with peptic ulcer disease has greatly diminished the need for antiulcer surgery. However, in societies where such drug therapy is considered too expensive and because occasional patients remain refractory to optimal medical therapy, elective surgery for duodenal ulcer disease is still carried out, If the required expertise is available, it can be undertaken laparoscopically. The advent of endoscopic therapies such as heater probe therapy and injection sclerotherapy has also greatly diminished the need for emergency surgery in bleeding peptic ulcer disease. Once again, however, when such therapy fails surgery is still indicated. El en with perforated peptic ulcer disease the role of surgery has receded somewhat, but here not because of changes in drug therapy. Nonoperative management of perforation is indicated in fit patients if the diagnosis is in doubt, in any patient when surgical facilities are unavailable (e.g., remote geographic areas, on board ship), or when a patient is extremely ill either because of comorbidity or late presentation of the disease. Operation should be considered in all patients when the perforation is established to be unsealed, particularly after a trial of conservative management, and in all patients who are otherwise fit.