摘要
目的探讨残胃幽门螺杆菌（Hp）感染的临床特点及其相关因素。方法选择胃大部切除术后出现消化道症状行胃镜检查的患者89例，回顾性分析其临床资料。比较不同手术原因、不同术式、不同炎性反应程度、术后时间、是否存在胆汁反流等因素与残胃Hp感染的关系，并分析残胃Hp感染的相关因素。结果89例患者中残胃Hp感染29例，Hp阳性率为32．6％（29／89）。因十二指肠球部溃疡（并发出血／穿孔）、胃溃疡（并发出血／穿孔）、胃癌、平滑肌肉瘤行胃大部切除术患者Hp阳性率比较差异均无统计学意义（P〉0．05），Billroth Ⅰ与Billroth Ⅱ术后患者Hp阳性率比较差异无统计学意义（P〉0．05）。残胃炎和吻合口炎随着炎性反应程度的加重（中度以下和中重度），Hp阳性率升高，中度以下和中重度患者Hp阳性率比较差异有统计学意义[残胃炎：27．3％（12／44）比57．1％（16／28），吻合口炎：25．0％（10／40）比50．0％（18／36），JP〈0．05]。胃大部切除术后距离胃镜检查≤10年和〉10年患者Hp阳性率分别为43．9％（18／41）、22．9％（11／48），差异有统计学意义（r=4．433，P=0．035）。胃镜下有明显胆汁反流患者Hp阳性率低于无明显胆汁反流患者E22．2％（10／45）比43．2％（19144）]，差异有统计学意义（r=4．449，P=0．035）。Logistic多元回归分析结果显示，炎性反应程度（中重度）和有胆汁反流与残胃Hp感染有相关性，炎性反应程度（中重度）30残胃Hp感染的危险因素（OR=1．24，95％CI：1．22，1．56，P=0．01），有胆汁反流为残胃Hp感染的保护因素（OR=0．76，95％CI：0．58～0．99，P=0．04）。结论残胃Hp感染可促进并加重残胃黏膜炎性反应，残胃Hp感染和胆汁反流均可导致残胃黏膜病变，二者可为独立致病因素，也可同时致病，规范根除残胃Hp感染十分重要，还应对残胃定期行胃镜、Hp、病理组织学等检查。
Objective To explore the clinical characteristics and related factors of Helicobacter pylori （Hp） infection in gastric stump lesion. Methods Eighty-nine patients with subtotal gastrectomy gastrointestinal symptoms underwent gastroscope, the clinical data were retrospectively analyzed. The relationship between gastric Hp infection and different operation reasons, different operation, different degree of inflammation, postoperative time, the existence of bile reflux was assessed. Results There were 29 cases of gastric Hp infection,the positive rate of Hp was 32.6% （29/89）. There were no significant difference between different preoperative disease such as duodenal ulcer （bleeding/perforation）,gastric ulcer （bleeding/perforafion）,gastrie cancer, leiomyosareoma and HP infection （P 〉0.05）. There was no significant different positive rate of Hp infection between Billroth I and Billroth II after operation （P 〉 0.05）. The rate of Hp infection increased with the degree of inflammation （moderate to severe） in gastric stump and anastomotic inflammation. There were significant d/fference [gastrtis severity of inflammation： 27.3% （12/44） vs. 57.1% （16/28）, anastomotic inflammation： 25% （ 10/40 ）vs. 50% （18/36）, P 〈 0.05 ] ; there was significant difference between two groups of more than 10 years [43.9% （ 18/41 ） ] and less than 10 years [ 22.9% （11/48） ] of Hp infection rate （X2 = 4.433,P = 0.035） ; the positive rate of Hp infection in group of no bile reflux under gastroscopy were higher than the group of bile reflux,there was significant difference [ 22.2% （ 10/45 ） vs. 43.2% （19/44） ,X^2 = 4.449, P = 0.035 ）. Multivariate Logistic regression analysis showed that, the degree of inflammation （severe） and bile reflux was associated with gastric Hp infection, inflammation （severe） was the dominant risk factor [OR = 1.24,95% CI： 1.22-1.56,P = 0.01 ], with bile reflux were protective factors [OR =0.76, 95% C1：0.58-0.99,P =0.04]. Conclusions Hp infection can promote and aggravate the gastric remnant mucosa inflammation, Hp infection and bile reflux can lead to gastric mucosa pathological changes, there can be independence pathogenic factors, also can cause at the same time, regulate the eradication of residual gastric Hp infection is very important, also deal with the residual stomach regular line of gastroscope and Hp, histologic examination.
出处
《中国医师进修杂志》
2013年第17期31-33,共3页
Chinese Journal of Postgraduates of Medicine
关键词
螺杆菌
幽门
胃切除术
残胃
胆汁反流
Helicobacter pylori
Gastrectomy
Residual stomach
Bile reflux
