幽门螺杆菌感染在残胃黏膜病变中作用的临床观察

目的:通过检测残胃黏膜幽门螺杆菌(Hp)感染,探讨Hp与残胃黏膜病变的关系.方法:对45例胃大部切除的残胃进行胃镜、病理检查和Hp检测,以同期非残胃患者为对照组,进行以上三项的比较.结果:①残胃组和对照组Hp检出率分别为22.2%和60%(P＜0.05).②存在胆汁反流和非胆汁反流患者Hp检出率分别为17.2%和43.8%.(P＜0.05)③胆汁反流发生率,毕罗Ⅱ式手术明显多于毕罗Ⅰ式,分别为46.6%和17.7%(P＜0.05).④残胃黏膜病理,Hp感染和非Hp感染患者有中-重度胃黏膜病变并有异型增生分别为66.7%和21.2%(P＜0.05).对有Hp感染的对照组和残胃组的病理改变无显著差别(p>0.05).结论:Hp感染是残胃炎发生的重要原因.根除Hp有临床意义.毕罗Ⅱ式较毕罗Ⅰ式手术胆汁反流发生高:而伴有胆汁反流者Hp感染率较低.应该综合治疗.

Analysis Relationship between the Remnant Stomach and the Infection of Helicobacter Pylori

Objectives: To study the relationgship between infection of Helicobacter pylori(H.pylori) and residual gastric lesion after distal gastrectomy. Methods: The subjects were 45 patients of residual stomach after distal gastrectomy and control group. They were investigated by gastroendoscopy,pathology and detection of H.pylori. Results: The H.pylori-positivity rate of patients with gastrectomy was 22.2%,and the control was 60%(P<0.05);The H.pylori-positivity rate of patients with bile reflux was 17.2% and the negtive rate was 43.8% (P<0.05).The bile reflux rate of the patients who underwent gastrectomy with Billroth II (46.6%) were more than Billroth I (17.7%)(P<0.05). The mild-severe inflammation of gastric mucosa in the patients with bile reflux were more serious than that in non-reflux patients significantly(P<0.05).Of patients with Hylori.p, 66.7% had mild-severe lesion of gasric mucosa,but those without H.pylori were only 21.2%(P<0.05). There are no significant difference between the H.pylori- posi-tivity of patients with bile reflux and control(P>0.05). Conclusions: H.pylori infection is an important factor of remnant gastritis. The bile reflux rate of the patients with Billroth II gastrectomy are more than Billroth I .The H.pylori infection rate is lower in the bile reflux patients. It is neccessary to eradicate H.pylori for the patients with remnant stomach after distaul gastrectomy.