胃大部切除术后胆汁反流性残胃炎与术式和幽门螺杆菌感染的关系及治疗的研究

目的 探讨胃大部切除术后胆汁反流性残胃炎与术式、幽门螺杆菌(Hp)感染的关系及临床疗效.方法 选取我院2008年1月至2011年6月收治的胃大部切除术后胆汁反流性残胃炎患者143例作为观察组,其中采用Billroth Ⅰ术52例,采用BillrothⅡ术91例.选取同期未进行手术的患者236例作为对照组.采用快速尿素酶试验法和改良的Giemsa染色法检测患者的Hp.结果 观察组Hp感染率24.5％(35/143)]明显低于对照组42.8％ (101/236)](P＜0.05),Billroth Ⅰ术后患者的Hp感染率21.2％(11/52)]略低于BillrothⅡ术后患者26.4％ (24/91)] (P ＞0.05),Billroth Ⅰ术后患者的胆汁反流阳性率51.9％ (27/52)]明显低于Billroth Ⅱ术后患者80.2％ (73/91)] (P ＜0.05),胆汁反流阳性患者的Hp感染率 19.0％ (19/100)]明显低于胆汁反流阴性患者37.2％ (16/43)] (P ＜0.05).结论 Hp感染是残胃炎的主要致病因素之一.胃大部切除术后胆汁反流性残胃炎患者发生Hp感染的概率大幅降低,胆汁反流是患者Hp感染的有效保护因素.

The research on subtotal resection of bile reflux of residual gastritis between operation helicobacter pyloriinfection and treatment

Objective To investigate the relationship among bile reflux of residual gastritis after subtotal resection, helicobaeter pylori （Hp）infection and the efficacy of operation treatment. Methods One hundred and forty-three patients of subtotal resection of bile reflux of residual gastritis from January 2008 to June 2011 were selected as the observation group. Fifty-two patients received Billroth I operation, meanwhile 91 patients received Billroth Ⅱ operation. Two hundred and thirty-six patients who did not have operations were as the control group. The rapid urease test and modified Giemsa staining method were used for the detection of patients with Helicobacter pylori. Results Hp infection rate in the observation group was lower than that in the control group 24. 5% （ 35/143 ） vs 42. 8% （ 101/236）, P 〈 0. 05 ]. Hp infection rate in Billroth I operation patients was slightly lower than that in the Billroth II operation patients （P 〉 0. 05）. Bile reflux positive rate in Billroth operation patients was significantly lower than that in the Billroth Ⅱ operation patients 51.9% （ 27/52 ） vs 80. 2% （ 73/91 ）, P 〈 0.05 ] . Hp infection rate in bile reflux patients with positive was significantly lower than that in the bile reflux patients with negative 19.0% （19/100） vs37.2% （16/43）, P〈0.05]. Conciusions Hp infection is one of the major factors causing residual gastritis. Hp infection reduces significantly in patients bile reflux gastritis after subtotal gastrectomy. Hp infection patients with bile reflux is an effective protective factor.