Fukuhara Kenichiro, Osugi Harushi, Takada Nobuyasu, Takemura Masashi, Lee Shigeru, Taguchi Shinich, Kaneko Masahiro, Tanaka Yoshinori, Fujiwara Yushi, Nishizawa Satoshi, Kinoshita Hiroaki
Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Hepatogastroenterology. 2004 Jul-Aug;51(58):1241-4.
BACKGROUND/AIMS: Many patients who undergo distal gastrectomy develop remnant gastritis. This report describes the correlation between remnant gastritis and the amount of duodenogastric reflux and looks at the relationship between Helicobacter pylori infection and duodenogastric reflux in remnant gastritis.
Sixty-two patients who underwent curative distal gastrectomy for gastric cancer with radical lymphadenectomy were studied. The period of bile reflux (percent time) into the gastric remnant was measured with the Bilitec 2000 under standardized conditions. Remnant gastritis was semi-quantified using the neutrophil infiltration score based on the updated Sydney System, and the presence of H. pylori infection was determined 12 weeks after the surgery.
Overall, the correlation was not significant between the neutrophil infiltration score and the percent time (p=0.08). Similarly, the correlation was not significant in patients with H. pylori infection (p=0.30), but it was significant in patients without H. pylori infection (p=0.03).
Duodenogastric reflux after distal gastrectomy can cause remnant gastritis in patients without H. pylori infection. Reconstruction with biliary diversion is protective against the development of remnant gastritis.
背景/目的：许多接受远端胃切除术的患者会发生残胃炎。本报告描述了残胃炎与十二指肠-胃反流程度之间的相关性，并探讨了幽门螺杆菌感染与残胃炎中十二指肠-胃反流之间的关系。
对62例行胃癌根治性远端胃切除术并根治性淋巴结清扫术的患者进行研究。在标准化条件下，使用Bilitec 2000测量胆汁反流至残胃的时间（百分比）。根据更新的悉尼系统，用中性粒细胞浸润评分对残胃炎进行半定量，并在术后12周确定幽门螺杆菌感染情况。
总体而言，中性粒细胞浸润评分与反流时间百分比之间无显著相关性（p=0.08）。同样，在幽门螺杆菌感染患者中相关性不显著（p=0.30），但在无幽门螺杆菌感染患者中相关性显著（p=0.03）。
远端胃切除术后的十二指肠-胃反流可在无幽门螺杆菌感染的患者中引起残胃炎。采用胆流改道重建术可预防残胃炎的发生。
