Rodríguez-Sanjuán Juan C, Fernández-Santiago Roberto, García Rosa A, Trugeda Soledad, Seco Isabel, la de Torre Fernando, Naranjo Angel, Gómez-Fleitas Manuel
Department of General Surgery II, University Hospital Marqués de Valdecilla, Santander, Spain.
World J Surg. 2005 Jul;29(7):849-52. doi: 10.1007/s00268-005-7797-x.
Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19-96 years) were operated on between 1996 and 2002, and treated by simple closure followed by Hp eradication and NSAID avoidance. The data were prospectively collected in a database. Hp infection was diagnosed in 68 patients (73.9%). Thirty-four patients (37%) consumed nonsteroidal anti-inflammatory drugs (NSAIDs), and 23 (25%) had both Hp infection and NSAID antecedents. The perforation was gastric in 4 cases and pre-pyloric, pyloric or duodenal in 88. There were postoperative complications in 24 patients (26%) and 4 patients died (4.3%). Hp eradication was shown in 46 patients. There was clinical ulcer recurrence in 4 (4.3%); in 3 of them recurrence manifested as re-perforation, all in gastric locations. Overall relapse and re-perforation 1-year crude rates were 6.1% and 4.1%, respectively. Crude rates for non-gastric ulcer recurrence were 0 at 1 year and 2.6% at 2 years and for non-gastric ulcer re-perforation rates were 0 at 1 and 2 years. This therapeutic strategy is associated with a low rate of recurrence and no re-perforations in case of duodenal, pyloric, or pre-pyloric perforated ulcers, but it is not acceptable for perforated gastric ulcers.
单纯缝合后根除幽门螺杆菌（Hp）已成为治疗穿孔性溃疡最常用的方法。然而，其疗效和安全性仍有待确定。为了评估复发率和再穿孔率，并作为次要目标分析穿孔性溃疡患者和对照组的Hp感染率，我们进行了一项前瞻性研究。1996年至2002年间，对92例连续患者（年龄19 - 96岁）进行了手术，采用单纯缝合，随后根除Hp并避免使用非甾体抗炎药（NSAID）。数据前瞻性地收集于一个数据库中。68例患者（73.9%）被诊断为Hp感染。34例患者（37%）使用过非甾体抗炎药（NSAID），23例（25%）既有Hp感染又有NSAID使用史。穿孔部位为胃穿孔4例，幽门前、幽门或十二指肠穿孔88例。24例患者（26%）出现术后并发症，4例患者死亡（4.3%）。46例患者实现了Hp根除。4例（4.3%）出现临床溃疡复发；其中3例复发表现为再穿孔，均发生在胃部位。总体1年复发率和再穿孔率的粗率分别为6.1%和4.1%。非胃溃疡1年复发粗率为0，2年为2.6%，非胃溃疡1年和2年再穿孔率均为0。这种治疗策略与十二指肠、幽门或幽门前穿孔性溃疡的低复发率和无再穿孔相关，但对于胃穿孔性溃疡是不可接受的。
