Giuliani Andrea, Caporale Alessandro, Demoro Martino, Benvenuto Eugenio, Scarpini Massimo, Spada Sebastiano, Angelico Francesco
Department of Surgery P. Valdoni, University La Sapienza, Rome, Italy.
World J Surg. 2005 Sep;29(9):1127-30. doi: 10.1007/s00268-005-7713-4.
The mucosa of the gastric stump is considered at greater risk of dysplastic and neoplastic changes than that of the intact stomach. The combination of enteric reflux and Helicobacter pylori infection may have a synergistic damaging effect on the mucosa of the gastric remnant, both producing and increasing mucosal proliferation. The aim of this study was to assess whether the occurrence of H. pylori infection in the remnant mucosa of partially gastrectomized subjects for peptic ulcer disease is associated with an increase of the mucosal precursor lesions of malignancy. A series of 151 subjects who underwent partial gastrectomy for peptic ulcer disease were submitted to upper digestive endoscopy for long-term surveillance. Biopsy specimens of the gastric stump were tested for the occurrence of H. pylori infection and for the presence of precancerous mucosal lesions. The prevalence of H. pylori colonization in the remnant stomach was less than 30% and similar in subjects with different time intervals between gastrectomy and endoscopy. Age at surgery (chi(2): p = 0.03) and H. pylori infection (chi(2): p = 0.002) were significantly associated with the grading of mucosal lesions. The prevalence of normal mucosa was 10 times higher in H. pylori-negative patients as in H. pylori-positive ones (22.0% vs. 2.4%), and the prevalence of intestinal metaplasia was four times higher in H. pylori-positive patients than in H. pylori-negative ones (19.6% vs. 4.6%). We concluded that H. pylori infection may play a causal role in the development of gastric lesions in the operated stomach.
与完整胃的黏膜相比，胃残端黏膜被认为发生发育异常和肿瘤性改变的风险更高。肠反流和幽门螺杆菌感染相结合可能对胃残余黏膜产生协同损害作用，二者均可导致并增加黏膜增殖。本研究的目的是评估因消化性溃疡病接受部分胃切除术的患者，其残余黏膜中幽门螺杆菌感染的发生是否与恶性肿瘤黏膜前体病变的增加有关。对151例因消化性溃疡病接受部分胃切除术的患者进行了上消化道内镜检查以进行长期监测。对胃残端的活检标本进行幽门螺杆菌感染检测和癌前黏膜病变检测。残余胃中幽门螺杆菌定植的患病率低于30%，在胃切除术后与内镜检查之间不同时间间隔的患者中相似。手术时年龄（χ²：p = 0.03）和幽门螺杆菌感染（χ²：p = 0.002）与黏膜病变分级显著相关。幽门螺杆菌阴性患者正常黏膜的患病率是幽门螺杆菌阳性患者的10倍（22.0%对2.4%），幽门螺杆菌阳性患者肠化生的患病率是幽门螺杆菌阴性患者的4倍（19.6%对4.6%）。我们得出结论，幽门螺杆菌感染可能在手术胃中胃病变的发生中起因果作用。
