腹腔镜Roux-en-Y胃旁路手术患者幽门螺杆菌感染的患病率及术前检测和治疗的价值

Prevalence of Helicobacter pylori infection and value of preoperative testing and treatment in patients undergoing laparoscopic Roux-en-Y gastric bypass.

作者信息

Papasavas Pavlos K, Gagné Daniel J, Donnelly Patricio E, Salgado Javier, Urbandt Jorge E, Burton Kristen K, Caushaj Philip F

机构信息

Temple University School of Medicine, Clinical Campus, Western Pennsylvania Hospital, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.

出版信息

Surg Obes Relat Dis. 2008 May-Jun;4(3):383-8. doi: 10.1016/j.soard.2007.08.014. Epub 2007 Nov 5.

DOI:10.1016/j.soard.2007.08.014

PMID:17974495

Abstract

BACKGROUND

Previous studies have reported a high prevalence of Helicobacter pylori infection in patients undergoing Roux-en-Y gastric bypass (RYGB) and a greater incidence of anastomotic ulcer in patients positive for H. pylori, leading to recommendations for routine preoperative screening. Our hypotheses were that the prevalence of H. pylori in patients undergoing RYGB is similar to that of the general population and that preoperative H. pylori testing and treatment does not decrease the incidence of anastomotic ulcer or pouch gastritis.

METHODS

A retrospective analysis of H. pylori serology, preoperative and postoperative endoscopy findings, and the development of anastomotic ulcer or erosive pouch gastritis was performed. All patients positive for H. pylori received treatment. Univariate parametric and nonparametric statistical tests, as well as multiple logistic regression analyses, were performed.

RESULTS

A total of 422 LRYGB patients were included in the study. Of these patients, 259 (61.4%) were tested for H. pylori and 163 (38.6%) were not. Of the 259 patients, 58 (22.4%) tested positive for H. pylori, 197 (76.1%) tested negative, and 4 (1.5%) had an equivocal result. Postoperatively, 53 patients (12.6%) underwent upper endoscopy. Of these 53 patients, 19 (4.5%) had positive endoscopy findings for anastomotic ulcer (n = 16) or erosive pouch gastritis (n = 3). Five patients underwent biopsy at endoscopy; all biopsies were negative for H. pylori. No difference was found in the rate of positive endoscopy between patients tested preoperatively for H. pylori (5%) and patients not tested (3.7%).

CONCLUSION

The results of our study have shown that the prevalence of H. pylori infection in patients undergoing RYGB is similar to that of the general population. Our study has shown that H. pylori testing does not lower the risk of anastomotic ulcer or pouch gastritis.

摘要

背景

既往研究报道，接受Roux-en-Y胃旁路术（RYGB）的患者幽门螺杆菌（H. pylori）感染率很高，且H. pylori阳性患者吻合口溃疡的发生率更高，因此建议进行术前常规筛查。我们的假设是，接受RYGB的患者中H. pylori的感染率与普通人群相似，术前进行H. pylori检测和治疗并不会降低吻合口溃疡或胃袋胃炎的发生率。

方法

对H. pylori血清学、术前和术后内镜检查结果以及吻合口溃疡或糜烂性胃袋胃炎的发生情况进行回顾性分析。所有H. pylori阳性患者均接受治疗。进行了单变量参数和非参数统计检验以及多因素逻辑回归分析。

结果

本研究共纳入422例接受腹腔镜Roux-en-Y胃旁路术（LRYGB）的患者。其中，259例（61.4%）接受了H. pylori检测，163例（38.6%）未接受检测。在259例患者中，58例（22.4%）H. pylori检测呈阳性，197例（76.1%）检测呈阴性，4例（1.5%）结果不明确。术后，53例患者（12.6%）接受了上消化道内镜检查。在这53例患者中，19例（4.5%）内镜检查发现吻合口溃疡（n = 16）或糜烂性胃袋胃炎（n = 3）呈阳性。5例患者在内镜检查时进行了活检；所有活检H. pylori均为阴性。术前接受H. pylori检测的患者（5%）和未接受检测的患者（3.7%）内镜检查阳性率无差异。