El-Nakeeb Ayman, Fikry Amir, Abd El-Hamed Tito M, Fouda El Yamani, El Awady Saleh, Youssef Tamer, Sherief Doaa, Farid Mohamed
Mansoura University Hospital, General Surgery Department, Dep. 8, Egypt.
Int J Surg. 2009 Apr;7(2):126-9. doi: 10.1016/j.ijsu.2008.12.001. Epub 2008 Dec 6.
This study was conducted to elucidate the prevalence of Helicobacter pylori in patients with a perforated duodenal ulcer and to determine whether eradication of H. pylori prevent ulcer recurrence following simple repair of the perforation.
Eighty-three patients with perforated duodenal ulcer (68 males); mean age was 47.8 years+/-7.2. Antral mucosal biopsies (to determine the status of HP by rapid urease test, culture and histological examination/staining) were obtained during laparotomy by passing a biopsy forceps through the perforation site. H. pylori positive patients who had undergone patch repair were randomized into the eradication group who received amoxicillin, metranidazole plus omperazole and the control group was given omeprazole alone. Follow-up endoscopy and antral biopsies were performed at 8 weeks, 16 weeks and 1 year to show ulcer healing and determine H. pylori state.
Of 77 patients in the study, 65 patients (84.8%) had H. pylori. These patients were randomly divided into the triple therapy group (34 patients) and the control group (31 patients). Eradication of H. pylori was significantly higher in the triple therapy group than the control group and initial ulcer healing was significantly better in the eradication group. After 1 year, ulcer recurrence was (6.1%) in the eradication group vs. (29.6%) in the control group (P=0.001).
H. pylori was present in a high proportion of patients with duodenal ulcer perforation. Eradication of H. pylori after simple closure of a perforated duodenal ulcer reduced the incidence of recurrent ulcer.
本研究旨在阐明十二指肠溃疡穿孔患者中幽门螺杆菌的患病率，并确定根除幽门螺杆菌是否能预防穿孔简单修补术后溃疡复发。
83例十二指肠溃疡穿孔患者（68例男性）；平均年龄47.8岁±7.2岁。在剖腹手术期间，通过将活检钳经穿孔部位获取胃窦黏膜活检组织（通过快速尿素酶试验、培养及组织学检查/染色来确定幽门螺杆菌状态）。接受修补术的幽门螺杆菌阳性患者被随机分为根除组（接受阿莫西林、甲硝唑加奥美拉唑）和对照组（仅给予奥美拉唑）。在8周、16周和1年时进行随访内镜检查及胃窦活检，以观察溃疡愈合情况并确定幽门螺杆菌状态。
研究中的77例患者中，65例（84.8%）有幽门螺杆菌。这些患者被随机分为三联疗法组（34例患者）和对照组（31例患者）。三联疗法组幽门螺杆菌根除率显著高于对照组，根除组初始溃疡愈合情况明显更好。1年后，根除组溃疡复发率为（6.1%），而对照组为（29.6%）（P = 0.001）。
十二指肠溃疡穿孔患者中幽门螺杆菌感染比例较高。十二指肠溃疡穿孔简单闭合术后根除幽门螺杆菌可降低溃疡复发率。
