Department of Surgery, State University of New York at Buffalo, 100 High Street, Buffalo, NY 14203, USA.
Surg Endosc. 2009 Nov;23(11):2531-4. doi: 10.1007/s00464-009-0449-8. Epub 2009 May 15.
A preoperative screening and treatment program for pre-existing H. pylori infections was hypothesized to reduce postoperative bariatric complications and associated morbidity as the role of H. pylori in gastrointestinal symptomatology and peptic ulcer disease is well established.
A single-institution, single-surgeon, IRB-approved, retrospective chart review was performed. It included 183 consecutive patients who underwent an initial laparoscopic gastric bypass over a 40-month period from December 2003 to April 2006. The patients were divided into a H. pylori untested group (125 patients) and a tested and treated if indicated group (58 patients). Patient demographics and incidence of hospital re-admissions, GI ulceration and bleeding, perforated viscus, esophagogastroduodenoscopy (EGD), and foregut symptoms were documented at routine follow-up and emergency room visits. Results were subjected to analysis with Fisher's exact test.
Seven patients (12%) in the tested group were positive for H. pylori and treated. The number of GI ulcers and bleeding, EGDs, ER visits, and hospital re-admissions were not statistically different between groups; however, in the untested group, six patients (5%) presented with viscus perforation compared with none in the tested and treated group (p = 0.09). Demographics for both groups were similar and both had a large number of nonspecific foregut symptoms.
Preoperative H. pylori screening should continue, especially in geographically high-prevalence areas, as data suggest that the incidence of viscus perforation may be reduced with preoperative treatment if indicated.
术前对幽门螺杆菌（H. pylori）感染进行筛查和治疗的方案，可降低减重手术后的并发症和相关发病率，因为 H. pylori 在胃肠道症状和消化性溃疡病中的作用已得到充分证实。
进行了一项单机构、单外科医生、IRB 批准的回顾性图表审查，其中包括 183 例连续患者，他们在 2003 年 12 月至 2006 年 4 月的 40 个月期间接受了初次腹腔镜胃旁路手术。将患者分为未检测 H. pylori 的组（125 例）和检测并根据需要治疗的组（58 例）。记录患者的人口统计学资料以及医院再次入院、GI 溃疡和出血、穿孔、食管胃十二指肠镜（EGD）和上消化道症状的发生率，在常规随访和急诊就诊时记录。结果采用 Fisher 确切检验进行分析。
在检测组中，有 7 例（12%）H. pylori 阳性并接受治疗。两组之间 GI 溃疡和出血、EGD、ER 就诊和医院再次入院的数量无统计学差异；然而，在未检测组中，有 6 例（5%）患者出现内脏穿孔，而在检测和治疗组中则无（p = 0.09）。两组的人口统计学特征相似，均有大量非特异性上消化道症状。
应继续进行术前 H. pylori 筛查，特别是在地理高发地区，如果术前治疗有指征，数据表明可能会降低内脏穿孔的发生率。
