Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Helicobacter. 2012 Apr;17(2):148-52. doi: 10.1111/j.1523-5378.2011.00928.x.
The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and Helicobacter pylori eradication.
To perform a systematic review and meta-analysis to ask whether this change in practice is in fact justified.
A search on the Cochrane Controlled Trials Register, Medline, and Embase was made for controlled trials of duodenal ulcer perforation patients using simple closure method plus postoperative H. pylori eradication therapy versus simple closure plus antisecretory non-eradication therapy. The long-term results for prevention of ulcer recurrence were compared.
The pooled incidence of 1-year ulcer recurrence in H. pylori eradication group was 5.2% [95% confidence interval (CI) of 0.7 and 9.7], which is significantly lower than that of the control group (35.2%) with 95% CI of 0.25 and 0.45. The pooled relative risk was 0.15 with 95% CI of 0.06 and 0.37.
Helicobacter pylori eradication after simple closure of duodenal ulcer perforation gives better result than the operation plus antisecretory non-eradication therapy for prevention of ulcer recurrence. All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients.
消化性溃疡最常见的并发症是出血和穿孔。在许多地区，明确的酸减少手术已经让位于简单的闭合和幽门螺杆菌根除。
进行系统评价和荟萃分析，以确定这种实践上的改变是否合理。
在 Cochrane 对照试验登记处、Medline 和 Embase 上进行了一项搜索，寻找使用简单闭合方法加术后幽门螺杆菌根除治疗与简单闭合加抗分泌非根除治疗的十二指肠溃疡穿孔患者的对照试验。比较了预防溃疡复发的长期结果。
幽门螺杆菌根除组 1 年溃疡复发的累积发生率为 5.2%（95%置信区间为 0.7%至 9.7%），明显低于对照组（35.2%），95%置信区间为 0.25%至 0.45%。合并相对风险为 0.15，95%置信区间为 0.06 至 0.37。
与手术加抗分泌非根除治疗相比，简单闭合十二指肠溃疡穿孔后进行幽门螺杆菌根除对预防溃疡复发有更好的效果。所有十二指肠溃疡穿孔患者均应进行幽门螺杆菌感染检测，所有感染患者均应进行根除治疗。
