Department of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
J Surg Res. 2013 Jun 15;182(2):219-26. doi: 10.1016/j.jss.2012.10.046. Epub 2012 Nov 9.
Eradication of Helicobacter pylori has become part of the standard therapy for peptic ulcer. However, the role of H pylori eradication in perforation of peptic ulcers remains controversial. It is unclear whether eradication of the bacterium confers prolonged ulcer remission after simple repair of perforated peptic ulcer.
A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of H pylori eradication on prevention of ulcer recurrence after simple closure of perforated peptic ulcers. The primary outcome to evaluate these effects was the incidence of postoperative ulcers; the secondary outcome was the rate of H pylori elimination.
The meta-analysis included five randomized controlled trials and 401 patients. A high prevalence of H pylori infection occurred in patients with perforated peptic ulcers. Eradication of H pylori significantly reduced the incidence of ulcer recurrence at 8 wk (risk ratio 2.97; 95% confidence interval: 1.06-8.29) and 1 y (risk ratio 1.49; 95% confidence interval: 1.10-2.03) postoperation. The rate of H pylori eradication was significantly higher in the treatment group than in the nontreatment group.
Eradication therapy should be provided to patients with H pylori infection after simple closure of perforated gastroduodenal ulcers.
根除幽门螺杆菌已成为治疗消化性溃疡的标准疗法之一。然而，幽门螺杆菌根除在消化性溃疡穿孔中的作用仍存在争议。目前尚不清楚在对穿孔性消化性溃疡进行单纯修补术后，细菌的根除是否能延长溃疡的缓解期。
系统评价和荟萃分析了随机对照试验，以评估幽门螺杆菌根除对单纯闭合穿孔性消化性溃疡后预防溃疡复发的影响。评估这些影响的主要结局是术后溃疡的发生率；次要结局是幽门螺杆菌的消除率。
荟萃分析纳入了 5 项随机对照试验和 401 名患者。穿孔性消化性溃疡患者幽门螺杆菌感染的发生率较高。根除幽门螺杆菌可显著降低术后 8 周（风险比 2.97；95%置信区间：1.06-8.29）和 1 年（风险比 1.49；95%置信区间：1.10-2.03）时溃疡复发的发生率。治疗组的幽门螺杆菌根除率明显高于未治疗组。
对于单纯闭合的胃十二指肠溃疡穿孔患者，应在幽门螺杆菌感染后给予根除治疗。
