Hwang Jae Jin, Lee Dong Ho, Kang Kyu Keun, Lee Ae-Ra, Yoon Hyuk, Shin Cheol Min, Park Young Soo, Kim Nayoung
Jae Jin Hwang, Dong Ho Lee, Kyu Keun Kang, Ae-Ra Lee, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 463-707, South Korea.
World J Gastroenterol. 2015 Apr 7;21(13):3936-43. doi: 10.3748/wjg.v21.i13.3936.
To investigate the eradication rate and histological changes after Helicobacter pylori (H. pylori) eradication treatment following subtotal gastrectomy for gastric cancer.
A total of 610 patients with H. pylori infection who had undergone surgery for either early or advanced gastric adenocarcinoma between May 2004 and December 2010 were retrospectively studied. A total of 584 patients with proven H. pylori infection after surgery for gastric cancer were enrolled in this study. Patients received a seven day standard triple regimen as first-line therapy and a 10 d bismuth-containing quadruple regimen as second-line therapy in cases of eradication failure. The patients underwent an esophagogastroduodenoscopy (EGD) between six and 12 mo after surgery, followed by annual EGDs. A further EGD was conducted 12 mo after confirming the result of the eradication and the histological changes. A gastric biopsy specimen for histological examination and Campylobacter-like organism testing was obtained from the lesser and greater curvature of the corpus of the remnant stomach. Histological changes in the gastric mucosa were assessed using the updated Sydney system before eradication therapy and at follow-up after 12 mo.
Eradication rates with the first-line and second-line therapies were 78.4% (458/584) and 90% (36/40), respectively, by intention-to-treat analysis and 85.3% (458/530) and 92.3% (36/39), respectively, by per-protocol analysis. The univariate and multivariate analyses revealed that Billroth II surgery was an independent factor predictive of eradication success in the eradication success group (OR = 1.53, 95%CI: 1.41-1.65, P = 0.021). The atrophy and intestinal metaplasia (IM) scores 12 mo after eradication were significantly lower in the eradication success group than in the eradication failure group (0.25 ± 0.04 vs 0.47 ± 0.12, P = 0.023; 0.27 ± 0.04 vs 0.51 ± 0.12, P = 0.015, respectively). The atrophy and IM scores 12 mo after successful eradication were significantly lower in the Billroth II group than in the Billroth I group (0.13 ± 0.09 vs 0.31 ± 0.12, P = 0.029; 0.32 ± 0.24 vs 0.37 ± 0.13, P = 0.034, respectively).
Patients with H. pylori following subtotal gastrectomy had a similar eradication rate to patients with an intact stomach. H. pylori eradication is recommended after subtotal gastrectomy.
研究胃癌胃大部切除术后幽门螺杆菌（H. pylori）根除治疗后的根除率及组织学变化。
回顾性研究2004年5月至2010年12月间因早期或进展期胃腺癌接受手术治疗的610例H. pylori感染患者。本研究共纳入584例胃癌手术后确诊为H. pylori感染的患者。患者接受为期7天的标准三联疗法作为一线治疗，根除失败时接受为期10天的含铋四联疗法作为二线治疗。患者在术后6至12个月接受食管胃十二指肠镜检查（EGD），随后每年进行一次EGD。在确认根除结果和组织学变化12个月后再进行一次EGD。从残胃体部的小弯和大弯处获取胃活检标本进行组织学检查和类弯曲杆菌检测。在根除治疗前及随访12个月后，使用更新的悉尼系统评估胃黏膜的组织学变化。
意向性分析显示，一线和二线治疗的根除率分别为78.4%（458/584）和90%（36/40），符合方案分析分别为85.3%（458/530）和92.3%（36/39）。单因素和多因素分析显示，毕罗Ⅱ式手术是根除成功组中预测根除成功的独立因素（OR = 1.53，95%CI：1.41 - 1.65，P = 0.021）。根除成功组根除12个月后的萎缩和肠化生（IM）评分显著低于根除失败组（分别为0.25±0.04对0.47±0.12，P = 0.023；0.27±0.04对0.51±0.12，P = 0.015）。毕罗Ⅱ式组成功根除12个月后的萎缩和IM评分显著低于毕罗Ⅰ式组（分别为0.13±0.09对0.31±0.12，P = 0.029；0.32±0.24对0.37±0.13，P = 0.034）。
胃大部切除术后H. pylori感染患者的根除率与胃完整患者相似。建议胃大部切除术后进行H. pylori根除治疗。
