Sebastian M, Chandran V P, Elashaal Y I, Sim A J
Department of Surgery, Al Ain Hospital, United Arab Emirates.
Br J Surg. 1995 Mar;82(3):360-2. doi: 10.1002/bjs.1800820325.
This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.
本研究调查了穿孔性消化性溃疡病中一种可能的病原体，即幽门螺杆菌，及其与持续性溃疡的关系。29例穿孔性消化性溃疡患者在剖腹手术时接受了穿孔单纯缝合术。术后第8天进行的13C尿素呼气试验在24例患者中呈阳性。出院6周后接受上消化道内镜检查的17例患者中，14例13C尿素呼气试验呈阳性。对内镜检查时采集的黏膜样本进行的活检尿素酶试验在这14例患者中的12例呈阳性，表明存在幽门螺杆菌持续活动性感染。13C尿素呼气试验和活检尿素酶试验呈阳性的7例患者有持续性十二指肠溃疡。13C尿素呼气试验阴性的3例患者在内镜检查时均无十二指肠溃疡的证据。十二指肠溃疡持续率高与幽门螺杆菌感染发生率高之间的关联表明，所有穿孔性消化性溃疡病患者均应给予抗生素治疗以根除这种微生物。
