Künzle J E, Modena J L, Ziliotto Júnior A, Mendes J A
Serviço de Cirurgia de Ribeirao Preto.
Hepatogastroenterology. 1997 Mar-Apr;44(14):599-603.
BACKGROUND/AIMS: The role of Helicobacter pylori as a cause of peptic ulcer is still subject to controversy. The Kock's postulates have not been yet fulfilled; the bacteria can be found in normal persons, and it persists in the stomach after the ulcer is healed.
The authors analyzed 41 persons formerly submitted to surgery (after 8 years and 4 months, as a mean), 31 to highly selective vagotomy, and 10 to truncal or selective vagotomy plus gastroduodenal drainage. All of them were asymptomatic, or had symptoms not related to ulcer relapse.
At endoscopy the ulcers were healed in all 41 individuals, and there was evidence of gastritis in three. The histopathological exam showed gastritis in all biopsy specimens. The search of H. pylori by urease method and by Giemsa staining was positive in 40.
It was concluded that the gastric acid secretion reduced by vagotomy was the main factor to healing the ulcer, not subordinated to H. pylori.
背景/目的:幽门螺杆菌作为消化性溃疡病因的作用仍存在争议。科赫法则尚未得到满足;该细菌可在正常人中发现,且溃疡愈合后仍在胃中持续存在。
作者分析了41例曾接受手术的患者(平均8年零4个月后),其中31例行高选择性迷走神经切断术,10例行全胃或选择性迷走神经切断术加胃十二指肠引流术。所有患者均无症状,或有与溃疡复发无关的症状。
在内镜检查中,所有41例患者的溃疡均已愈合,3例有胃炎证据。组织病理学检查显示所有活检标本均有胃炎。通过尿素酶法和吉姆萨染色法检测幽门螺杆菌,40例呈阳性。
得出的结论是,迷走神经切断术降低胃酸分泌是溃疡愈合的主要因素,不受幽门螺杆菌影响。