Tokunaga Y, Hata K, Ryo J, Kitaoka A, Tokuka A, Ohsumi K
Department of Surgery, Maizuru Municipal Hospital, Kyoto, Japan.
J Am Coll Surg. 1998 Jun;186(6):659-63. doi: 10.1016/s1072-7515(98)00128-8.
A lack of change in prevalence of severe ulcer complications requiring emergency operation has been reported, despite the common use of histamine-2 (H2)-receptor antagonists and proton pump inhibitors. This may be attributable to use of ulcerogenic drugs or Helicobacter pylori (HP) infection, or both. In this study, HP infection was evaluated semiquantitatively in patients with peptic ulcer who required surgery, and the severity of histologic change was investigated.
We reviewed a total of 113 consecutive patients (98 men and 15 women) operated on for perforation, hemorrhage, or stenosis of gastroduodenal ulcer between January 1986 and December 1995. Detection of HP was carried out by immunohistochemical staining. We graded the density of HP infection according to the number of individual HP bacteria counted in a highly magnified visual field (x 1,000 of light microscopy). The grade of HP infection was defined as follows: (0) = 0; (1+) = 1-9; (2+) = 10-29; (3+) = 30-99; (4+) > or = 100. The severity of gastritis was evaluated by histologic examination using the criteria of Rauws.
Although the number of operations for gastroduodenal ulcer declined significantly, the rate of emergency operation for gastroduodenal ulcer increased from 60% to 90%, with the result that the frequency of operations for perforation or bleeding remained virtually constant and that for stenosis significantly decreased. HP infection was more prevalent in perforated ulcer (92%) than hemorrhagic ulcer (55%) or stenotic ulcer (45%). The grades of HP infection were 3.0 +/- 0.14 (mean +/- SEM) in perforated ulcer, 2.3 +/- 0.34 in hemorrhagic ulcer, and 2.5 +/- 0.22 in stenotic ulcer. Perforated ulcer was associated with significantly more severe HP infection and gastritis changes than hemorrhagic ulcer or stenotic ulcer.
This study indicates that patients with perforated ulcer were infected with HP more severely than those with hemorrhagic ulcer or stenotic ulcer at the time of surgery. A close relationship was observed between the perforated ulcer and the density of HP infection determined semiquantitatively using immunohistochemical stain.
尽管组胺-2（H2）受体拮抗剂和质子泵抑制剂已被广泛使用，但据报道，需要急诊手术的严重溃疡并发症的患病率并未改变。这可能归因于使用致溃疡药物或幽门螺杆菌（HP）感染，或两者兼而有之。在本研究中，我们对需要手术的消化性溃疡患者的HP感染进行了半定量评估，并研究了组织学变化的严重程度。
我们回顾了1986年1月至1995年12月期间因胃十二指肠溃疡穿孔、出血或狭窄而接受手术的113例连续患者（98例男性和15例女性）。通过免疫组织化学染色检测HP。我们根据在高倍视野（光学显微镜×1000）中计数的单个HP细菌数量对HP感染密度进行分级。HP感染分级定义如下：（0）=0；（1+）=1-9；（2+）=10-29；（3+）=30-99；（4+）≥100。使用Rauws标准通过组织学检查评估胃炎的严重程度。
尽管胃十二指肠溃疡手术数量显著下降，但胃十二指肠溃疡急诊手术率从60%上升至90%，结果是穿孔或出血的手术频率基本保持不变，而狭窄的手术频率显著下降。HP感染在穿孔性溃疡（92%）中比出血性溃疡（55%）或狭窄性溃疡（45%）中更常见。穿孔性溃疡的HP感染分级为3.0±0.14（平均值±标准误），出血性溃疡为2.3±0.34，狭窄性溃疡为2.5±0.22。与出血性溃疡或狭窄性溃疡相比，穿孔性溃疡与更严重的HP感染和胃炎变化相关。
本研究表明，手术时穿孔性溃疡患者的HP感染比出血性溃疡或狭窄性溃疡患者更严重。使用免疫组织化学染色半定量测定的穿孔性溃疡与HP感染密度之间存在密切关系。
