Mihmanli M, Isgor A, Kabukcuoglu F, Turkay B, Cikla B, Baykan A
Department of Surgery and Pathology, Sisli Etfal Training Hospital, Istanbul, Turkey.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1610-2.
BACKGROUND/AIMS: H. pylori has been described as an opportunistic pathogen attracted by changes in the gastric mucosa caused by inflammation and ulceration. However, the role of H. pylori infection in the perforation of duodenal ulcers has not yet been clearly determined. The aim of this study was to assess the prevalence of H. pylori infection in patients undergoing laparotomy for repair of a perforated duodenal ulcer.
Patients who underwent surgery for a perforated duodenal ulcer in our Surgical Unit between January 1994 and July 1996 were included in this study. The study population consisted of eighteen patients with a mean age of 32.7 (21-48) years. All of the patients were male. Patients with chronic duodenal ulcer perforation and with no contraindications for definitive surgery, such as peritonitis, shock (blood pressure <90 mm Hg), age >60 years, or more than a 12-hour elapse from the time of perforation, were treated by bilateral truncal vagotomy and Weinberg pyloroplasty. The ulcer was excised with the pyloric ring. The cut was then extented by about 2 cm on both the gastric and duodenal sides. Two biopsies were taken from the antral mucosa by endoscopic biopsy forceps. The defect was closed transversely. The ulcer specimen and the antral biopsies were fixed separately in 10% formalin solution and sent to the department of Histopathology. The specimens were stained with Hematoxylin-Eosin and examined for H. pylori . Sections of the ulcer specimen were especially investigated for the presence of H. pylori through all layers of the ulcer.
H. pylori was found in the antral biopsies of 16 patients (88.8%). In seven of the ulcer specimens (38.8%), H. pylori was present in the mucosa and also extended through the wall of the ulcer. H. pylori was positive in the antral biopsies of all patients with H. pylori present in the ulcer wall.
In our study, H. pylori was present at a high ratio in the antral biopsies of patients with duodenal ulcer perforation. The presence of H. pylori throughout the ulcer wall to a considerable extent emphasizes the fact that eradication of H. pylori is important in the treatment of perforated duodenal ulcer.
背景/目的：幽门螺杆菌被认为是一种机会致病菌，受炎症和溃疡引起的胃黏膜变化吸引。然而，幽门螺杆菌感染在十二指肠溃疡穿孔中的作用尚未明确。本研究旨在评估因十二指肠溃疡穿孔行剖腹手术患者中幽门螺杆菌感染的患病率。
本研究纳入了1994年1月至1996年7月在我院外科接受十二指肠溃疡穿孔手术的患者。研究对象为18例患者，平均年龄32.7（21 - 48）岁，均为男性。对于慢性十二指肠溃疡穿孔且无确定性手术禁忌证（如腹膜炎、休克（血压<90 mmHg）、年龄>60岁或穿孔时间超过12小时）的患者，采用双侧迷走神经干切断术和温伯格幽门成形术治疗。将溃疡与幽门环一并切除。然后在胃和十二指肠两侧各延长切口约2 cm。通过内镜活检钳从胃窦黏膜取两块活检组织。横向关闭缺损处。将溃疡标本和胃窦活检组织分别固定于10%甲醛溶液中，送组织病理学科室。标本用苏木精 - 伊红染色，检查是否存在幽门螺杆菌。对溃疡标本切片尤其要检查幽门螺杆菌在溃疡各层中的存在情况。
16例患者（88.8%）的胃窦活检组织中发现幽门螺杆菌。7例溃疡标本（38.8%）中，幽门螺杆菌存在于黏膜中且穿透溃疡壁。溃疡壁中有幽门螺杆菌的所有患者，其胃窦活检组织中幽门螺杆菌均呈阳性。
在我们的研究中，十二指肠溃疡穿孔患者的胃窦活检组织中幽门螺杆菌感染率很高。幽门螺杆菌在溃疡壁各层中的存在在很大程度上强调了根除幽门螺杆菌在十二指肠溃疡穿孔治疗中的重要性。
