残胃胆汁反流与幽门螺杆菌感染之间的关系
郑华君, 吕宾, 徐毅, 范一宏, 孙翠萍, 浙江中医学院附属医院消化内科 浙江省杭州市 310006
汪晓庆, 浙江省杭州市中医院消化内科 浙江省杭州市 310024
通讯作者: 郑华君, 310006, 浙江省杭州市, 浙江中医学院附属医院消化内科. zhj@126.com
收稿日期: 2004-12-27 接受日期: 2005-01-20
摘要
目的: 观察胃大部切除术后胆汁反流与残胃H pylori感染之间的关系.
, 百拇医药
方法: 残胃组患者101例，其中BillrothⅠ式58例，Billroth II式43例，同期未手术患者4501例作为对照组.残胃组内又分别根据H pylori、胆汁反流与否、反流程度分层比较.以快速尿素酶试验及改良Giemsa染色检测幽门螺杆菌.
结果: 残胃组H pylori感染率(21.79%)显著低于对照组(41.16%)，两组之间比较具有统计学意义(P<0.05);Billroth I 式组H pylori感染率为21.43%，Billroth II式组H pylori感染率为22.22%，两组比较无统计学意义;Billroth I式组胆汁反流阳性率57.14%与Billroth II式组的88.89%相比较具有统计学意义(P<0.001);残胃胆汁反流阳性患者H pylori感染率为35.44%，胆汁反流阴性患者H pylori感染率为45.45%，两组比较具有统计学意义(P<0.01);残胃组患者不同程度胆汁反流的H pylori感染率之间无统计学意义;不同程度胆汁反流的H pylori现患比均小于1.0.
, http://www.100md.com
结论: 残胃H pylori感染率低于未手术者，胆汁反流是H pylori感染的保护因素，但与H pylori感染严重程度无线性关系.
郑华君, 吕宾, 汪晓庆, 徐毅, 范一宏, 孙翠萍. 残胃胆汁反流与幽门螺杆菌感染之间的关系. 世界华人消化杂志 2005;13(11):1353-1355
参考文献
1 Kellosalo J, Alavaikko M, Laitinen S. Effect of biliary tractprocedures on duodenogastric reflux and the gastric
mucosa. Scand J Gastroenterol 1991;23:1272-1278
, 百拇医药
2 许国铭, 李石. 现代消化病学. 北京: 人民军医出版社, 1999:710
3 Safatle-Ribeiro AV, Ribeiro U Jr, Clarke MR, Sakai P, Ishioka S,Garrido AB Jr, Gama- Rodrigues J, Safatle NF, Reynolds
JC. Relationship between persistence of Helicobacterpylori and dysplasia, intestinal, metaplasia, atrophy,inflammation, and cell proliferationfollowing partial gastrectomy. Dig Dis Sci 1999;44:243-252
4 王金莹, 金懋林, 李吉友, 吕有勇. 胃黏膜病变中幽门螺杆菌感染与c-met基因表达相关性的分析. 中华消化杂志 1996;
, 百拇医药
16:360-361
5 刘文忠. 幽门螺杆菌研究进展. 上海: 上海科学技术文献出版社, 2001:30-43
6 Tomtitchong P, Onda M, Matsukura N, Tokunaga A, Kato S, MatsuhisaT, Yamada N, Hayashi A. Helicobacter
pylori infection in the remnantstomach after gastrectomy: with special reference to the differencebetween Billroth I
and II anastomoses. J Clin Gastroenterol 1998;27(Suppl 1): S154-158
, 百拇医药
7 Nagahata Y, Kawakita N, Azumi Y, Numata N, Yano M,Saitoh Y. Etiological involvement of Helicobacter pylori
in "reflux" gastritis aftergastrectomy. Am J Gastroenterol 1996;91:2130-2134
8 Kawai Y, Tazuma S, Inoue M. Bile acid reflux and possibleinhibition of Helicobacter pylori infection in subjects
without gastric surgery. Dig Dis Sci 2001;46:1779-1783
, 百拇医药 9 李晓波, 刘文忠, 戈之铮, 冉志华, 陈晓宇, 徐蔚文, 萧树东. 胃大部切除术后患者幽门螺杆菌感染诊断方法的评估.
中华消化杂志 2002;22:608-610
10 Schilling D, Adamek HE, Wilke J, Schauwecker P, Martin WR, ArnoldJC, Benz C, Labenz J, Riemann JF. Prevalence
and clinical importance of Helicobacterpylori infection in patients after partial gastric resection forpeptic ulcer disease.
A prospective evaluation ofHelicobacter pylori infection on 50 resected patients compared withmatched
, 百拇医药
nonresected controls. ZGastroenterol 1999;37:127-132
11 曾锦章, 张万岱, 张洪海, 彭武和, 张振书, 周殿元. 关于胆汁反流性胃炎诊断标准的探讨. 中华消化内镜杂志 1997;
14:287
12 王伯军.胆汁反流性胃炎的病因分析及与幽门螺杆菌关系. 中华消化杂志 2004;24:298-299
13 Valle J, Kekki M, Sipponen P, Ihamaki T, Siurala M. Long-termcourse and consequences of Helicobacter pylori
gastritis: results of a 32-yearfollow-up study. Scand J Gastroenterol 1996;31:546-550
, 百拇医药
14 Farsakh NA, Roweily E, Steitieh M, Butchoun R, Khalil B. Prevalenceof Helicobacter pylori grow in patients with gall
stone before and aftercholecystectomy: a longitudinal study. Gut 1995;36:675-678
15 Johannesson KA, Hammar E, Stael von Holstein C. Mucosal changes inthe gastric remnant: long-term effects of
bile reflux diversion and Helicobacterpylori infection. Eur J Gastroenterol Hepatol 2003;15:35-40
, 百拇医药
16 Lee Y, Tokunaga A, Tajiri T, Masuda G, Okuda T, Fujita I, Kiyama T,Yoshiyuki T, Kato S, Matsukura N, Yamada
N. Inflammation of the gastricremnant after gastrectomy: mucosal erythema is associated with bile reflux
and inflammatory cellularinfiltration is associated with Helicobacter pylori infection. JGastroenterol 2004;39:520-526
17 Robles-Campos R, Lujan-Mompean JA, Parrilla-Paricio P, Bermejo-LopezJ, Liron-Ruiz R, Torralba-Martinez
, http://www.100md.com
JA, Morales-Cuenca G, Molina-MartinzezJA. Role of Helicobacter pylori infection and duodenogastric refluxin
the pathogenesis of alkaline refluxgastritis after gastric operations. Surg Gynecol Obstet 1993;176:594-598
18 Niemela S, Karttunen T, Heikkila J, Maentausta O, Lehtola J.Relationship of Campylobacter pylori and
duodenogastric reflux. Dig Dis Sci 1989;34:1021-1024
19 Han SW, Evans DG, el-Zaatari FA, Go MF, Graham DY. The interactionof pH. bile, and Helicobacter pylori may
explain duodenal ulcer. Am JGastroenterol 1996;91:1135-1137
20 许国铭. 胆汁反流相关性疾病. 上海: 上海科学技术出版社, 2002:194-208
编辑 张海宁, 百拇医药( 郑华君,吕 宾,汪晓庆,徐 毅,范一宏,孙翠萍)
汪晓庆, 浙江省杭州市中医院消化内科 浙江省杭州市 310024
通讯作者: 郑华君, 310006, 浙江省杭州市, 浙江中医学院附属医院消化内科. zhj@126.com
收稿日期: 2004-12-27 接受日期: 2005-01-20
摘要
目的: 观察胃大部切除术后胆汁反流与残胃H pylori感染之间的关系.
, 百拇医药
方法: 残胃组患者101例，其中BillrothⅠ式58例，Billroth II式43例，同期未手术患者4501例作为对照组.残胃组内又分别根据H pylori、胆汁反流与否、反流程度分层比较.以快速尿素酶试验及改良Giemsa染色检测幽门螺杆菌.
结果: 残胃组H pylori感染率(21.79%)显著低于对照组(41.16%)，两组之间比较具有统计学意义(P<0.05);Billroth I 式组H pylori感染率为21.43%，Billroth II式组H pylori感染率为22.22%，两组比较无统计学意义;Billroth I式组胆汁反流阳性率57.14%与Billroth II式组的88.89%相比较具有统计学意义(P<0.001);残胃胆汁反流阳性患者H pylori感染率为35.44%，胆汁反流阴性患者H pylori感染率为45.45%，两组比较具有统计学意义(P<0.01);残胃组患者不同程度胆汁反流的H pylori感染率之间无统计学意义;不同程度胆汁反流的H pylori现患比均小于1.0.
, http://www.100md.com
结论: 残胃H pylori感染率低于未手术者，胆汁反流是H pylori感染的保护因素，但与H pylori感染严重程度无线性关系.
郑华君, 吕宾, 汪晓庆, 徐毅, 范一宏, 孙翠萍. 残胃胆汁反流与幽门螺杆菌感染之间的关系. 世界华人消化杂志 2005;13(11):1353-1355
参考文献
1 Kellosalo J, Alavaikko M, Laitinen S. Effect of biliary tractprocedures on duodenogastric reflux and the gastric
mucosa. Scand J Gastroenterol 1991;23:1272-1278
, 百拇医药
2 许国铭, 李石. 现代消化病学. 北京: 人民军医出版社, 1999:710
3 Safatle-Ribeiro AV, Ribeiro U Jr, Clarke MR, Sakai P, Ishioka S,Garrido AB Jr, Gama- Rodrigues J, Safatle NF, Reynolds
JC. Relationship between persistence of Helicobacterpylori and dysplasia, intestinal, metaplasia, atrophy,inflammation, and cell proliferationfollowing partial gastrectomy. Dig Dis Sci 1999;44:243-252
4 王金莹, 金懋林, 李吉友, 吕有勇. 胃黏膜病变中幽门螺杆菌感染与c-met基因表达相关性的分析. 中华消化杂志 1996;
, 百拇医药
16:360-361
5 刘文忠. 幽门螺杆菌研究进展. 上海: 上海科学技术文献出版社, 2001:30-43
6 Tomtitchong P, Onda M, Matsukura N, Tokunaga A, Kato S, MatsuhisaT, Yamada N, Hayashi A. Helicobacter
pylori infection in the remnantstomach after gastrectomy: with special reference to the differencebetween Billroth I
and II anastomoses. J Clin Gastroenterol 1998;27(Suppl 1): S154-158
, 百拇医药
7 Nagahata Y, Kawakita N, Azumi Y, Numata N, Yano M,Saitoh Y. Etiological involvement of Helicobacter pylori
in "reflux" gastritis aftergastrectomy. Am J Gastroenterol 1996;91:2130-2134
8 Kawai Y, Tazuma S, Inoue M. Bile acid reflux and possibleinhibition of Helicobacter pylori infection in subjects
without gastric surgery. Dig Dis Sci 2001;46:1779-1783
, 百拇医药 9 李晓波, 刘文忠, 戈之铮, 冉志华, 陈晓宇, 徐蔚文, 萧树东. 胃大部切除术后患者幽门螺杆菌感染诊断方法的评估.
中华消化杂志 2002;22:608-610
10 Schilling D, Adamek HE, Wilke J, Schauwecker P, Martin WR, ArnoldJC, Benz C, Labenz J, Riemann JF. Prevalence
and clinical importance of Helicobacterpylori infection in patients after partial gastric resection forpeptic ulcer disease.
A prospective evaluation ofHelicobacter pylori infection on 50 resected patients compared withmatched
, 百拇医药
nonresected controls. ZGastroenterol 1999;37:127-132
11 曾锦章, 张万岱, 张洪海, 彭武和, 张振书, 周殿元. 关于胆汁反流性胃炎诊断标准的探讨. 中华消化内镜杂志 1997;
14:287
12 王伯军.胆汁反流性胃炎的病因分析及与幽门螺杆菌关系. 中华消化杂志 2004;24:298-299
13 Valle J, Kekki M, Sipponen P, Ihamaki T, Siurala M. Long-termcourse and consequences of Helicobacter pylori
gastritis: results of a 32-yearfollow-up study. Scand J Gastroenterol 1996;31:546-550
, 百拇医药
14 Farsakh NA, Roweily E, Steitieh M, Butchoun R, Khalil B. Prevalenceof Helicobacter pylori grow in patients with gall
stone before and aftercholecystectomy: a longitudinal study. Gut 1995;36:675-678
15 Johannesson KA, Hammar E, Stael von Holstein C. Mucosal changes inthe gastric remnant: long-term effects of
bile reflux diversion and Helicobacterpylori infection. Eur J Gastroenterol Hepatol 2003;15:35-40
, 百拇医药
16 Lee Y, Tokunaga A, Tajiri T, Masuda G, Okuda T, Fujita I, Kiyama T,Yoshiyuki T, Kato S, Matsukura N, Yamada
N. Inflammation of the gastricremnant after gastrectomy: mucosal erythema is associated with bile reflux
and inflammatory cellularinfiltration is associated with Helicobacter pylori infection. JGastroenterol 2004;39:520-526
17 Robles-Campos R, Lujan-Mompean JA, Parrilla-Paricio P, Bermejo-LopezJ, Liron-Ruiz R, Torralba-Martinez
, http://www.100md.com
JA, Morales-Cuenca G, Molina-MartinzezJA. Role of Helicobacter pylori infection and duodenogastric refluxin
the pathogenesis of alkaline refluxgastritis after gastric operations. Surg Gynecol Obstet 1993;176:594-598
18 Niemela S, Karttunen T, Heikkila J, Maentausta O, Lehtola J.Relationship of Campylobacter pylori and
duodenogastric reflux. Dig Dis Sci 1989;34:1021-1024
19 Han SW, Evans DG, el-Zaatari FA, Go MF, Graham DY. The interactionof pH. bile, and Helicobacter pylori may
explain duodenal ulcer. Am JGastroenterol 1996;91:1135-1137
20 许国铭. 胆汁反流相关性疾病. 上海: 上海科学技术出版社, 2002:194-208
编辑 张海宁, 百拇医药( 郑华君,吕 宾,汪晓庆,徐 毅,范一宏,孙翠萍)
