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目的探讨影响内镜下黏膜切除术(EMR)致溃疡愈合的相关因素,确定奥美拉唑治疗EMR相关溃疡的适宜疗程。方法39例EMR手术病人,术后服用奥美拉唑20mg,共28d;EMR术后第1、2、4周,行内镜检查溃疡面积及分期,并与初始EMR相关溃疡的面积进行比较。同时记录病人的年龄、EMR术式、幽门螺杆菌(Hp)感染情况、病理结果、病损部位、服药的剂量及相关症状。结果EMR术后第2周、第4周其溃疡分期及溃疡愈合率无明显差异(P>0.05),而与第1周相比均有明显差异(P<0.01)。EMR相关溃疡的愈合与患者年龄、性别、病理结果、Hp感染溃疡部位无关(P>0.05),而与吸烟、非甾体抗炎药物、EMR术式有关(P<0.01)。吸烟、服用非甾体抗炎药物者愈合质量差,单纯EMR愈合最好,而黏膜下注射法分片黏膜切除术(EMR-P)及透明帽辅助法黏膜切除术(EMR-C)溃疡愈合差。结论应用奥美拉唑2~4周均可有效治疗EMR相关溃疡,用药4周溃疡愈合质量高,禁烟、禁服甾体抗炎药物、根除Hp有利于溃疡愈合。
Objective To investigate the influencing factors of ulcer healing caused by endoscopic mucosal resection (EMR) and to determine the appropriate course of omeprazole in the treatment of EMR-related ulcer. Methods Thirty-nine patients with EMR surgery were given omeprazole 20 mg for 28 days after operation. The area and stage of ulcer were examined by endoscopy at 1, 2 and 4 weeks after EMR, and compared with the area of initial EMR-related ulcer. At the same time, the patient’s age, EMR procedure, H. pylori (Hp) infection, pathological findings, lesion location, medication dose and related symptoms were recorded. Results There was no significant difference in ulcer staging and ulcer healing between the second week and the fourth week after EMR (P> 0.05), but significantly different from the first week (P <0.01). The healing of EMR-related ulcer was not related to age, sex, pathology and Hp infection (P> 0.05), but was related to smoking, NSAIDs and EMR (P <0.01). Smoking, non-steroidal anti-inflammatory drugs were poor quality of healing, simple EMR healing the best, and mucosal submucosal grafting (EMR-P) and clear cap-assisted mucosal resection (EMR-C) ulcer healing difference. Conclusions Omeprazole can be used to treat EMR related ulcer 2 ~ 4 weeks after the treatment. Oral ulcer healing is good after 4 weeks of treatment, and no smoking and no anti-steroid anti-inflammatory drugs. Eradication of Hp is beneficial to ulcer healing.