论文部分内容阅读
目的 探讨不同时机根除幽门螺杆菌(Helicobacter pylori,Hp)对内镜黏膜下剥离术(Endoscopic submucosal dissection,ESD)后溃疡愈合的影响.方法 选取2015年9月至2017年2月因胃黏膜内癌或高级别上皮内瘤变的Hp阳性患者97例,随机分配为ESD术前根除组(A组,30例)、ESD术后3天根除Hp组(B组,34例)、ESD术后8周根除HP组(C组,33例),于术后4周行胃镜检查,记录并比较3组患者的人工溃疡面积减少率、溃疡分期、S1期溃疡愈合率.采用单因素方差分析或kruskal-Wallis H秩和检验比较溃疡面积减少率,使用卡方检验或Fisher检验比较溃疡分期及S1期溃疡愈合率.结果 ESD术后4周复查胃镜,A,B,C组溃疡面积减少率分别为(91.0±4.7)％、(88.9±4.8)％、(89.1±4.5)％,各组间差异均无统计学意义(P＞0.05).A,B,C组溃疡分期人数(S1/H2/H1/A2)分别为(3/10/14/3)、(3/11/16/4)、(1/5/19/8),各组间差异均无统计学意义(P＞0.05).A,B,C组S1期溃疡愈合率分别为10.0％(3/30)、8.82％(3/34)、3.03％(1/33),各组间差异均无统计学意义(P＞0.05).结论 不同时机根除Hp对4周时人工溃疡面积减少率、人工溃疡愈合分期及S1期溃疡愈合率无影响.“,”Objective To investigate the effect of Helicobacter pylori eradication on ulcer healing after endoscopic submucosal dissection (ESD) at different time.Methods A total of 97 Hp-positive patients with gastric mucosal carcinoma and high-grade intraepithelial neoplasia and Hp infection were enrolled in this study from September 2015 to February 2017.The patients were randomly divided into receiving eradication therapy for Hp before ESD group (group A,n =30) or 3 days after ESD group (group B,n =34) or 8 weeks after ESD group (group C,n =33).The ulcer area reduction rate and the ulcer staging were monitored and compared among the groups.The reduction rate of ulcer area was compared with the kruskal-Wallis test,and the ulcer staging and the scarring rate of ulcers of S1 were compared by chi-square test or Fisher test.Results Four weeks later,the reduction rate of ulcer area in group A,B and C were (91.0 ±4.7) ％,(88.9 ± 4.8) ％ and (89.1 ± 4.5) ％,respectively.There was no statistically significant difference among the groups (all P ＞ 0.05).The number of different levels of ulcer stage (S1/H2/H1/A2) in group A,B and C were (3/10/14/3),(3/11 / 16/4),(1/5/19/8),respectively.There was no statistically significant difference among the groups (all P ＞ 0.05).The scarring rate of ulcers of S1 were 10.0％ (3/30),8.82％ (3/34) and 3.03％ (1/33),respectively.There was no statistically significant difference among the groups (all P ＞ 0.05).Conclusion Hp eradication at different time does not affect the reduction rate of ulcer area,the ulcer staging and the scarring rate of ulcers of S1.