影响EMR相关溃疡愈合的相关因素分析  

Analysis of Correlation Factors on the Healing of EMR-Related Ulcer

作　　者：刘锦涛[1] 余细球[1] 杨建荣[1] 侯华军[1] 黄威[1] 

机构地区：[1]深圳市罗湖区人民医院消化内科,深圳518001

出　　处：《临床消化病杂志》2007年第3期166-169,共4页Chinese Journal of Clinical Gastroenterology

基　　金：深圳市科技计划资助项目:JH200505270450A

摘　　要：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 on healing of endoscopic mucosal resection（EMR） induced ulcers, and determine the suitable duration of omeprazole on the EMR-related ulcer. Methods 39 patients who had undergone EMR were studied. After EMR, they were treated with omeprazole（20 mg,twice a day） for 28 days. After EMR,the first week,the second week and the fourth week,the ulcer size and stage were compared with those of the initial EMR-induced ulcer by endoscopy at the same time. Each patient＇ s age,gender,EMR methods,histopathology,site of the lesion, helicobacter pylori （Hp） infection and ulcer-reared symptoms during the 4 week period after EMR were recorded. Results No significant differences were observed between the second week and the fourth week after EMR in terms of ulcer healing ratio （ P 〉 0. 05 ） or stage（ P 〉 0. 05 ）. Their ulcer healing was better than the first week＇ s. The healing of the EMR-related ulcer had no correlation with patient＇s age, gender, histopathology, Hp infection and the site of the lesion （ P 〉 0. 05 ）, and had correlation with smoking, NSAID and E MR methods （ P 〈 0. 05 ）. The smoker or NSAID group had a bad quality of ulcer, and ulcer induced by EMR healed better than that by E MR-P and EMR- C. Conclusion For EMR-induced ulcer, treatment with omeprazole for 2 week is equivalent to treatment for 4 weeks. However, a better quality of ulcer healing in the fourth week than in that the second week is observed. Hp eradication therapy and avoiding smoking and NSAID may improve the quality of ulcer healing of EMR-related ulcer.

关 键 词：EMR相关溃疡 内镜下黏膜切除术 奥美拉唑 

分 类 号：R573.1[医药卫生—消化系统]