良性和恶性病因术后残胃黏膜组织学变化特征及幽门螺杆菌感染状况  

Histological changes of gastric mucosa and Helicobacter pylori infection status in patients after operation due to benign or malignant gastric diseases

作　　者：李富林 李雪 彭代荣 Li Fulin;Li Xue;Peng Dairong(Department of General Surgery,Shimian County People’s Hospital,Ya’an 625400,China)

机构地区：[1]四川省石棉县人民医院普外科,雅安市625400

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第3期253-257,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的分析良性和恶性病因术后残胃黏膜组织学变化特征与幽门螺杆菌感染状况的关系。方法回顾性分析2014年2月至2019年2月于四川省石棉县人民医院因良性和恶性病因行胃部手术治疗患者共80例,其中36例为良性消化性溃疡患者(良性组),44例为早期胃患癌者(胃癌组),两组患者术后均行黏膜组织学与胃镜检测。分析入组患者病例资料(首次行胃大部切除手术时年龄、性别、术后病程、行胃镜检测年龄、幽门螺杆菌感染、手术病因、病理和胃镜检测结果和手术方式等),观察患者胃黏膜病变[慢性萎缩性胃炎(CAG)、肠化生(IM)和异型增生(DYS)发生率]、幽门螺杆菌感染率与胃黏膜炎症与活动性异常等,比较两组患者中幽门螺杆菌感染者与未感染者胃黏膜的病理特征。结果良性组患者手术年龄为(40.46±6.71)岁,低于胃癌组[(54.08±8.17)岁],胃镜检测年龄及术后病程分别为(67.78±11.36)岁、(27.26±8.87)年,高于胃癌组[(61.99±11.03)岁和(8.04±6.57)年],差异均有统计学意义(t=10.419、P<0.001,t=3.102、P=0.003,t=13.964、P<0.001);良性组患者幽门螺杆菌感染和胃黏膜活动性异常比例分别为47.22%(17/36)和66.67%(24/36),均显著高于胃癌组[31.82%(14/44)和40.91%(18/44)],差异有统计学意义(χ^2=4.147、P=0.039,χ^2=8.239、P=0.003)。良性组、胃癌组患者中幽门螺杆菌感染者胃黏膜活动性异常、CAG及癌前病变比例均高于无幽门螺杆菌感染者,而NAG比率低于无幽门螺杆菌感染者,差异均有统计学意义(P均<0.05)。结论胃大部切除手术后残胃黏膜病变与进展和幽门螺杆菌感染存在一定关系,为预防残胃黏膜癌变可在幽门螺杆菌检测基础上加强胃镜随访。To analyze the relationship between histologic changes of gastric mucosa and Helicobacter pylori(H.pylori)infection after operation caused by benign and malignant gastric disease.Methods Total of 80 patients after operation with benign or malignant causes in Shimian County People’s Hospital of Sichuan Province from February 2014 to February 2019 were collected,retrospectively,among whom,36 cases with benign peptic ulcer(benign group)and 44 cases with early gastric cancer(gastric cancer group);after operation,mucosal histology and gastroscopy were performed,respectively.The clinical data of the patients were analyzed(age of the first subtotal gastrectomy,sex,course of operation,age of gastroscopy detection,H.pylori infection,surgical causes,pathology,results of gastroscopy and surgical methods).The gastric mucosal lesions[incidences of chronic atrophic gastritis(CAG),intestinal metaplasia(IM)and dysplasia(DYS)],the infection rates of H.pylori and the abnormal inflammation and activity of gastric mucosa were analyzed,respectively.Results The age of receiving operation in benign group was(40.46±6.71)years old,significantly lower than that of gastric cancer group[(54.08±8.17)years old](t=10.419,P<0.001).The age of taking gastroscopy examination and postoperative course were(67.78±11.36)years old and(27.26±8.87)years old,significantly higher than those of gastric cancer group[(61.99±11.03)years old and(8.04±6.57)years old],with significant differences(t=3.102,P=0.003;t=13.964,P<0.001).The rates of H.pylori infection and abnormal gastric mucosal activity in benign group were 47.22%(17/36)and 66.67%(24/36),respectively,which were significantly higher than those in the gastric cancer group[31.82%(14/44)and 40.91%(18/44)],with significant differences(χ^2=4.147,P=0.039;χ^2=8.239,P=0.003).Abnormal gastric mucosal activity,CAG and precancerous lesions of cases with H.pylori infeciton were significantly higher than cases without H.pylori infeciton in benign groups and gastric cancer groups,but the rate of NAG was si

关 键 词：胃切除术 幽门螺杆菌 胃黏膜 病理组织 

分 类 号：R735.2[医药卫生—肿瘤]