影响残胃泌酸功能的相关性因素分析

Clinical research of acid secreting function in patients with gastric stump

目的研究胃远端部分切除术后患者泌酸功能及其与黏膜病理改变、胆汁反流和幽门螺杆菌(Hp)感染的相关性。方法采用24hpH监测仪测定51例残胃患者空腹胃内pH值,根据24h胃内平均pH值分为低泌酸组(pH≥3)和正常泌酸组(pH<3)。胃镜观察残胃黏膜以及Hp检测。结果低泌酸组患者35例,其中29例黏膜呈重度萎缩;正常泌酸组16例,其中4例呈重度黏膜炎症(P=0.006)。胆汁反流率在低泌酸组和正常泌酸组分别为37.4%和18.7%(P=0.014)。两组间Hp感染率差异无显著性。62.7%的患者胃酸分泌减少,已接受抑酸药物治疗。结论24h动态胃pH监测可有效评价残胃患者胃黏膜泌酸功能。胆汁反流和残胃炎症程度与黏膜泌酸功能有相关性。约1/3残胃患者保持正常胃酸分泌功能,临床上有大量患者接受了不必要的抑酸治疗。

[Objective] To investigate acid-secreting functional status of gastric stump and the clinical significance. [Methods] pH value of gastric stump in 24 hours was monitored. Gastric mucosa was observed by endoscopy and biopsy. Helicobacter pylori were examined. [ Results ] 35 patients with partial gastrectomy showed pH≥ 3 in 24 hours, including 29 with atrophic gastritis. 16 showed pH〈3, including 4 with severe gastritis. The ratio of bile reflux in patients with 24-hour-pH mean value ≥3 and 〈3 were 37.4% and 18.7%, respectively. There was no significant difference between the two groups. About 62.7% of the patients who had no or little capability to produce acid received acid suppressing therapy. [Conclusions] 24 h pH monitoring is an efficient method to detect mucosa acid secreting function in patients with gastric stump. The degree of gastritis correlates with acid secretion of mucosa. Many patients（about 1/3） who have normal acid secreting function receive unnecessary acid suppressing treatment.