Hp根治治疗对消化性溃疡伴良性幽门梗阻患者内镜球囊扩张术后的影响

Effects of Helicobacter pylori radical treatment on endoscopic balloon dilatation in patients with benign pyloric obstruction complicated with peptic ulcer

目的探讨幽门螺杆菌(Hp)根治治疗对消化性溃疡(PU)伴良性幽门梗阻患者内镜球囊扩张术后的影响。方法选取2014年7月至2016年7月西安市北方医院消化内分泌内科收治的PU伴良性幽门梗阻患者80例为研究对象,按入院顺序编号后随机分为观察组和对照组各40例。对照组给予常规对症支持治疗,并在内镜下行球囊扩张术;观察组在此基础上给予Hp根治治疗,术后定期随访1年,比较两组患者的治疗效果、手术相关指标及血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、胃泌素(GAS)水平,以胃流出道梗阻评分系统(GOOSS)、消化性溃疡疾病量表(PUDQ)、胃肠疾病生命质量指数(GIQLI)评价进食、疾病严重程度及生活质量,同时记录复发情况及并发症。结果观察组患者的治疗有效率为95.0%,明显高于对照组的80.0%,差异有统计学意义(P<0.05);两组患者的住院时间、治疗费用比较差异均无统计学意义(P>0.05),观察组患者的胃排空时间为(1.8±0.3)h,短于对照组的(2.0±0.4)h,差异有统计学意义(P<0.05);观察组患者治疗后血清IL-6、TNF-α和GAS分别为(24.1±2.3)pg/L、(6.0±1.3)μg/L、(23.4±2.7)mg/L,均明显低于对照组的(30.4±3.2)pg/L、(8.1±1.2)μg/L、(36.5±3.4)mg/L,差异均有统计学意义(P<0.05);观察组患者治疗后的GOOSS评分、PUDQ评分和IQLI评分分别为(2.5±0.5)分、(105.4±1.7)分、(123.3±1.6)分,均明显高于对照组的(1.9±0.2)分、(100.8±1.2)分、(112.1±1.7)分,差异均有统计学意义(P<0.05);观察组患者治疗后1年幽门梗阻复发率为2.5%,低于对照组的17.5%,差异有统计学意义(P<0.05),但两组并发症发生率比较差异无统计学意义(P>0.05)。结论 Hp根治治疗联合内镜球囊扩张术可明显提高PU伴良性幽门梗阻患者临床疗效,改善其血清炎症因子水平及胃肠功能、生活质量,且复发率低,不会明显增加并发症,值得在临床推广应用。

Objective To explore the effects of Helicobacter pylori （Hp） radical therapy on endoscopic balloondilatation in patients with benign pyloric obstruction complicated with peptic ulcer （PU）. Methods A total of 80 casesof PU patients with benign pyloric obstruction, who treated in Department of Digestive Endocrinology of the NorthernHospital of Xi＇an City from July 2014 to July 2016, were selected for the study and numbered by admission sequence,and then were divided into the observation group and the control group, with 40 cases in each group. The control groupwas given routine symptomatic support therapy and endoscopic balloon dilatation, and the observation group was giv-en Hp radical treatment on this basis. The patients were regularly followed up for 1 year, and the treatment effect, thelevels of surgical related indexes and serum interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） and gastrin （GAS）were measured and compared between the two groups. And the Gastric Outflow Obstruction Scoring System （GO-OSS）, Digestive Ulcer Disease Scale （PUDQ）, Gastrointestinal Disease Quality of Life Index （GIQLI） were used toevaluate the eating, the severity of the disease and the quality of life, and the recurrence and complications were record-ed. Results The effective rate of treatment was 95.0% in the observation group, which was significantly higher than80.0% in the control group （P〈0.05）. There was no significant difference in the length of hospital stay and hospitaliza-tion cost between the two groups （P〉0.05）, and the gastric emptying time was （1.8±0.3） h in the observation groupversus （2.0±0.4） h in the control group （P〈0.05）. The levels of serum IL-6, TNF-α and GAS were respectively （24.1±2.3） pg/L, （6.0±1.3） μg/L and （23.4±2.7） mg/L in the observation group, which were significantly lower than corre-sponding （30.4±3.2） pg/L （8.1±1.2） μg/L and （36.5±3.4） mg/L in the control group （P〈0.05）. The scores of GOUD,PUDQ and GIQLI were respectively （2.5±0.5）, （105.4±1.7） and （123.3±1.6） points in the observation group, whichwere significantly higher than corresponding （1.9±0.2）, （100.8±1.2） and （112.1±1.7） points in the control group （P〈0.05）. After 1 year of treatment, the recurrence rate of pyloric obstruction was 2.5% in the observation group, whichwas significantly lower than 17.5% in the control group （P〈0.05）, and there was no significant difference in the compli-cation rates between the two groups （P〉0.05）. Conclusion Hp radical treatment combined with endoscopic balloon dil-atation can significantly improve the clinical efficacy of PU patients with benign pyloric obstruction, strengthen its se-rum inflammatory factors levels, gastrointestinal function and the quality of life with low recurrence rate, and not signifi-cantly increase the complications. Therefore, it is worthy of clinical promotion and application.