幽门螺旋菌根除於消化性溃疡穿孔修补术後之预防溃疡复发效果.pptVIP

幽門螺旋菌根除於消化性潰瘍穿孔修補術後之預防潰瘍復發效果 — 系统性文獻回顧及統合分析Eradication of Helicobacter Pylori for Prevention of Ulcer Recurrence after Simple Closure of Perforated Peptic Ulcer: A Meta-Analysis of Randomized Controlled Trials王忠信1,2、謝志華3、魏柏立1,4、馬漢平1,2、蔡行瀚1,2、吳志雄1,3、譚家偉1,4,5台北醫學大學醫學系1、署立雙和醫院急診醫學科2、署立雙和醫院一般外科3、台北醫學大學附設醫院一般外科4、台北醫學大學附設醫院實證醫學中心5 * Background: Eradication of helicobacter pylori has become part of the standard therapy for peptic ulcer. However, the role of Helicobacter Pylori eradication in perforation of peptic ulcers remains controversial. It is unclear whether eradication of the bacterium confers prolonged ulcer remission after simple repair of perforated peptic ulcer. Objective: The present study is conducted to evaluate the role of H. Pylori eradication in the prevention of ulcer recurrence following simple repair of peptic ulcer perforation. Conclusions: Eradication therapy should be provided to patients with Helicobacter pylori infection after simple closure of perforated gastroduodenal ulcers. Methods: A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of Helicobacter Pylori eradication on prevention of ulcer recurrence after simple closure of perforated peptic ulcers. The primary outcome to evaluate these effects was the incidence of postoperative ulcers; the secondary outcome was the rate of Helicobacter Pylori elimination. Figure 1. Eradication versus Control. Outcome: HP eradicated at 8 weeks and 1 year Figure 2. Eradication versus Control. Outcome: Ulcer presentation at 1 year Figure 3. Eradication versus Control. Outcome: Symptomatic ulcer recurrence Results: The meta-analysis included 5 randomized controlled trials and 401 patients. A high prevalence of Helicobacter Pylori infection occurred in patients with perforated peptic ulcers. Eradication of Helicobacter Pylori significantly reduced the incidence of ulcer recurrence at 8 wk risk ratio 2.97; 95% CI: 1.06 to 8.29 and 1 y risk ratio 1.49; 9