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 Recur
rence 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 infe
ction after simple closure of perforated gastroduodenal ulcers.
Study or Subgroup
4.1.1 Helicobacter eradicated (at 8 weeks)
El-Nakeeb 2009 Kate 2001
Ng 2000
Subtotal (95% CI)
Total events
Heterogeneity: Tau² = 0.75; Chi² = 24.30, df = 2 (P < 0.00001); I² = 92% Test for overall effect: Z = 2.08 (P = 0.04)
4.1.2 Helicobacter pylori eradicated (at 1 year)
El-Nakeeb 2009 Kate 2001
Subtotal (95% CI)
Total events
Heterogeneity: Tau² = 0.00; Chi² = 0.55, df = 1 (P = 0.46); I² = 0% Test for overall effect: Z = 2.57 (P = 0.01)
Events 31 51 43 125 28 21 49 Total 34 64 51 149 33 40 73 Events 7 34 8 49 14 15 29 Total 31 60 48 139 27 37 64 Weight 31.9% 36.0% 32.1% 100.0% 61.0% 39.0% 100.0% M-H, Random, 95% CI 4.04 [2.09, 7.81] 1.41 [1.09, 1.81] 5.06 [2.66, 9.63] 2.97 [1.06, 8.29] 1.64 [1.11, 2.42] 1.29 [0.79, 2.11] 1.49 [1.10, 2.03]
Eradication Control Risk Ratio Risk Ratio
M-H, Random, 95% CI
0.01 0.1 1 10 100
Favours control Favours eradication
Study or Subgroup
El-Nakeeb 2009 Ng 2000
Total (95% CI)
Total events
Heterogeneity: Tau² = 0.00; Chi² = 0.23, df = 1 (P = 0.63); I² = 0% Test for overall effect: Z = 3.56 (P = 0.0004)
Events 2 2 4 Total 33 42 75 Events 8 16 24 Total 27 42 69 Weight 48.0% 52.0% 100.0% M-H, Random, 95% CI 0.20 [0.05, 0.88] 0.13 [0.03, 0.51] 0.16 [0.06, 0.44]
Eradication Control Risk Ratio Risk Ratio
M-H, Random, 95% CI
0.01 0.1 1 10 100
Favours eradication Favours control
Study or Subgroup El-Nakeeb 2009
Ng 2000
Total (95% CI) Total events
Heterogeneity: Tau² = 0.00; Chi² = 0.07, df = 1 (P = 0.79); I² = 0% Test for overall effect: Z = 2.71 (P = 0.007)
Events 1 1 2 Total 33 42 75 Events 5 9 14 Total 27 42 69 Weight 48.4% 51.6% 100.0% M-H, Random, 95% CI 0.16 [0.02, 1.32] 0.11 [0.01, 0.84] 0.13 [0.03, 0.57]
Eradication Control Risk Ratio Risk Ratio
M-H, Random, 95% CI
0.01 0.1 1 10 100
Favours eradication Favours control
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 40 1 patients. A high prevalence of Helic
obacter Pylori infection occurred in p
atients with perforated peptic ulcers. Eradication of Helicobacter Pylori si gnificantly reduced the incidence of u lcer recurrence at 8 wk (risk ratio 2.9 7; 95% CI: 1.06 to 8.29) and 1 y (risk ratio 1.49; 95% CI: 1.10 to 2.03) post operation. The rate of Helicobacter P
ylori eradication was significantly hig
her in the treatment group than in the nontreatment group.
