幽门螺杆菌感染与腹腔镜远端胃癌根治术后近期结局：一项倾向评分匹配研究

Helicobacter pylori Infection and Short-Term Outcomes after Laparoscopy-Assisted Distal Gastrectomy: A Propensity Score Matching Study

摘要: 目的：幽门螺杆菌(Helicobacter pylori, Hp)感染是胃癌的重要危险因素。本研究旨在探讨Hp感染是否影响腹腔镜远端胃癌根治术(laparoscopy-assisted distal gastrectomy, LADG)患者的近期临床结局。方法：回顾性分析2023年至2024年在青岛大学附属医院胃肠外科接受LADG的胃癌患者，根据术前Hp状态分为Hp阳性组和Hp阴性组，并采用1:1倾向评分匹配(propensity score matching, PSM)平衡两组基线特征。结果：共纳入310例患者，经过PSM匹配后获得95对基线特征及手术变量均衡的患者。Hp阳性组术后并发症发生率为8.42%。与Hp阴性组相比，Hp阳性组患者术后胃肠道功能恢复略有延迟，表现为首次排气时间延长。此外，部分炎症指标(如CRP、PCT)在术后特定时间点显示出两组之间的差异。结论：Hp感染状态对LADG患者的总体短期临床结局无显著影响。但Hp可能与术后胃肠道功能恢复延迟及炎症反应调节有关，为进一步探讨围手术期免疫调控机制提供了新的研究方向，有必要在前瞻性研究中进行验证。

Abstract: Objective: Helicobacter pylori (Hp) infection is a major risk factor for gastric cancer. This study aimed to evaluate whether Hp infection influences the short-term clinical outcomes of patients undergoing laparoscopy-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was conducted on gastric cancer patients who underwent LADG between 2023 and 2024 in the Department of Gastrointestinal Surgery at the Affiliated Hospital of Qingdao University. Patients were categorized into Hp-positive and Hp-negative groups based on preoperative Hp status. A 1:1 propensity score matching (PSM) approach was applied to balance baseline characteristics between groups. Results: A total of 310 patients were included, and 95 matched pairs with comparable baseline and perioperative characteristics were generated after PSM. The postoperative complication rate in the Hp-positive group was 8.42%. Compared with the Hp-negative group, Hp-positive patients experienced slightly delayed gastrointestinal function recovery, reflected by a longer time to first flatus. In addition, certain inflammatory markers (such as CRP and PCT) showed intergroup differences at specific postoperative time points. Conclusion: Hp infection status did not significantly affect the overall short-term clinical outcomes in patients undergoing LADG. However, Hp infection may be associated with delayed postoperative gastrointestinal recovery and modulation of inflammatory responses. These findings provide new insights into perioperative immunological mechanisms and warrant further validation in prospective studies.