ABSTRACT
Objective To investigate the antibiotic resistance trend of commonly used antibiotics of Helicobacter pylori (H.pylori) in Huzhou district,and to summarize the efficacy of eradication in related digestive diseases.Methods In year 2009,2013,2014 and 2015,8 139 gastric mucosa samples of patients undergoing gastroendoscopy examination were collected and H.pylori strains were isolated and cultured.The situation of resistance to levofloxacin,clarithromycin,metronidazole,amoxicillin,tetracycline and furazolidone was analyzed.The infection and antibiotics resistance of H.pylori were analyzed in 11 digestive diseases including functional dyspepsia,chronic gastritis,acute gastritis,duodenitis,gastric ulcer,duodenal ulcer,gastrointestinal dysfunction,gastric cancer,residual gastritis,reflux esophagitis and gastric lymphoma.The eradication schemes and eradication rate of H.pylori was reviewed in six digestive diseases including functional dyspepsia,chronic gastritis,duodenitis,gastric ulcer,duodenal ulcer and reflux esophagitis.Fisher's exact test was performed to compare the differences among the groups.Results A total of 3 263 H.pylori strains were obtained and the infection rate of H.pylori was 40.09％ (3 263/8 139).The H.pylori infection rates of 11 digestive diseases were from 0 to 57.89％,and which was high in duodenal ulcer,gastric ulcer,duodenitis,chronic gastritis and functional dyspepsia (57.89％,726/1 254;49.83％,301/604;42.91％,118/275;37.45％,1 518/4 053 and 36.78％,146/397;respectively).The results of single antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that resistance rate of H.pylori to levofloxacin and clarithromycin reached 23.09％ (663/2 871) and 17.87％ (513/2 871),respectively.The resistance rate tolevofloxacin dramatically increased from 5.03％ (8/159) in 2009 to 28.24％ (586/2 075) in 2015;the resistance rate to clarithromycin increased from 12.58％ (20/159) in 2009 to 21.78％ (452/2 075) in 2015;meanwhile,the resistance rate of H.pylori to metronidazole was nearly 100.00％.However,the resistance rates to amoxicillin,tetracycline and tetracycline were all zero.The results of double antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that the rate of both levofloxacin and clarithromycin resistance was 7.73 ％ (222/2 871).The double antibiotic resistance rate of levofloxacin and clarithromycin in different diseases fluctuated between 4.82 ％ and 10.96 ％.Totally 1 479patients of six digestive diseases were treated with quadruple therapy,and 1 363 patients were followed up after eradication therapy,with the eradication rate of 85.99％ (1 172/1 363).Conclusions In Huzhou district,for six common digestive diseases needed or planed for H.pylori eradication,any combination of two drugs in all three drugs including amoxicillin,tetracycline and furazolidone is the first choice for treatment.Only when patients are allergic to penicillin or furazolidone and tetracycline can not be obtained,will levofloxacin and clarithromycin be chosen.A high eradication rate can be achieved by choosing eradication schemes according to the results of H.pylori drug sensitivity test in local region.
ABSTRACT
Objective To study the efficacy and feasibility of the one-stage and two classification method to treat concomitant gallbladder stones and common bile duct stones.Methods 56 consecutive patients with concomitant gallbladder stones and common bile duct stones in Central Hospital of Huzhou were treated with the one-stage and two classification method from January 2013 to January 2017.According to the size and quantity,common bile duct stones were divided into difficult stones and non difficult stones.In plan A (n =35),endoscopic stone clearance and laparoscopic cholecystectomy were undertaken in a single operation to treat non difficult stones,In plan B (n =21),laparoscopic cholecystectomy and CBD exploration without T-tube insertion were undertaken in a single operation to treat difficult stones.The operation success rate,postoperative complications,hospitalization stay and follow-up outcomes were analyzed.Results Fifty-six patients were enrolled in the study.Fifty-one patients were treated by the one-stage and two classification method.Among them,thirty-two patients followed treatment plan A.Three patients were convened to plan B because of failure of bile duet intubation.Nineteen patients were treated by plan B.One patient was converted to laparotomy,and another underwent T-tube drainage.The incidence of complication was 7.1％.Post-ERCP pancreatitis happened in one patient.Post ERCP bleeding happened in another patient (1.6％).Bile leakage occurred in one patient,and incision infection occurred in one patient.There were no deaths.During a follow-up of 6-24 months,no stone recurrence and bile duct stenosis were observed.Conclusion The one-stage and two classification method was an effective and feasible alternative to manage concomitant gallbladder stones and common bile duct stones.