目的 探討復(fù)胃散聯(lián)合雷尼替丁治療幽門螺桿菌陽性胃潰瘍合并胃癌癌前病變的臨床效果。方法 收集茂名市茂南區(qū)人民醫(yī)院2009年1月—2013年12月在門診和住院收治的1 360例幽門螺桿菌陽性胃潰瘍合并胃癌癌前病變患者，按隨機數(shù)字法分為治療組和對照組，每組680例。對照組給予復(fù)胃散膠囊，1.5 g/次，3次/d。治療組在內(nèi)鏡輔助下確定患者病灶位置，并注射雷尼替丁注射液；第二天開始服用復(fù)胃散膠囊，用法用量同對照組。兩組患者均治療2個月。治療后，對兩組患者臨床癥狀療效、胃鏡療效、病理療效及幽門螺桿菌根除率進行比較。結(jié)果 治療組和對照組證候療效總有效率分別為88.5%、68.1%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組胃鏡下潰瘍、充血水腫、糜爛、黏膜變白、顆粒增生、血管透見的癥狀均有所好轉(zhuǎn)，治療組各癥狀的有效率均高于對照組，兩組有效率比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組腸上皮化生、異型增生、腸上皮化生和異型增生兩者兼有的癌前病變總有效率分別為69.8%、70.0%、66.7%，均明顯高于對照組的39.8%、42.5%、36.5%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療組和對照組幽門螺桿菌根除率分別為95.2%、77.1%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 復(fù)胃散膠囊聯(lián)合內(nèi)鏡下注射雷尼替丁注射液治療幽門螺桿菌陽性胃潰瘍合并胃癌前病變具有較好的臨床療效，可充分發(fā)揮內(nèi)鏡注射的局部大劑量治療和中藥組分的協(xié)同作用，提高治療有效率。

Objective To investigate the clinical efficacy of Fuweisan combined with ranitidine in treatment of Hp positive gastric ulcer merger of precancerous lesions. Methods Patients with Hp positive gastric ulcer merger of precancerous lesions (1 360 cases) who came to Maonan People's Hospital of Maoming City from January 2009 to December 2013 were randomly divided into treatment and control groups (n = 680). Patients in the control group were po administered with Fuweisan Capsule (10 g) for three times daily. Lesion locations of patients in the treatment group were determined under the endoscope, and the patients were injected with ranitidine. From day 2, the patients in the treatment group were treated with Fuweisan Capsule, and the usage and dosage were the same as the control group. Two groups were treated for two months. After treatment, the clinical symptoms efficacy, endoscopy efficacy, pathology efficacy, and Hp eradication rates of two groups were compared. Results Clinical symptoms efficacy in treatment and control groups were 88.5% and 68.1%, with significant differences (P < 0.05). After treatment, the symptoms of ulcer, hyperemia edema, erosion, mucous membrane to bleach, particles hyperplasia, and see-through blood vessels were improved, the effective rate of the treatment group was higher than that of the control group. And there were significant differences between the two groups (P < 0.05). After treatment, total effective rate of precancerous lesions such as intestinal metaplasia, hyperplasia, intestinal metaplasia, and hyperplasia in the treatment group were 69.8%, 70.0%, and 66.7%, respectively, which were significantly higher than those of control group (39.8%, 42.5%, and 36.5%), with significant differences (P < 0.05). Hp eradication rates of treatment and control groups were 95.2% and 77.1%, with significant differences (P < 0.05). Conclusion Fuweisan Capsule combined with endoscopic Ranitidine Injection has good clinical efficacy in treatment of Hp positive gastric ulcer merger of precancerous lesions, which can give full synergistic effect of local high-dose therapy in endoscopic injection and traditional Chinese medicine composition, so as to improve the treatment efficiency.