目的 探讨复胃散联合雷尼替丁治疗幽门螺杆菌阳性胃溃疡合并胃癌癌前病变的临床效果。方法 收集茂名市茂南区人民医院2009年1月—2013年12月在门诊和住院收治的1 360例幽门螺杆菌阳性胃溃疡合并胃癌癌前病变患者，按随机数字法分为治疗组和对照组，每组680例。对照组给予复胃散胶囊，1.5 g/次，3次/d。治疗组在内镜辅助下确定患者病灶位置，并注射雷尼替丁注射液；第二天开始服用复胃散胶囊，用法用量同对照组。两组患者均治疗2个月。治疗后，对两组患者临床症状疗效、胃镜疗效、病理疗效及幽门螺杆菌根除率进行比较。结果 治疗组和对照组证候疗效总有效率分别为88.5%、68.1%，两组比较差异有统计学意义（P<0.05）。治疗后，两组胃镜下溃疡、充血水肿、糜烂、黏膜变白、颗粒增生、血管透见的症状均有所好转，治疗组各症状的有效率均高于对照组，两组有效率比较差异有统计学意义（P<0.05）。治疗后，治疗组肠上皮化生、异型增生、肠上皮化生和异型增生两者兼有的癌前病变总有效率分别为69.8%、70.0%、66.7%，均明显高于对照组的39.8%、42.5%、36.5%，两组比较差异有统计学意义（P<0.05）。治疗组和对照组幽门螺杆菌根除率分别为95.2%、77.1%，两组比较差异有统计学意义（P<0.05）。结论 复胃散胶囊联合内镜下注射雷尼替丁注射液治疗幽门螺杆菌阳性胃溃疡合并胃癌前病变具有较好的临床疗效，可充分发挥内镜注射的局部大剂量治疗和中药组分的协同作用，提高治疗有效率。

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.