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Dieulafoy 病 21 例临床分析

目的 探讨 Dieulafoy 病的病因、临床表现、诊断及治疗。 方法 回顾性分析笔者所在医院于 1998–2014 年期间收治的 21 例 Dieulafoy 病患者的临床资料。 结果 21 例 Dieulafoy 病患者的发病诱因：饮酒 6 例，长期服用非甾体类抗炎药 6 例，食辛辣食物刺激 5 例，精神刺激 1 例，其余 3 例无诱因。临床表现：均突发起病，17 例表现为呕血及大量黑便，3 例表现为大量呕血，1 例仅表现为黑便。所有病例入院后行急诊胃镜检查，确诊 20 例，1 例漏诊。病变位于胃底部 4 例，位于胃体近贲门小弯侧 13 例，位于胃角 2 例，位于十二指肠球部2 例。20 例行内镜下止血治疗，15 例经内镜下止血成功，5 例失败。内镜止血成功的 15 例患者获访 8～20 个月，中位数为 14 个月，随访期间均未再出血。6 例行外科手术治疗，包括胃镜引导下腹腔镜胃楔形切除 3 例，胃镜引导下腹腔镜单纯血管缝扎 1 例，开腹胃大部切除术 1 例，腹腔镜胃大部切除术 1 例。术后 6 例患者获访 6～14 个月，中位数为 9 个月，随访期间 5 例未再出血；1 例于术后 6 个月再次出血，但出血量少，经抑酸、止血等保守治疗后出血停止。 结论 急诊胃镜是诊断 Dieulafoy 病的首选方法。Dieulafoy 病的治疗首选内镜下止血，内镜止血不成功者可考虑手术治疗，手术方式首选双镜联合局部楔形切除术。

采用鼻胃镜对食管上段狭窄患者行经皮内镜下胃造瘘术的围手术期护理一例

胃镜下避孕套辅助取出巨大义齿异物一例

中药治疗消化性溃疡疗效观察

摘要:目的: 观察自拟中药胃病I号方治疗消化性溃疡的疗效。 方法 :采用随机数字将90例消化性溃疡患者分为两组,治疗组60例,采用自拟中药胃病I号方治疗;对照组30例,采用奥美拉唑、阿莫西林、克拉霉素治疗。观察两组治疗前后证候疗效、胃镜疗效、临床症状改善情况及幽门螺杆菌(Hp)的根除率。 结果 :治疗组证候总有效率与对照组比较差异有统计学意义(〖WTBX〗P lt;0.05),治疗组证候疗效优于对照组,治疗组胃镜总有效率、Hp根除率分别与对照组比较差异无统计学意义(〖WTBX〗P gt;0.05),治疗组疗效与对照组相当。治疗组在改善上腹疼痛方面与对照组疗效相当,但在改善食欲不振、返酸、嗳气方面,治疗组疗效优于对照组。 结论 :自拟中药胃病I号方治疗消化性溃疡疗效肯定,副反应少,值得推广。

Combination Therapy in Bleeding Esophageal Varices with Under Gastroscope Injection of Sclerosing Agent and Drug Treatment

目的:观察比较胃镜下硬化剂注射联合药物治疗和单纯硬化剂注射治疗、药物治疗食管静脉曲张出血的疗效。方法:95例肝硬化并食管静脉曲张出血患者,分成三组。32例患者给予硬化剂注射联合药物治疗,31例患者给予硬化剂治疗,32例患者给予药物治疗。观察三组患者急诊止血率,近期出血率、远期再出血率、曲张静脉消失率、曲张静脉复发率。 结果: 联合组、硬化剂组、药物组急诊止血率分别为93.8%.90.3%、68.8%;联合组、硬化剂组、药物组近期出血率分别为6.3%、9.7%、46.9%;联合组、硬化剂组、药物组曲张静脉消失率分别为90.6%、83.9%、1.9%;联合组、硬化组与药物组急诊止血率、近期出血率、曲张静脉消失率有显著差异。联合组、硬化剂组、药物组远期出血率分别为9.4%、59.4%、31.3%; 联合组、硬化剂组、药物组曲张静脉复发率分别为18.8%、45.2%、87.5%;联合组与硬化组、药物组远期出血率、曲张静脉复发率有显著差异。结论:胃镜下硬化剂注射联合药物治疗食管静脉曲张出血可显著提高疗效。

无痛胃镜下行食管静脉曲张套扎术后患者麻醉苏醒期的护理

【摘要】　目的　总结对无痛胃镜下行食管静脉曲张套扎术患者麻醉苏醒期的护理要点。　方法　2009年3月－2009年10月，对83例食管静脉曲张患者在无痛胃镜下行曲张静脉套扎术，术后麻醉苏醒期采取密切观察、积极预防、及时处置等有效护理措施，防止并发症发生。　结果　麻醉苏醒期，有7例患者出现低氧血症，1例出现反流但无误吸。　结论　积极有效的护理措施，能有效降低无痛胃镜下食管静脉曲张套扎术患者麻醉苏醒期相关并发症的发生率。

Diagnosis and treatment of esophageal foreign body: Operation or endoscopy?

ObjectiveTo summarize our experience in the treatment of esophageal foreign bodies.MethodsA retrospective analysis of 149 patients of esophageal foreign bodies in the Second Affiliated Hospital of Air Force Military Medical University from December 2011 to May 2019 was carried out, including 75 (50.3%) females and 74 (49.7%) males with an average age of 57 (2-85) years.ResultsThere were 146 patients confirmed by endoscopy, and 3 patients were not found foreign body. Among the confirmed patients, 127 patients were removed by gastroscope and 19 patients were treated by operation. Esophageal foreign bodies are mainly related to the types of food. Jujube seed is the most common food foreign body in the northwest China. The injury rate of mucosal was 47.54% within 48 hours. The complication rate of taking out the foreign body after 48 hours was 100.0%. The success rate by endoscopy decreased (P=0.005), if the foreign body combined perforation. There was no statistical difference between the neck and other parts when using ultra-fine gastroscope (P=0.157).ConclusionThe sharper the foreign body is, the easier the perforation is. The earlier the foreign body is removed, the less complications are. The size of the foreign body determines the difficulty of endoscopic removal. Gastroscopy is the first choice for diagnosis and treatment, especially ultra-fine gastroscopy, and the foreign bodies that cannot be removed by endoscopy need surgical treatment.

Relationship between Clinicopathological Characteristics and Invasion Depth of Early Gastric Cancer

ObjectiveTo investigate the relationship between clinicopathological characteristics and invasion depth of early gastric cancer (EGC), in order to put forward suitable regimens for EGC with different clinicopathological characteristics. MethodsThe clinicopathological data of 18 patients with EGC diagnosed from January 2008 to January 2013 were retrospectively analyzed. Clinicopathologic variables such as age, gender, tumor size and location, Helicobacter pylori infection, melaena, macroscopic type, and histopathological type were investigated by using chi-square test for their possible relationship with the depth of invasion. ResultsLymph node metastasis was more common in patients with submucous cancer (3/9, 33.3%) than in those with mucous cancer (0/9, 0%). Submucosal invasion was found in 77.8% (7/9) of undifferentiated adenocarcinoma cases, whereas only 22.2% (2/9) of differentiated adenocarcinoma had submucosal invasion. TypeⅢ EGC had a significant association with submucosal invasion (P<0.05). ConclusionEndoscopic treatment is unsuitable for patients with Type Ⅲ EGC.

七氟醚用于小儿无痛胃镜的临床研究

目的 研究七氟醚在小儿无痛胃镜的临床应用。 方法 2008年8月-2009年6月，随机选择60例行胃肠镜术的患儿，分为观察组和对照组。观察组在七氟醚麻醉下行胃肠镜手术，对照组仅行表面麻醉下行胃肠镜手术。 结果 对照组患儿不能接受胃镜重复检查（90.0%），观察组患儿能接受复检（93.3%）。七氟醚复合罗库溴铵能实现无痛胃镜检查，麻醉平稳。 结论 七氟醚达到了理想的小儿胃肠镜术的麻醉要求，可有效安全地应用，值得在临床推广应用。

术中胃镜辅助治疗食管癌术后上消化道出血

目的 总结术中胃镜辅助治疗食管癌术后上消化道出血的临床经验。 方法 回顾性分析2001年3月至2009年3月成都军区总医院6例食管癌手术后上消化道出血患者经胃镜辅助手术治疗的临床资料，其中男5例，女1例；年龄55~78岁,平均年龄64岁。6例食管癌手术后患者均于术后24 h内发生上消化道出血，需再次手术止血，在胃镜辅助下查找出血点，通过直接缝扎、局部药物注射、微波凝固和金属夹进行止血处理,再次手术后观察止血效果。 结果 再次手术后6例患者上消化道出血立即停止,血压回升,均未发生吻合口瘘和胸胃穿孔等并发症，痊愈出院。随访6例，随访时间3个月~1年，随访期间1例死于放、化疗并发症，其余患者均未发生上消化道出血。 结论 胃镜辅助手术治疗食管癌手术后上消化道出血，能准确查找出血部位，通过缝扎、局部药物注射,微波凝固治疗、金属夹止血的应用,控制出血迅速可靠,方法简单、安全。