内镜下氩离子凝固治疗与联合治疗对消化性溃疡出血的疗效比较

目的 探讨内镜下氩离子凝固治疗与氩离子凝固联合药物注射治疗上消化道溃疡出血的疗效。 方法 将123例内镜下有活动出血的溃疡患者分为2组。46例接受内镜下氩离子凝固止血治疗,77例接受氩离子凝固联合药物注射治疗。 结果 两种方法的即时止血率均为100％,有效止血率在氩离子凝固治疗组为84．8％,在联合治疗组为92．2％,两组比较无统计学差异（P〉0．05）,且所有病例无穿孔及其它术后并发症。 结论 两种内镜下治疗均能有效、安全止血,联合治疗并不优于单独氩离子凝固治疗。     

Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial

Aims/hypothesis  This observer-blind, randomised controlled trial was designed to determine the effect of a foot care education programme in the secondary prevention of foot ulcers. Methods  People with newly healed foot ulcers attending one of three specialist clinics were allocated to receive either targeted, one-to-one education or usual care, using a computer-generated random allocation sequence that had been prepared in advance but which was concealed from the clinical researcher. The primary outcome was ulcer incidence at 12 months. Secondary outcomes were ulcer incidence at 6 months and incidence of amputation, mood (Hospital Anxiety and Depression Scale) and quality of life (Diabetic Foot Ulcer Scale) at 6 and 12 months. Protective foot care behaviours (Nottingham Assessment of Functional Footcare) were assessed at 12 months. Results  There were 87 (mean [SD] age 63.5 [12.1] years) patients in the intervention group and 85 control patients (mean [SD] age 64.9 [10.9] years). The groups were comparable at baseline. No significant differences (p > 0.05) were observed between groups in ulcer incidence at either 6 months (intervention 30%, control 21%) or 12 months (intervention 41%, control 41%). Recommended foot care behaviours at 12 months were better in the intervention than in the control group (p = 0.03), but education had no significant (p > 0.05) effect on mood, quality of life or amputations. Conclusions/interpretation  Even though the intervention was associated with improved foot care behaviour, there was no evidence that this programme of targeted education was associated with clinical benefit in this population when compared with usual care. The usefulness and optimal delivery of education to such a high-risk group requires further evaluation. Trial registration: ClinicalTrials.gov NCT00729456 Funding: Diabetes UK project grant RD02/0002535     

胃溃疡的B超诊断研究

本文报告经手术、胃镜和病理证实的150例胃溃疡的B超检查结果。总检出符合率为82%,其中溃疡直径<0.5cm及≤1.5cm者良性溃疡分别占91%和81.8%;>1.5cm者恶性溃疡为79.2%。提出了小凹陷增厚型和大凹陷增厚型二种声像图类型,对漏误诊的原因进行了分析。作者认为,B超诊断本病无痛苦、经济、较可靠,是首选方法之一;对溃疡的性质,可根据凹陷的大小形态、胃壁增厚的范围、胃蠕动变化程度及胃周围有无淋巴结肿大和其它脏器有无浸润转移进行鉴别。     

尿素呼气试验和粪便抗原检测对消化性溃疡出血患者幽门螺杆菌感染诊断价值的Meta分析

背景在消化性溃疡出血（PUB）患者中,抑酸药物的使用以及出血状态等会对幽门螺杆菌（H.pylori）感染的诊断造成干扰,关于尿素呼气试验（UBT）和粪便抗原检测（SAT）应用于出血患者的诊断准确性报道并不一致。目的明确UBT和SAT用于PUB患者H.pylori感染的准确性。方法计算机检索PubMed、EMBase、the Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、中国生物医学文献服务系统（CBM）,收集有关PUB患者运用UBT和/或SAT诊断H.pylori感染的诊断准确性试验,检索时间为建库至2021-03-31。提取资料并应用QUADAS-2工具进行文献质量评价;运用双变量混合效应模型和网络Meta分析模型（NMA）合并诊断试验效应量;采用Meta回归和亚组分析的方法探究异质性的来源。结果共纳入18篇文献,总计25项研究,包含1 105例患者。Meta分析结果显示,UBT、SAT诊断PUB患者H.pylori感染的合并灵敏度为0.90〔95%CI（0.79,0.95）〕、0.89〔95%CI（0.81,0.94）〕,合并特异度为0.91〔95%CI（0.86,0.95）〕、0.75〔95%CI（0.59,0.87）〕,合并诊断比值比为88.89〔95%CI（31.01,254.82）〕、24.35〔95%CI（13.76,43.09）〕,合并阳性似然比为10.07〔95%CI（6.07,16.71）〕、3.60〔95%CI（2.11,6.12）〕,合并阴性似然比为0.11〔95%CI（0.05,0.24）〕、0.15〔95%CI（0.09,0.24）〕,综合受试者工作特征（SROC）曲线下面积为0.93〔95%CI（0.90,0.95）〕、0.91〔95%CI（0.88,0.93）〕。Meta回归提示,取样时间对UBT和SAT的灵敏度异质性存在影响,取样时间和H.pylori感染判定标准对UBT的合并特异度异质性存在影响。Deek漏斗图提示纳入研究间不存在潜在发表偏倚（PUBT=0.53,PSAT=0.64）。结论UBT具有更好地发现PUB患者H.pylori感染的能力,对疾病诊断的帮助优于SAT。鉴于SAT的假阳性结果,针对PUB患者不推荐单独使用SAT,同时依据取样时间与诊断效能的负相关性,为尽量避免质子泵抑制剂对检测结果的影响,推荐血流动力学稳定条件下尽早完善H.pylori相关检测。     

皮肤溃疡的护理方法及研究

目的：探讨临床常见皮肤溃疡的最佳护理方法。方法：将55例病人计67处溃疡按基本条件相当原则随机分成A、B、C三组，A组18例22处伤口采用清创冲洗后，给予自制油纱敷料封闭外敷，同时口服或鼻饲维生素C片，1．5dd；B组18例21处．伤口采用口服或鼻饲维生素C片，0．3g/d．其它同A组；C组19例24处，伤口采用碱性成纤维细胞生长因子外喷溃疡面处，其它方法同A组。结果：C组愈合率最高，且平均显效时间和愈合时间均较A、B两组明显缩短；C组伤口愈合所需费用与A组相近，但明显少于B组。结论：采用清创冲洗后用碱性成纤维细胞生长因子加自制油纱敷料封闭，糖尿病足外用胰岛素，加用大剂量维生素C有助于各种皮肤溃疡愈合的最佳方法。     

Giant duodenal ulcers

Twenty-six giant duodenal ulcers, all correctly diagnosed prior to endoscopy, are presented. The concept of the ulcer/bulb ratio (ratio of longest diameter of the ulcer to that of the total bulb including the ulcer) is introduced. In all cases this ratio was 0.8 or greater; in 18 cases (69%) the ulcer completely replaced the duodenal bulb. An ulcer within an ulcer appearance, representing a small area of deeper ulceration within the giant ulcer, was noted in 8 (31%). Half of the patients have remained symptom-free on medical therapy alone. Only two patients in our series (8%) died of complications of giant duodenal ulcer.     

法莫替丁联合羟氨苄青霉素、替硝唑根除幽门螺杆菌的疗效观察

目的：评价法莫替丁（高舒达）、羟氨苄青霉素、替硝唑三联疗法对幽门螺杆菌（Ｈｐ）相关性消化性溃疡的疗效。方法：将８５例Ｈｐ阳性的十二指肠和／或胃溃疡患者随机分为２组：①法莫替丁组，４２例，每次口服法莫替丁２０ｍｇ、羟氨苄青霉素１０００ｍｇ、替硝唑５００ｍｇ，均每日２次，；②兰索拉唑（达克普隆）组４３例，每次口服兰索拉唑３０ｍｇ、羟氨苄青霉素１０００ｍｇ、替硝唑５００ｍｇ，也均为每日２次，进行对照观察。均２周为１疗程，疗程结束达４周时复查Ｈｐ。结果：兰索拉唑组有３例因过敏性皮疹终止治疗，余下４０例用于统计学分析。法莫替丁组和兰索拉唑组Ｈｐ根除率分别为８８．１％和９０．０％；十二指肠溃疡和／或胃溃疡的愈合率分别为９０．５％和９２．５％。结论：法莫替丁组的Ｈｐ根除率和溃疡愈合率与兰索拉唑组相比较，两组间的差异无显著性（Ｐ＞０．０５）。表明两种三联疗法对根除Ｈｐ和治疗消化性溃疡均有良好效果，均是可供选择的治疗方案。但前者有副作用较少，价格较低廉的优点     

上消化道溃疡穿孔的超声表现及其定位诊断价值

目的探讨上消化道溃疡穿孔的声像图表现及超声定位诊断的价值。方法回顾性分析31例经手术证实的上消化道溃疡穿孔患者的声像图资料。结果手术证实超声定位的31例上消化道溃疡穿孔部位全部符合。直接声像表现为局部胃窦或十二指肠球部壁全层中断,胃肠腔内外回声贯通,可见"漏斗征"、"通道征"声像图。间接声像表现有膈下游离气体、腹腔积液,穿孔断端向内塌陷,肝下间隙大网膜增厚包裹等。结论上消化道溃疡穿孔具有特征性声像图表现,超声弥补了X线检查无法定位的缺陷,对临床的诊断治疗具有重要意义。