内镜黏膜下剥离术治疗早期胃癌

目的 探讨内镜黏膜下剥离术(ESD)治疗早期胃癌的有效件及安全性.方法 对20例早期胃癌患者共21处病灶进行ESD治疗,观察治疗的情况及效果.结果 21处病灶一次性整块切除率为95.2%(20/21),组织学治愈性切除率为90.5%(19/21).平均手术时间50.4 min.急性少量出血率4.8%(1/21),术后腹痛发生率为76.2%(16/21),未发生急性大量出血、穿孔、术后延迟出血.2个月时复查胃镜,溃疡愈合率100%.平均随访9.2个月(8～12个月),局部无残留、复发及异时病灶发生.结论 ESD町提高一次性完整切除率和组织学治愈性切除率,是一种治疗早期胃癌的安全有效的方法.     

原发性十二指肠恶性肿瘤诊治分析

目的探讨原发性十二指肠恶性肿瘤的临床表现、病理学特征及诊治手段。方法回顾性分析1990年至2008年间收治的原发性十二指肠恶性肿瘤39例患者的临床资料。结果发病部位以乳头周围区为主26例,其他部位13例。临床主要表现为腹痛(26例),梗阻(32例),消化道出血(18例)和发热(6例)。病理学类型腺癌多见(33例),其他6例。术前经内镜检查确诊率为86.2%,CT/PET-CT协助确诊率85.3%。18例行根治性手术,21例行姑息性手术,行胰十二指肠切除3年和5年生存率分别为77.8%和16.7%;姑息性手术2.5~36个月死亡。结论原发性十二指肠恶性肿瘤好发于十二指肠乳头周围区,腺癌为主;临床以上腹痛、梗阻、消化道出血为主要表现,但缺乏特征性。CT/PET-CT及内镜检查仍是诊断原发性十二指肠恶性肿瘤的主要手段,手术切除是主要治疗方法。     

Is there still a role for sucralfate in the treatment of gastritis?

The endoscopic diagnosis of gastritis is usually made when a patient develops symptoms and undergoes an upper gastrointestinal endoscopy. There are often obvious aetiological causes such as smoking, alcohol Helicobacter pylori infection or drug treatment. Lifestyle changes can sometimes improve symptoms but often patients will be treated with a proton pump inhibitor. The stomach mucosa produces a protective mucous to prevent damage cause by gastric acid and exogenous agents can disrupt this layer. Repair of this protective layer can be enhanced by reduction in gastric acid secretion using H2 receptor antagonist or proton pump inhibitors or by cytoprotective drugs such as misoprostol, sucralfate, aluminium ions or bismuth subsalts. Sucralfate is a complex polymer which at a low pH changes its chemical configuration and binds to serum protein to form a protective layer protecting the mucosa against further injury. Cytoprotective drugs were the first line treatment for peptic disease including gastritis for many years but since the launch of cimetidine in 1976 and the subsequent launch of omeprazole in 1988, their use has slowly declined. First line treatment for patients with symptomatic gastritis after removal of potential causative factors is likely to be a proton pump inhibitor in 2019. This is despite the fact that there is some evidence that sucralfate is superior than a H2 receptor antagonist in the endoscopic healing rates in patients with gastritis. The logical treatment choice in patients with resistance symptoms is a combination of a proton pump inhibitor and sucralfate but evidence is lacking. Until such evidence is available In the meantime, we would suggest that there is a role for sucralfate in the treatment of intransigent gastritis and that mucosal protection should be considered even ahead of acid suppression given its favourable safety and toxicity profile.