胃手术后胃植物石的预防及护理

胃植物石的发生并不少见，但胃手术后胃植物石的形成鲜有文献报道。我院从2000年1月-2003年12月共收治12例胃手术后因进食柿子而引发的胃内结石，现报道如下。     

经内镜综合治疗胃柿石症

胃石(gastric bezoar)是动物或植物成分等在胃腔内凝结而形成的异物,柿石是最常见的胃石.近年来,胃柿石症在产柿地区逐渐成为较为常见的消化道疾病,本院自2003年1月至2007年10月检出胃柿石40例,作者对其中的34例胃柿石症患者采取内镜下及药物综合治疗,取得了较为满意的临床效果,现报道如下.     

胃手术后胃瘫综合征患者的护理

<正> 胃手术后胃瘫综合征是一种以胃流出道非机械性梗阻为主要征象的功能性疾病。胃瘫综合征国外发生率为5%～24%,国内为4.7%,是胃手术后一种较为严重的并发症。我院1997年1月—2007年12月发生胃手术后胃瘫综合征(下称胃瘫)     

胃手术后胃无力症14例诊治体会

胃手术后胃无力症是指各种胃手术后出现的一种不伴吻合口或输出空肠袢机械性梗阻因素的功能性排空障碍,又称胃排空延迟综合征.其病因尚无定论,治疗上目前也无特定的有效方法.本文就胃手术后胃无力症的病因、诊断、治疗进行初步探讨.     

胃镜在手术后胃瘫综合征的治疗效应与临床意义

手术后胃瘫综合征(postsurgical gastroparesis syndrome,PGS)是一种腹部手术后非机械性梗阻,由于胃动力因素、精神因素等综合影响引起的,以胃排空障碍为主要征象的胃动力紊乱综合征.2003～2010年,武汉大学人民医院共收治41例PGS患者,常规行胃镜联合综合性非手术方法治疗PGS,不仅能明确诊断且能加速非手术方法的治愈时间,报道如下.     

胃柿石致胃溃疡的成因及治疗

近年来,胃石病逐渐增多,且并发胃溃疡、上消化道出血、胃穿孔.现结合文献将四川大学华西医院1996～2001年收治的16例胃柿石合并溃疡患者报道如下.     

毕Ⅱ式胃空肠吻合术后十二指肠残端癌3例

胃肿瘤手术后残胃可癌变．毕Ⅱ式胃空肠吻合术后十二指肠残端癌十分少见,1994年至2002年作者等收治3例,现报道如下。     

胃手术后胃瘫综合征病人的护理

胃手术后胃瘫综合征是一种以胃流出道非机械性梗阻为主要征象的功能性疾病。我院2006年5月-2009年5月胃手术后发生胃瘫32例，经过积极的保守治疗和有效的护理，均恢复了胃肠功能。现报告如下。     

胃手术吻合口残线的影响及处理体会

我院1986年8月～1998年8月,纤维胃镜报告的胃手术后缝合线残留54例,男34例,女20例,年龄15～68岁,平均年龄36.5岁。胃手术后时间半年至5年不等,平均时间2.5年,与同期108例胃手术比较,其结果报道如下。1　临床资料本组54例,术前诊断消化性溃疡并出血18例,消化性溃疡并穿孔32例,消     

胃镜诊断残胃癌与残胃复发癌(附62例报道)

我院自1982年1月～1996年12月胃镜检查手术后胃822人次,检出残胃癌26例,残胃复发癌36例,现予报道,并加以分析、讨论。     

血清胃蛋白酶原与良、恶性溃疡

目的通过检测血清胃蛋白酶原Ⅰ(PGI)、血清胃蛋白酶原Ⅱ(PGII),探讨胃溃疡及胃癌患者血清PGI、血清PGII及血清PGI/血清PGII的变化规律。方法研究了2005年5月至2006年1月在我院消化内镜中心行胃镜检查者171例,并设正常人对照12例:用免疫放射法(IRMA)测定了其血清PGI及PGII并计算PGI/PGII即PGR。171例胃病患者分组情况:①消化性溃疡组105例;②胃癌组66例。结果①消化性溃疡患者血清PGI及PGII升高(P<0.05)。在溃疡组的分层研究中,血清PGI及PGII升高在活动组更为明显,而在愈合组变化无统计学意义。②胃癌患者血清PGI降低、PGR降低(P<0.01)。在胃癌组的分层研究中:早期胃癌患者PGI及PGR明显降低;进展期胃癌患者PGI及PGR亦降低,两者间无统计学差异(P>0.05)。结论测定血清PGI、PGII水平及PGR值对胃溃疡及胃癌患者的鉴别诊断具有重要的参考意义。     

Near-total gastric necrosis caused by acute gastric dilatation

Gastric dilatation caused by psychogenic polyphagia or bulimia may, under extreme circumstances, progress to total gastric necrosis. We have described a patient in whom acute abdominal symptoms and signs developed while he was receiving psychiatric treatment. Laparotomy showed massive gastric dilatation with near-total infarction. Total gastrectomy with cervical esophagostomy, feeding and decompressing jejunostomies, and wide drainage of the gastric bed were done. After staged reconstruction, recovery was uneventful.     

胃部手术患者经不同侧鼻孔安置胃管的对比研究

目的 探讨不同侧鼻孔置人胃管对术中胃管调整的影响.方法 将200例胃部手术患者随机分为两组.对照组术前经右鼻孔插人胃管,实验组术前经左鼻孔插入胃管,观察两组患者术中发生胃管调整困难的差异.结果 经左鼻孔插入胃管术中发生胃管涮整困难的患者为1例,经右鼻孔插人胃管术中发生胃管调整困难的患者为24例.对经右鼻孔插入胃管术中发生胃管调整(向里插入一部分)困难的患者实施拔除胃管改为经左鼻孔插入后,成功23例.不同侧鼻孔安置胃管术中发生胃管调整困难的百分率差异有统计学意义(X2=24.18,P<0.05).结论 对行胃部手术的患者,术前经左鼻孔留置胃管可有效降低术中胃管调整的困难,减轻患者鼻咽部及食道黏膜的损伤.     

胃手术后并发胃瘫综合征的诊断和治疗

目的 探讨胃手术后胃瘫综合征的诊断及治疗。方法 回顾性分析21例胃手术后胃瘫综合征的临床资料。结果 本组胃瘫综合征发生率3．9％，诊断主要依据患者的临床症状、上消化道造影和胃镜检查，经保守治疗痊愈。结论 综合保守治疗是胃瘫综合征较为理想的治疗方法。     

Endosonography in gastric lymphoma and large gastric folds.

To establish a correct preoperative differential diagnosis between gastric lymphoma and cancer is essential but can be difficult as endoscopic biopsies can sometimes provide a low diagnostic yield. By EUS, infiltrative carcinoma tends to show a vertical growth in the gastric wall, while lymphoma tends to show mainly a horizontal extension. EUS provides an accurate staging of gastric lymphoma, showing the exact level of infiltration and the presence of perigastric lymph nodes, thus the physician can obtain an accurate prognosis for each patient and select the best form of treatment accordingly. The response to chemoradiotherapy can also be investigated very accurately by EUS. Large gastric folds are seen in a great number of benign and malignant conditions. Diagnosis represents a clinical challenge because etiology may be extremely varied and standard biopsies are often inconclusive. Different diseases show different levels of infiltration of the gastric wall, thus a characteristic echo-pattern helps for the differential diagnosis. Endosonography, used always in combination with biopsy, allows to rule out malignancies and to select the most appropriate treatment for each patient (medical or surgical).     

Acrylonitrile-induced gastric mucosal necrosis: role of gastric glutathione

Acrylonitrile [vinyl cyanide (VCN)] induces acute hemorrhagic focal superficial gastric mucosal necrosis or gastric erosions. In this report the authors have studied the mechanism of the VCN-induced gastric erosions. VCN-induced gastric lesions are coupled with a marked decrease of gastric reduced glutathione (GSH) concentration. Pretreatment of rats with various metabolic modulators (cytochrome P-450 monooxygenase and GSH) before VCN demonstrated that there is an inverse and highly significant correlation between gastric GSH concentration and the VCN-induced gastric erosions. Pretreatment of rats with sulfhydryl-containing compounds protected against the VCN-induced gastric necrosis and blocked the VCN-induced gastric GSH depletion. Furthermore, pretreatment of rats with atropine, which blocks muscarinic receptors, protected rats against the VCN-induced gastric erosions. The working hypothesis is that depletion and/or inactivation of critical endogenous sulfhydryl groups causes configurational changes of cholinergic receptors and increases agonist binding affinity, which, among other actions, leads to the causation of gastric mucosal erosions.     

Delayed gastric emptying and gastric autoimmunity in type 1 diabetes

OBJECTIVE: Delayed gastric emptying and/or gastrointestinal symptoms occur in 30-50% of diabetic patients. Known contributing factors are autonomic neuropathy and acute hyperglycemia, but the role of gastric autoimmunity has never been investigated, although 15-20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs). We studied gastric motility in diabetes in relation to PCA status, autonomic nerve function, HbA(1c), thyroid-stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology. RESEARCH DESIGN AND METHODS: Gastric emptying of solids and liquids (measured by (13)C-octanoic acid and (13)C-glycine breath tests, respectively) was tested in euglycemic conditions in 42 type 1 diabetic patients (male/female: 29/13; 15 PCA+; mean age 40 +/- 15 years; mean HbA(1c) 7.8 +/- 0.9%). Gastrointestinal symptoms, autonomic nerve function (Ewing tests), PCA status (indirect immunofluorescence), gastric histology, and acid secretion (pentagastrin) were assessed. RESULTS: Solid gastric emptying was delayed in 40% and liquid emptying in 36% of patients. Gastric motility did not correlate with symptoms. PCA status, gastric morphology, and acid secretion were similar in those with and without gastroparesis. HbA(1c) level (beta = 1.34, P = 0.011) was the only risk factor for delayed solid emptying in a logistic regression model testing HbA(1c), autonomic nerve function, PCA, HP status, age, sex, diabetes duration, and TSH. Half-emptying time for liquids correlated with TSH level (r = 0.83, P < 0.0001) and autonomic neuropathy score (r = -0.79, P = 0.001). CONCLUSIONS: We found that approximately 50% of type 1 diabetic patients studied had delayed gastric emptying that did not correlate with symptoms. Gastric autoimmunity did not contribute to diabetic gastroparesis. Metabolic control was worse in patients with delayed solid emptying.