胃嗜酸性肉芽肿26例报告

目的进一步探讨胃嗜酸性肉芽肿的诊断与治疗。方法对２６例胃嗜酸性肉芽肿的临床资料进行回顾性分析。结果钡餐检查１９例,诊断胃溃疡１１例,胃癌８例。胃镜检查１４例,诊断胃溃疡８例,胃癌４例,胃嗜酸性肉芽肿２例。外周血中嗜酸粒细胞增多１０例。术中快速病理检查确诊１１例。行胃大部切除术１６例,胃癌根治术１０例。２３例随访０．５～１８年,无复发病例。结论胃镜活检及术中快速病理检查可确诊嗜酸性肉芽肿,胃大部切除     

胃嗜酸性肉芽肿26例报告

目的　进一步探讨胃嗜酸性肉芽肿的诊断与治疗。方法　对 2 6例胃嗜酸性肉芽肿的临床资料进行回顾性分析。结果　钡餐检查 19例 ,诊断胃溃疡 11例 ,胃癌 8例。胃镜检查 14例 ,诊断胃溃疡 8例 ,胃癌 4例 ,胃嗜酸性肉芽肿 2例。外周血中嗜酸粒细胞增多 10例。术中快速病理检查确诊 11例。行胃大部切除术 16例 ,胃癌根治术 10例。 2 3例随访 0 5～ 18年 ,无复发病例。结论　胃镜活检及术中快速病理检查可确诊嗜酸性肉芽肿 ,胃大部切除术是其主要的治疗方法。     

胃嗜酸性肉芽肿(附22例报告)

为探讨胃嗜酸性肉芽肿的诊断,病理学特点和临床处理,作者分析了经手术和病理检查证实的胃嗜酸性肉芽肿２２例,其中行胃癌分切除术１４例,胃次全切除术６例,全国切除术１例,胃癌根治术１例。     

胃嗜酸性肉芽肿误诊32例分析

胃嗜酸性肉芽肿误诊３２例分析同济医科大学附属同济医院外科（武汉，４３００３０）陈汝福钱家勤戴植本山东省潍坊医学院病理教研室吕士军胃嗜酸性肉芽肿是一种原因不明、瘤样增生性疾病，术前确诊困难，极易误诊为胃癌或胃溃疡。我们自１９８４年９月至１９９６年１２月...     

胃嗜酸性肉芽肿12例报告

作者总结经病理诊断证实为胃嗜酸性肉芽肿１２例。所有患者术前均误诊为胃癌。１２例患者均施行了根治性胃大部切除手术治疗。术后随访无复发。作者认为：胃溃疡、消化道大出血、幽门梗阻、息肉样病变是该病常见并发症；主张进行胃粘膜剥离活检法或深取至粘膜下组织做病理检查，以确定诊断，必要时可试用肾上腺皮质激素作诊断性治疗。     

胃嗜酸性细胞肉芽肿八例误诊分析

胃嗜酸性细胞肉芽肿八例误诊分析林师设我院自１９８６年以来，从４１０例胃切除标本中，检出８例胃嗜酸性肉芽肿（ＧＥＧ），术前均误诊。本文通过对误诊原因的分析，着重对本病的诊断及治疗作初步探讨。临床资料本组８例中男７例，女１例。年龄５２～６７岁。病史５年内...     

胃嗜酸性肉芽肿的临床特点及误诊原因分析(附14例报告)

目的 探讨胃嗜酸性肉芽肿的诊断、误诊原因和治疗方法。方法 对１４例胃嗜酸性肉芽肿的临床资料进行回顾性分析。结果 全部病例均有上腹疼痛和返酸史;伴溃疡形成１１例,穿孔４例,上消化道出血３例;术前行胃镜检查２例,Ｘ线钡餐透检查６例,无１例获确诊;其余病例余全部误诊为胃溃疡或癌肿。结论胃镜多部位取材,特别是在溃疡与周边青草要行处,采取挖掘式取材,能减少误诊率,胃大部切除术是主要的治疗方法。     

胃嗜酸性肉芽肿的诊断与治疗

目的 提高胃嗜酸性肉芽肿的诊治水平及疗效。方法 回顾性分析1988年8月-1998年10月我院收治经手术病理证实的胃嗜酸性肉芽肿病人20例，并进行随访。结果 ５例行部分胃切除，８例行大部胃切除，３例行次全胃切除。４例行根治性胃切除术，手术无并发症及死亡。随访经Ｘ线钡餐或纤维胃镜复查１８例（９０％），其中７～９年１０例，４～６年６例，１－３年２例，均无复发，且未见癌变。结论 仔细询问病史，Ｘ线钡餐、纤维胃镜及外周血嗜酸性粒细胞计数是明确胃嗜酸性肉芽肿的重要依据。其中纤维胃镜必须在边缘作挖掘式活检深达胃粘膜下组织病理检查。可提高术前诊断率。手术切除是最有效的治疗方法。     

胃嗜酸性肉芽肿11例报告

胃嗜酸性肉芽肿是一种原因不明的以胃粘膜下层及肌层受到嗜酸性细胞浸润为特征的一种病变,极易误诊为胃癌和胃溃疡.     

脊椎嗜酸性肉芽肿（附14例报告）

报道经病理证实的脊椎嗜酸性肉芽肿１４例的治疗结果。其中１２例随访１～１８年，平均４年８个月，９例不全瘫痪者中，７例完全恢复，２例部分恢复；１例完全瘫痪者部分恢复。通过临床资料分析，着重阐述了脊椎嗜酸性肉芽肿的诊断和治疗方法的选择，认为有神经根或脊髓受压者，应以手术治疗为主，结合放疗或化疗；而无神经根或脊髓受压者，以放疗为主，结合化疗。早期诊断和正确的治疗是防止瘫痪发生的关键。     

72例早期胃癌的诊断、治疗及预后分析

目的探讨早期胃癌(early gastric carcinoma,EGC)的诊断、治疗及影响预后的因素。方法回顾性分析1995年6月至2002年6月我院EGC的临床资料。结果本组EGC共72例,肿瘤部位:贲门部1例,胃体13例,胃窦56例,双原发癌2例(胃窦加胃体,胃窦胃大弯加胃小弯)。黏膜内癌42例,黏膜下癌30例。肿瘤病理分型:低分化腺癌24例,中分化腺癌17例,高分化腺癌 5例,印戒细胞癌12例,低分化腺癌部分印戒细胞癌12例,局部黏膜癌变2例。淋巴结转移10例。 EGC患者多因上腹疼痛首诊。上消化道X线造影、B超、CT的EGC检出率分别为57％、3％和15％。胃镜检查68例,病理确诊率94％。全部患者接受D2胃癌根治术,18例术后化疗。1例肝、肺转移行导管介入治疗,1例骨转移。随诊0．5-9年,随诊率85％,5年生存率90％,死亡率3％。结论根治性手术治疗是EGC取得良好疗效的最佳途径。D2胃癌根治术是治疗EGC的标准术式。胃镜病理活检是EGC诊断的金标准。淋巴结转移率是影响EGC预后的主要因素。     

Gastric pseudolymphoma. A challenging clinical problem.

Gastric pseudolymphoma is a benign inflammatory condition that is usually associated with chronic gastric ulcer and often mimics gastric carcinoma or malignant lymphoma. Our experience with 12 histologically documented gastric pseudolymphomas at the Medical College of Virginia is presented with an emphasis on the approach to both diagnosis and surgical management. Preoperative diagnoses in this series ranged from benign gastric ulcer to gastric cancer. Treatment was by gastric resection in all cases and it included, as a minimum, antrectomy and excision of the lesion with an adequate gross margin. Of 11 cases with adequate follow-up, there are eight asymptomatic patients without recurrence and one patient who died of other causes without recurrence 5 years after gastrectomy. One patient developed recurrent pseudolymphoma in the proximal gastric remnant 39 months after a distal subtotal gastrectomy for pseudolymphoma. Another patient subsequently developed Hodgkin's disease of the gastric remnant, with regional lymph node and liver involvement, and died 35 months after the earlier subtotal gastrectomy for pseudolymphoma. Our clinical experience with this confusing and uncommon entity is compared with that previously reported in the medical literature.     

胃大部切除术后功能性残胃无力症的诊断与治疗

目的 探讨胃大部切除术后功能性残胃无力症的诊断与治疗措施。方法 对1990年2月至2000年9月收治的19例胃大部切除术后功能性残胃无力症的临床表现、诊断与治疗方法与结果回顾。结果19例患者经稀钡造影及胃镜检查均得到明确诊断,并经对症处理3-7周后均治愈。结论 胃大部切除术后功能性残胃无力症属非机械性梗阻,胃镜不仅对残胃无力有诊断作用,且有明显治疗作用,一经诊断明确者应行保守治疗,切忌再次手术,手术疗效不佳。     

The management of gastric ulcers. A current review.

In the past 10 years, 163 patients with documented gastric ulcers were treated at Vanderbilt University and Metropolitan Nashville General Hospitals. One hundred thirty-five were initially managed medically. Medical therapy was successful in 58 patients (43%) in this group. Twenty-eight (17%) patients required surgical treatment initially. An additional 77 patients (57%) became candidates for surgical management when their medical management failed. Of this group, 40 now have been surgically treated and 37 still have symptoms while on medical treatment. Three patients being treated for benign ulcers, two for as long as six years each, were found to have carcinoma of the stomach diagnosed by subsequent endoscopy and biopsy in one and by laparotomy with gastrectomy to include the ulcer in two. We consider subtotal gastrectomy or surgical resection of the antrum, including the ulcer site, to be the preferred surgical treatment for gastric ulcers, and this was done in 50 cases. Vagotomy was done in addition to the antrectomy in 31 of these, and in addition to the subtotal resection in 11. Two patients who had vagotomy and resection subsequently developed a marginal ulcer. One of these who had a subtotal resection and vagotomy healed with medical treatment. The one who had a vagotomy and antrectomy required a second vagotomy for a missed vagus nerve. Gastrointestinal endoscopy in the past 10 years has improved to the point that very few malignant ulcers are missed by endoscopic biopsy. Large ulcers, those that perforate or continue to bleed, and those that fail to heal on medical treatment for a maximum of 2 to 3 months should be submitted to an antrectomy that includes the ulcer. Vagotomy should be added in selected cases.     

胃切除术治疗胃十二指肠疾病临床分析

目的 了解胃大部分切除术治疗胃十二指肠疾病的状况。方法 收集我院近30年胃大部分手术的病历共1 289例,按70、80、90三个不同年代进行排列,并从年龄、性别、病因及术后情况等数据了解胃十二指肠疾病的变化。结果 溃疡病占83.9％,胃癌占14.5％,其它占 1.6％。胃溃疡手术在70,80,90年代依次为615、346及 127例,胃癌依次为32、52及103例,老年人溃疡和胃癌在三个年代的比例分别为 13.8％/22％、21％/50％和 32％/54.4％。治愈出院率为 99.1％。死亡 12例,病死率为0.9％(全部为大出血急诊手术者)。结论 20年来,需手术治疗的溃疡病明显减少,胃癌则显著增多;死亡原因与大出血急诊手术有关;减少胃手术的死亡关键在于重视老年人大出血的早期处理。     

Contractile function of the gallbladder after gastrectomy

Gallbladder contractile function was observed by B-mode ultrasonography on patients with radical gastrectomy for gastric carcinoma (20 cases), with subtotal gastrectomy for peptic ulcer (36 cases), and with highly selective vagotomy (7 cases). Thirty-one preoperative patients with peptic ulcer were used as control. It was found that within one month after radical or subtotal gastrectomy the average area and the volume of the gallbladder became much larger than that found in control group. The empty rate of the gallbladder was found decreased and the remainder bile increased. Early stage gallstones were found in two cases 11 and 13 months after gastrectomy. The inner diameter of the common bile duct was increased after radical gastrectomy. No definite relationship was found between gallbladder contractile disfunction and the mode of gastroenterostomy. It was also found that highly selective vagotomy had only slight influence on the biliary tract. These results suggest that gastrectomy has significant influence on the function of biliary tract and plays an important role in the formation of gallstones.     

Primary squamous cell carcinoma in the gastric remnant

A 67-year-old male developed primary gastric squamous cell carcinoma (SCC) 13 years after undergoing distal gastrectomy for gastric cancer. Gastroscopy revealed a type 2 gastric remnant tumor and tumor biopsies revealed poorly differentiated carcinoma. The patient underwent remnant gastrectomy with lateral segment hepatectomy, splenectomy, partial resection of diaphragm, and distal partial esophagectomy. The histological findings revealed SCC without an adenocarcinoma component in the gastric remnant tumor. The patient died 13 months after surgery due to multiple-organ metastasis of gastric SCC. The post-operative prognosis of gastric SCC cases tends to poorer than that of gastric adenocarcinoma. Early diagnosis is important to improve the prognosis of primary gastric SCC and pathogenetic analysis of gastric SCC may contribute to improving the diagnosis and treatment of carcinogenesis and the prognosis of gastric SCC.     

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目的 探讨胃大部切除术后吻合口溃疡发生的主要原因和手术治疗经验。方法 回顾性分析1996年3月至2001年5年间经手术治疗的9例吻合口溃疡病人的临床资料。结果 8例病人经原吻合口切除和胃空肠Roux-en－Y吻合术，1例行B－I式吻合，术后随访1－5年无溃疡再复发。结论 胃大部切除术后发生吻合口溃疡的主要原因与第一次手术切除胃的范围不够有关。对出现并发症的吻合口溃疡的病例应首先采取外科手术治疗；原吻合口切除和胃空肠Roux-en－Y吻合是治疗吻合口溃疡的效手段。