胃大部切除术后胆汁反流性残胃炎与术式和幽门螺杆菌感染的关系及治疗的研究

目的 探讨胃大部切除术后胆汁反流性残胃炎与术式、幽门螺杆菌(Hp)感染的关系及临床疗效.方法 选取我院2008年1月至2011年6月收治的胃大部切除术后胆汁反流性残胃炎患者143例作为观察组,其中采用Billroth Ⅰ术52例,采用BillrothⅡ术91例.选取同期未进行手术的患者236例作为对照组.采用快速尿素酶试验法和改良的Giemsa染色法检测患者的Hp.结果 观察组Hp感染率[24.5％(35/143)]明显低于对照组[42.8％ (101/236)](P＜0.05),Billroth Ⅰ术后患者的Hp感染率[21.2％(11/52)]略低于BillrothⅡ术后患者[26.4％ (24/91)] (P ＞0.05),Billroth Ⅰ术后患者的胆汁反流阳性率[51.9％ (27/52)]明显低于Billroth Ⅱ术后患者[80.2％ (73/91)] (P ＜0.05),胆汁反流阳性患者的Hp感染率[ 19.0％ (19/100)]明显低于胆汁反流阴性患者[37.2％ (16/43)] (P ＜0.05).结论 Hp感染是残胃炎的主要致病因素之一.胃大部切除术后胆汁反流性残胃炎患者发生Hp感染的概率大幅降低,胆汁反流是患者Hp感染的有效保护因素.     

残胃幽门螺杆菌感染的临床特征及治疗

目的 探讨残胃幽门螺杆菌感染的临床特征及治疗方法.方法 回顾性分析进行残胃胃镜检查的210例及随机抽取同期无胃肠道手术病史进行胃镜检查并做Hp检测的200例患者的临床资料.结果 残胃的Hp感染率为26.2%,不同手术原因Hp感染率比较差异无统计学意义,Billroth-Ⅰ式术后Hp阳性率明显高于毕Billroth-Ⅱ式手术后,有胆汁反流者Hp阳性率低于无胆汁反流,随着胃大部切除术后时间的延长,Hp的感染率愈来愈低,抗Hp的治疗转阴率为87.3%.结论 残胃Hp感染率偏低,但Hp残胃病变加重,目前常用的抗Hp的治疗方案加用胃黏膜保护剂和胃动力药物适合于治疗残胃的Hp感染,有一定的临床应用价值.     

胆胃康胶囊治疗胆汁反流性胃炎231例临床观察

目的观察对原发性胆汁反流性胃炎（BRG）的治疗效应。方法将291例BRG患者随机分为治疗组和对照组,治疗组231例服用胆胃康胶囊,对照组60例服用西沙必利。结果胆胃康胶囊具有缓解和消除临床症状,调节幽门功能紊乱,抑制胆汁反流,抑制和根除幽门螺杆菌（Hp）感染,且有明显改善、消除胃黏膜炎症病变等作用,临床总有效率为92.9%,明显优于西沙必利。结论胆胃康胶囊具有消热利湿、舒肝利胆,调节幽门功能紊乱,抑制胆汁反流,并能治疗胃黏膜炎症病变。     

不同类型胃食管反流病24h食管pH监测的临床研究

目的：研究不同类型胃食管反流病24h食管pH监测指标之间的相关性。方法对符合胃食管反流病（GERD）诊断标准的43例患者,经内镜检查分为反流性食管炎（RE）组、非糜烂性反流病（NERD）组、Barrettt食管组,随后进行高分辨多通道毛细灌注测压检查及食管pH动态监测,比较各组24h食管pH监测指标。结果三组患者食管pH〈4反流次数（次）,反流持续时间≥5 min反流次数（次）、pH〈4总时间, pH〈4百分时间（%）, DeMeester积分差异无统计学意义（P〉0.05）。结论不同类型胃食管反流病食管粘膜损伤与食管酸反流无相关性,食管组织化生与食管酸反流无相关性。     

Relationship of the gastric renmant lesions after gastrectomy and reconstructive procedures

目的 分析残胃黏膜病变与胃切除术式的关系.方法 回顾566例[毕Ⅰ式224例(A组)、毕Ⅱ式207例(B组)和胃食管吻合术135例(C组)]患者的胃镜、幽门螺旋杆菌、吻合口及残胃黏膜组织病理学等检查资料,分析残胃病变与胃切除术式的关系.结果 566例残胃黏膜病变中,吻合口炎占44.0％,残胃炎占72.1％,吻合口溃疡占11.7％,残胃癌占7.1％,反流性食管炎占9.5％,胆汁反流占38.7％.其中,B组中残胃炎、吻合口溃疡、残胃癌、胆汁反流等的发生率均高于A组.C组中反流性食管炎发生率明显高于A组和B组.吻合口炎的发生在三组中无统计学差异.结论 残胃黏膜病变与胃切除术式密切相关.     

反流性食管炎与幽门螺杆菌关系的研究

目的探讨反流性食管炎与幽门螺杆菌（Hp）感染的相关性。方法对通过内镜诊断的48例反流性食管炎患者行快速尿素酶检测Hp，并与同期轻度慢性胃炎患者59例进行比较。结果反流性食管炎患者Hp感染率（31．3％）低于慢性胃炎组（50．8％），差异有显著性（P〈0．05）。反流性食管炎患者各级之间Hp感染率差异无显著性（P〉0．05）；反流性食管炎中年龄≥65岁者Hp感染率高于年龄〈65岁者（P〈0．01）。结论反流性食管炎患者的Hp感染率低，Hp感染与反流性食管炎分级无相关性，但随年龄增长，Hp感染率呈增高趋势。     

残胃黏膜病变与胃切除术式的关系

目的分析残胃黏膜病变与胃切除术式的关系。方法回顾566例[毕Ⅰ式224例(A组)、毕Ⅱ式207例(B组)和胃食管吻合术135例(C组)]患者的胃镜、幽门螺旋杆菌、吻合口及残胃黏膜组织病理学等检查资料,分析残胃病变与胃切除术式的关系。结果 566例残胃黏膜病变中,吻合口炎占44.0%,残胃炎占72.1%,吻合口溃疡占11.7%,残胃癌占7.1%,反流性食管炎占9.5%,胆汁反流占38.7%。其中,B组中残胃炎、吻合口溃疡、残胃癌、胆汁反流等的发生率均高于A组。C组中反流性食管炎发生率明显高于A组和B组。吻合口炎的发生在三组中无统计学差异。结论残胃黏膜病变与胃切除术式密切相关。     

胆汁反流与肠上皮化生病理亚型的关系对预测胃癌危险性的研究

目的 观察评价胆汁反流与肠上皮化生病理亚型的关系对预测胃癌危险性的临床效果。方法 选取2018年1月1日～2019年4月31日我院收治的门诊及住院肠上皮化生且符合胆汁反流性胃炎诊断160例、符合幽门螺旋杆菌(Helicobacter pylori,Hp)感染160例,并分为两组,对其中胆汁反流性胃炎Hp阴性组和非胆汁反流性胃炎Hp阳性组均进行肠化生的病理亚型分型。总结分析胆汁反流与肠上皮化生病理亚型的关系,比较胆汁反流与Hp感染相关的胃黏膜肠上皮化生亚型的关系。结果 胆汁反流性胃炎组检出Hp阴性117例,非胆汁反流性胃炎组检出Hp阳性105例;胆汁反流性胃炎组Ⅰ型Hp阴性为39.32%显著地高于非胆汁反流性胃炎组Ⅰ型Hp阳性为9.52%(χ2=28.5557,P 0.05),胆汁反流性胃炎组Ⅱ型Hp阴性为50.43%与非胆汁反流性胃炎组Ⅱ型Hp阳性的49.52%比较差异无统计学意义(χ2=2.0003,P 0.05),胆汁反流性胃炎组Ⅲ型Hp阴性为10.26%明显的低于非胆汁反流性胃炎组Ⅲ型Hp阳性的40.96%(χ2=27.9777,P 0.05)。结论 对胃黏膜肠上皮化生患者行内镜诊断,能够对患者病情形态特征得到准确反映,患者病情病理分型以及病变程度越严重,检出率越高,而且与胃癌的发病率呈正相关。     

原发性胆汁反流相关危险因素分析及其与胃黏膜病变的关系

目的 分析原发性胆汁反流发生的相关危险因素,探讨原发性胆汁反流在胃黏膜病变中的临床意义。方法 选择2022年2～8月于我院消化内科住院接受普通胃镜检查以及幽门螺旋杆菌（HP）检查的患者810例,分为胆汁反流组（n=178）和无胆汁反流组（n=632）,记录患者临床资料,分析胆汁反流的相关危险因素。排除243例HP阳性患者,结合胃镜检查及病理结果将567例HP阴性患者根据胃黏膜病变程度依次分为正常组、慢性胃炎组、癌前病变组、胃癌（GC）组,比较各组胆汁反流检出率及反流程度。结果 在有无胆汁反流方面,两组性别、禁食时间、吸烟、饮酒、焦虑、胃泌素水平比较差异具有统计学意义（P<0.05）,年龄、体重指数、饮食辛辣、高血压、高血脂、糖尿病、HP感染率比较差异无统计学意义（P>0.05）,按年龄分组,18～45岁与46～75岁比较差异有统计学意义（P<0.05）。Logistic回归分析显示,胆汁反流的相关危险因素为女性、禁食时间过长、吸烟、饮酒、焦虑、胃泌素水平升高。在胃黏膜病变方面,排除HP对胃黏膜的影响后,正常组胆汁反流检出率明显低于慢性胃炎组、癌前病变组和胃癌组（P&l...     

胃食管反流病临床分型诊断的研究

目的：应用24h食管内胆红素与pH监测（食管内双监测）以及食管内镜检查对胃食管反流病（GERD）进行临床分型研究指导临床治疗。方法：按食管胆红素与pH双监测和食管内镜检查的情况结合病人症状对GERD进行临床分型，观察病人在各型的分布。结果：食管内24h胆红素与ph监测结果显示I、Ⅱ型病人的胆红素吸收值≥0.14及pH＜4总时间百分比、酸反流次数和胆汁反流次数较对照组和Ⅲ型明显增加（P＜0．05），而型和Ⅱ型间差异无显著性（P＞0．05），Ⅲ型病人分别为23．3％、65．9％、10．8％。结论：病理性酸反和胆汁反流的破坏作用是导致GERD的重要原因。临床分型对GERD治疗中药物选用具有指导作用。     

The influence of cimetidine,a histamine H2-receptor antagonist,on the gastric effects of reserpine in rats

The effects of the graded doses of cimetidine on both resting and reserpine-evoked gastric acid secretion were examined in relation to their influence on reserpine-induced ulceration, mast cell degranulation and mucosal microcirculatory changes in rat stomachs. Cimetidine 10 mg/kg or above reduced resting or reserpine-provoked gastric acid secretion as well as rumenal and glandular ulceration. However, non-acid-inhibiting doses, 5 mg/kg or below, continued to prevent glandular ulceration. Reserpine-evoked gastric glandular mucosal mast cell degranulation was unaffected by both acid-inhibiting and non-acid-inhibiting doses of cimetidine which dose-dependently blocked the superficial glandular mucosal microcirculatory volume changes. These results suggest that cimetidine prevents reserpine-induced glandular ulceration largely by blocking the ulcerogenic effect of histamine H₂-receptor-mediated mucosal microcirculatory congestion, in contrast to antagonising rumenal lesions through acid inhibition; they also support the idea that reserpine may release histamine mainly from the glandular mucosal mast cells. The possibility of another antiulcer mechanism, due to cytoprotection, is discussed.     

PGⅠ、PGⅡ的水平在胃癌诊断中的意义

目的探讨血清中胃蛋白酶原(PGⅠ、PGⅡ)含量及其比值(PGR),在胃癌诊断中的意义。方法采用时间分辨荧光免疫分析法(TRFIA),检测198例正常对照者、89例胃溃疡患者及67例胃癌患者血清中的PGⅠ、PGⅡ含量并计算PGR。结果胃溃疡患者PGⅠ、PGⅡ较正常对照组明显升高,差异具有显著性(P<0.05),PGR差异无显著性(P>0.05);胃癌患者PGⅠ、PGR较正常对照组显著降低,差异显著(P<0.01),PGⅡ差异无显著性(P>0.05)。结论测定血清PGⅠ、PGⅡ水平及PGR值对胃癌的早期筛查及鉴别诊断有临床意义。     

小儿急诊洗胃19例分析

目的分析小儿急诊洗胃的方法与临床效果。方法选取2011年1月至2013年1月收治的需急诊洗胃的小儿患者19例,均根据患儿的具体情况慎重进行洗胃处理,并对5岁以上与以下患儿的一次插管成功率、洗胃成功率、并发症发生率以及患儿家长满意率评价比较。结果 5岁以上患儿一次插管成功率100.0%;成功洗胃率100.0%,未见并发症发生,患儿家长满意率100.0%。5岁以下患儿一次插管成功率85.7%;成功洗胃率85.7%,并发症发生率14.3%,患儿家长满意率85.7%。5岁以上患儿洗胃效果更明显(P<0.05)。结论对小儿进行急诊洗胃治疗时,应慎重处理,对洗胃液的选用与用量,胃管的选用与插管的深度等进行综合控制,以提高患儿临床洗胃效果。     

A correlative study of the antiulcer effects of zinc sulphate in stressed rats

The effects on zinc sulphate pretreatment of rats on stress-induced gastric ulcers and on changes in mast cell counts were studied and correlated with changes in gastric mucosal microcirculation. The effects on zinc sulphate on blood pressure responses and on growth were also examined. Stress (2 h restraint at 4 degrees C) produced marked glandular mucosal ulceration, lowered the stomach wall mast cell counts and increased the microcirculatory blood volume in the superficial glandular mucosa. Zinc sulphate (22, 44 or 88 mg/kg; injected i.p. 48 h before stress) reversed all these changes in a dose-related manner. Blood pressure responses to i.v. acetylcholine, adrenaline or histamine were unaffected and growth of the rats as observed for 7 days after injection was not impaired. On the basis of these findings the mechanism of the antiulcer action of zinc sulphate is the following: inhibition of the stress-induced release of vasoactive agents from gastric mast cells and thus prevention of the subsequent microciculatory changes known to produce mucosal ulceration. Interference with vascular responses through direct blockade or toxicity is unlikely.     

Cholinergic-mediated gastric mast cell degranulation with subsequent histamine H1-and H2-receptor activation in stress ulceration in rats.

The effects of atropine, mepyramine, metiamide or NaHCO3 on gastric ulceration, gastric secretion and gastric mast cell degranulation were studied in stressed pylorus-occluded rats. The influence of dexamethasone pretreatment on stress ulcers in animals without pylorus occlusion (intact rats) was also examined. Stress produced a high glandular lesion incidence and ulcer index, and markedly lowered gastric secretion and glandular wall mast cell counts. Injected 0.5 h before stress, atropine, mepyramine or metiamide strongly antagonised ulceration. Atropine or metiamide, but not mepyramine, reduced gastric secretion. Only atropine prevented stress-induced mast cell changes. NaHCO3, given intragastrically before stress, did not prevent ulceration or mast cell degranulation despite complete neutralisation of gastric acid. Dexamethasone-induced gastric mucosal mast cell depletion could reduce stress ulceration. The findings show that stress degranulates stomach mast cells via a cholinergic pathway; released histamine from this source is largely responsbile for gastric ulceration through H1- and H2-receptor effects. Histamine H2-receptor-mediated gastric acid may play only a small contributory role in stress ulcers in rats. The antiulcer mechanisms of histamine H1- and H2-receptor blockade are discussed.     

Gastric mucosal blood flow in ethanol-induced mucosal damage in the rat

Gastric mucosal blood flow in ethanol-induced mucosal damage was studied in urethane-anaesthetised rats by reference to ¹⁴C-aminopyrine clearance in the gastric mucosa. Irrigation of the stomach with 30% ethanol in acid saline (100 mM HCl plus 50 mM NaCl) for 40 min broke the gastric mucosal barrier, as indicated by an increased outflow of Na⁺ and K⁺ ions and back-diffusion of H⁺ ions. Gastric mucosal blood flow also increased about 2-fold, decreasing after cessation of ethanol irrigation along with the net ion fluxes. The increase in gastric mucosal blood flow occasioned by 10, 20 and 30% ethanol in acid saline was directly proportional to the net fluxes of H⁺, Na⁺ and K⁺ ions. When the stomach was irrigated with 30% ethanol in a less acid medium (10 mM HCl, 90 mM choline chloride plus 50 mM NaCl) there was still a significant increase in the outflow of Na⁺ and K⁺ ions, but only a slight back-diffusion of H⁺ ions. During this low rate of acid back-diffusion 30% ethanol reduced gastric mucosal blood flow by about 50%. The results suggest that ethanol-induced mucosal damage in the rat is associated with an increase in gastric mucosal blood flow only if combined with back-diffusion of H⁺ ions.     

胃癌与胃溃疡患者血清白介素6表达及意义

目的对胃溃疡、胃癌患者及对照者的血清白介素6(IL-6)水平进行检测,探索IL-6与胃癌之间的关系及意义。方法选取60例临床确诊为胃癌的患者作为胃癌组,胃溃疡患者60例作为胃溃疡组,以及同期于本院体检中心体检的健康者50例作为对照组。采用抗原抗体反应和荧光量子点免疫层析技术对三组研究对象进行IL-6水平检测,对测量数据进行统计分析。结果胃癌组的IL-6水平为(207.79±31.24)pg/ml,胃溃疡组的IL-6水平为(56.42±6.17)pg/ml,对照组的IL-6水平为(24.55±2.51)pg/ml,胃癌组的IL-6水平明显高于胃溃疡组和对照组,胃溃疡组高于对照组,差异有统计学意义(P<0.05)。结论IL-6可以作为辅助诊断胃癌的血清学指标,有利于胃癌患者的早发现、早治疗,及获得良好的预后。     

胃癌合并胃穿孔的诊疗分析

目的分析胃癌合并胃穿孔的诊断和治疗。方法收集整理我院诊治的38例胃癌合并胃穿孔患者的临床资料和手术情况,分析病例的手术方式、并发症和存活率。结果三者并发症发生情况比较,根治性切除术并发症发生率明显低于其他手术方式,三者病例生存期比较,根治性切除术术后生存期明显长于其他两种手术方式。结论胃癌合并胃穿孔采用根治性切除术手术效果优于姑息性切除术和穿孔修补术。     

胃液糖类抗原19-9/72-4联合检测对胃癌的诊断价值

目的 探讨胃液糖类抗原72-4(CA72-4)、糖类抗原19-9(CA19-9)联合检测诊断胃癌的可行性.方法 应用自制胃液采集器通过胃镜分别采集研究组胃癌30例、对照组萎缩性胃炎32例、胃溃疡30例 和慢性浅表性胃炎30例患者的胃液,以ES-300全自动酶免分析仪批量同步检测CA72-4、CA19-9的表达.结果 研究组CA72-4、CA19-9检测水平分别为(83.54±143.70)U/ml和(47.05±29.64)U/ml,阳性检出率分别为76.66%和43.33%,均明显高于对照组(P<0.01);两者联合检查阳性率可达80.00%,32例萎缩性胃炎有2例CA72-4升高,其中1例患者9个月后确诊为胃癌.结论 胃液CA72-4、CA19-9联合检测可作为胃癌诊断的参考依据,也是晚期胃癌的重要指标.     

增生性胃息肉小凹分型的临床意义

目的探讨胃增生性息肉在放大内镜下胃黏膜小凹表现的临床意义。方法总结2004年2月至2006年12月间经放大内镜及病理检查确诊的胃增生性息肉的放大内镜表现及病理结果。结果55例患者共发现胃息肉116枚，其中胃息肉表面小凹呈A型改变占41．4％（48／116），B型占26．7％（31／116），C型占19．8％（23／116），D型占8．6％（10／116），E型占2．6％（3／116），1例小凹呈模糊不清（F型）占0．9％（1／116）。E型和F型胃小凹共4例病理均发现胃息肉呈中-重度不典型增生。结论胃增生性息肉出现E型和17型胃小凹提示病理学将出现不典型增生改变。