安胃疡胶囊在消化性溃疡中的治疗效果及其对胃泌素水平变化的探讨

目的:观察安胃疡胶囊在消化性溃疡临床综合治疗过程中疗效及其对胃泌素水平变化的探索。方法:选择消化性溃疡患者60例并按照序数分为均等的A组和B组,各30例,A组用安胃疡胶囊治疗,B组用奥美拉唑胶囊治疗,观察治疗周期6周。观察治疗后2周溃疡愈合进程,并跟访观察治疗后6个月胃溃疡愈合后复发情况。结果:A组总有效率为90%,B组为86.7%,两组比较差异无统计学意义(P>0.05)。但在降低胃泌素水平方面A组优于B组(P<0.05),并且A组不良反应发生率3%明显低于B组23%(P<0.05)。结论:安胃疡胶囊治疗消化性溃疡疗效更好,具有胃黏膜保护作用,且能降低患者胃泌素水平,不良反应发生率低,疗效显著,是抗消化性溃疡的理想药物,显著提高溃疡愈合质量及患者生命质量,易被接受。     

健胃愈疡片治疗消化性溃疡的临床分析

目的探讨健胃愈疡片治疗消化性溃疡的疗效及安全性。方法入选者为78例经胃镜检查诊断为消化性溃疡的患者。将患者随机平分为两组,对照组给予奥美拉唑胶囊20mg/d,口服,疗程4周;阿莫西林1g/d,口服,疗程2周。治疗组加用健胃愈疡片1.5g/d口服,疗程4周。结果对照组有效率为82.1%（32/39）,治疗组有效率为90.5%（37/39）,两组比较,差异无统计学意义。两组均未发现与药物相关的不良反应。结论健胃愈疡片治疗消化性溃疡效果显著,无不良反应,值得推广。     

胃大部切除与传统修补术治疗消化性溃疡急性穿孔临床疗效比较

目的探讨胃大部分切除与传统修补术治疗消化性溃疡急性穿孔的不同疗效。方法选取我院2000年5月至2007年5月80例消化性溃疡穿孔患者,按不同治疗方法分为两组,即采用穿孔单纯缝合修补组40例和采用胃大部分切除术Ⅰ期根治组40例进行比较分析。结果两组均无死亡病例,临床治愈率100%,随访1～3年,消化性溃疡穿孔修补组再次行Ⅱ期胃大部分切除28例。继续服药治疗24例。消化性溃疡穿孔行胃大部分切除组无溃疡复发,不需要继续服药治疗。结论消化性溃疡急性穿孔以胃大部分切除Ⅰ期根治术的方法疗效确切,避免Ⅱ期再次手术。     

四联疗法治疗消化性溃疡的疗效观察

目的:探讨四联疗法治疗消化性溃疡的临床疗效。方法:选取我院2009年5月～2011年10月消化性溃疡病人100例,并用快速尿素酶试验检测幽门螺杆菌为阳性。将患者随机分为对照组和观察组,每组50例。对照组采用阿莫西林胶囊、克拉霉素片、雷贝拉唑胶囊三联疗法,观察组在三联疗法基础上加用枸橼酸铋钾胶囊,每组患者疗程均为4周,治疗后对两组临床疗效与幽门螺杆菌根除率进行比较。结果:观察组治疗效果与幽门螺杆菌根除率均明显高于对照组,差异有统计学意义(P<0.05),两组不良反应比较,差异无统计学意义(P>0.05)。结论:四联疗法治疗消化性溃疡的疗效好,幽门螺杆菌根除率高,值得临床广泛应用。     

自拟方三军连海散治疗热郁血淤型消化性溃疡的疗效观察

目的:观察自拟方三军连海散治疗热郁血淤型消化性溃疡的临床疗效。方法:80例患者随机分为治疗组60例,对照组20例。治疗组用自拟方三军连海散治疗,对照组用奥美拉唑胶囊治疗。结果:部分临床症状两组均有所改善(P<0.05)。结论:自拟方三军连海散治疗消化性溃疡有显著效果。     

腹腔镜与开腹胃大部切除术治疗溃疡穿孔的疗效对比

目的:对比研究腹腔镜与开腹胃大部切除术治疗消化性溃疡穿孔的手术疗效及可行性。方法:将确诊为消化性溃疡穿孔行胃大部切除术的50~65岁的40例患者作为研究对象,其中22例行腹腔镜下胃大部切除术(腹腔镜组),18例行传统开腹胃大部切除术(开腹组)。对比两种手术的优缺点及手术疗效。结果:两组术中失血量、术后住院时间及手术时间差异有统计学意义(P0.05),术后并发症两组差异无统计学意义(P0.05)。结论:腹腔镜下胃大部切除术治疗消化性溃疡穿孔是安全、可行的,相较传统手术具有多方面的明显优势。     

荆花胃康胶丸联合三联方案治疗幽门螺杆菌的疗效分析

目的比较荆花胃康胶丸与常规三联方案联用根除幽门螺杆菌阳性的慢性胃炎及消化性溃疡者的疗效及安全性。方法选择64例慢性胃炎及消化性溃疡患者,经胃镜胃窦部黏膜活检及尿素酶检查证实为Hp阳性,治疗组服用荆花胃康胶丸＋三联疗法,对照组使用三联疗法,停药4周后观察幽门螺杆菌根除率。结果使用荆花胃康胶丸组根除率为90%,常规三联组根除率为73%,差异有统计学意义（P〈0.01）。结论荆花胃康胶丸联合三联方案根除幽门螺杆菌阳性的慢性胃炎及消化性溃疡者疗效确切、安全,值得临床推广。     

中西医结合治疗消化性溃疡疗效观察

目的:观察中西医结合治疗消化性溃疡的临床疗效.方法:将84例消化性溃疡患者分为治疗组和对照组各42例,对照组单纯服用西药治疗,治疗组在对照组的基础上结合服用自拟中药汤剂治疗.结果:治疗组与对照组的总有效率分别为95%、83%,两组比较具有显著性差异(P<0 05).结论:采用中西医结合治疗消化性溃疡,治愈率高.毒副作用小,值得推广应用.     

消化性溃疡行单纯修补术的临床效果分析

目的 探讨消化性溃疡穿孔患者行单纯修补术治疗的疗效.方法 将笔者所在医院2009年10月～2011年7月收治的40例消化性溃疡穿孔患者随机分为两组.对照组患者给予保守治疗,实验组患者给予单纯修补术治疗,比较两组患者的治疗效果.结果 实验组患者总有效率为93.75%,对照组患者总有效率为62.50%,实验组明显高于对照组（P ＜0.05）.结论 消化性溃疡穿孔患者行单纯修补术治疗可取得较好的疗效.     

奥美拉唑治疗消化性溃疡28例临床观察

目的 观察奥美拉唑治疗消化性溃疡的临床疗效,旨在为基层医院提供进一步的指导依据.方法 2009年1月～2011年1月选择笔者所在卫生院来院治疗的56例消化性溃疡患者,随机分为观察组和对照组两组,每组28例,对照组给予雷贝拉唑、呋喃唑酮、克拉霉素口服,观察组应用奥美拉唑、呋喃唑酮、克拉霉素口服,应用统计学方法比较两组的疗效.结果 两组患者的胃痛、返酸、烧心、暖气、腹胀、食欲不振等症状均明显消失,其中观察组的总有效率为92.86%,明显高于对照组（78.57%）,两组疗效比较,差异有统计学意义（P ＜0.05）.两组治疗前后血、尿常规和肝、肾功能检查均未异常.结论 奥美拉唑治疗消化性溃疡疗效确切,其明显优于雷贝拉唑,值得基层医院广泛推广和应用.     

埃索美拉唑持续泵入治疗急性上消化道大出血疗效观察

目的观察埃索美拉唑持续泵入治疗消化性溃疡合并急性上消化道大出血的临床疗效。方法对我院2012年1月-2014年3月收治的45例消化性溃疡合并上消化道大出血患者,随机分为治疗组（n=23）和对照组（n=22）。两组均在扩容、口服去甲肾上腺素冰盐水、心电监测、吸氧、留置胃管等常规治疗同时,观察组首次给予埃索美拉唑80mg静滴,然后8mg/h持续泵入,连用72h;对照组首次给予奥美拉唑80mg静滴,然后8mg/h持续泵入,连用72h。结果观察组有效率为91.3%,对照组有效率为54.5%,两组比较差异有统计学意义有（x2=7.77,P〈0.01）。副反应方面两组均未发现明显副作用。结论埃索美拉唑持续泵入治疗消化性溃疡合并上消化道大出血疗效肯定,安全可靠,值得临床推广应用。     

序贯疗法与三联疗法治疗幽门螺杆菌性消化性溃疡疗效分析

目的：分析序贯疗法与三联疗法治疗幽门螺杆菌性消化性溃疡的治疗效果。方法选择我院近1年来82例幽门螺杆菌性消化性溃疡患者,随机分为两组,甲组患者采用序贯疗法,乙组患者采用传统的三联疗法,对比分析两种治疗方法的治疗效果。结果甲组患者的幽门螺杆菌（Hp）根除率为92.7%、不良反应发生率为7.3%,与乙组 Hp 根除率80.5%、不良反应发生率26.8%相比差异有统计学意义（P ＜0.05）。结论给予幽门螺杆菌性消化性溃疡患者采用10d 序贯疗法,安全有效,可显著提高患者依从性,应在临床治疗中广泛推广。     

消化性溃疡穿孔单纯修补术后疗效观察

目的　观察胃、十二指肠溃疡穿孔行单纯缝合修补术后继以内科治疗的效果。方法　对168例胃、十二指肠溃疡穿孔患者行单纯修补术后 ,再行抗幽门螺杆菌等内科治疗 ,并跟踪随访观察。结果　本组 1年总复发率和胃、十二指肠溃疡复发率分别是 :术后正规内科治疗组为 5 .8% ,8.3 % ,3 .6% ;术后非正规内科治疗组 62 .9% ,66.7% ,5 8.8% ;术后未治疗组为 88.9% ,10 0 % ,80 .0 %。后 2组与正规治疗组间差异显著 (P <0 .0 5 )。术后采用正规内科治疗组 ,未出现出血、穿孔、幽门梗阻等并发症 ,无再手术者。出现并发症及再手术者 ,在非正规内科治疗组分别为 4.5 %和2 .4% ;在未接受内科治疗组为 42 .9%和 3 0 .0 %。吸烟者胃和十二指肠溃疡复发率分别为 80 .6%和 68.8% ,与不吸烟者差异有显著性 (P <0 .0 5 )。结论　溃疡穿孔单纯缝合修补操作简单、安全、并发症少 ,术后结合正规的内科治疗 ,效果满意。吸烟是影响溃疡愈合及复发的重要因素之一。     

Dual Roles of Peptic Ulcer in the Carcinogenesis or Extension of Early Gastric Cancer

Background: Early gastric cancer (EGC) often coexists with peptic ulcer. In this study we investigated the roles of peptic ulcer in the carcinogenesis and extension of gastric cancer.Methods: The clinicopathological characteristics of EGC and peptic ulcer and their relationship, as well as that of the background intestinal metaplasia, were compared among the following three groups: patients with peptic ulcer only inside the EGC (Contained group, 53 patients); patients with peptic ulcer only outside the EGC (Separate group, 26 patients); and patients of EGC with no peptic ulcer (Absent group, 43 patients).Results: In the Separate group, a male preponderance was observed (P = .006), and all EGCs developed in the middle or lower third of the stomach (P = .06). Most of the EGCs were an intestinal type of cancer with severe background intestinal metaplasia. Topographically, 88% of the peptic ulcers in the Separate group developed proximal to the EGC. On the other hand, in the Contained group, most EGCs developed in the middle third of the stomach with an intestinal/diffuse type ratio of 1:1. Peptic ulcers inside the EGC were significantly more shallow than those that developed outside the EGC (P = 0.008). Although the incidences of submucosal cancer were nearly the same among the three groups, the maximum cancer diameter tended to be increased in the Contained group compared to that in the Absent group, and the incidence of lymph node involvement tended to be higher in the Contained group (8%) as compared with the other two groups (4%–5%).Conclusions: These results suggest that peptic ulcer outside the EGC contributes to the development of the intestinal type of EGC, with the background of more severe intestinal metaplasia during the peptic ulcer healing processes, whereas peptic ulcer inside the EGC develops secondary to EGC and favors cancer extension and metastasis. Peptic ulcer associated with EGC can be considered to exert different biological roles in the carcinogenesis or extension of ECG according to the location of the peptic ulcer.     

PREDICTING POOR OUTCOME IN PERFORATED PEPTIC ULCER DISEASE

Background : Despite modern medications for peptic ulcers, patients frequently require emergency surgery for complications of ulcer disease. Many of these patients have coexisting medical problems which not only predispose to perforated ulcer disease, but also influence the clinical outcome. This study reviews the outcome of a group of patients with perforated ulcer disease and examines the influence of a range of comorbidity factors on the outcome. Methods : A retrospective chart review of all cases of perforated peptic occurring over a period of 9 years. Results : One hundred and forty-nine perforated peptic ulcers in 147 patients were diagnosed between 1987 and 1996. Coexisting malignancy, use of immunosuppressives or corticosteroids, pre-operative shock and admission to intensive care were all significantly associated with reperforation by univariate analysis. However, logistic regression analysis indicated that none of these factors independently predicted reperforation which, therefore, occurs as a multifactorial event with all the above factors contributing. Death from perforated ulcer disease was related to pre-operative shock, malignancy, admission to intensive care and reperforation when examined by univariate analysis. Furthermore, logistic regression analysis showed that coexisting malignancy and reperforation were significant predictors of mortality. Conclusions : Perforated peptic ulcer disease remains a frequent clinical problem in patients with short dyspeptic histories, who may or may not have been using ulcerogenic medications. It is a significant cause of morbidity and mortality among an often aged and otherwise unwell group of patients. Patients with underlying malignant disease, who may be immunosuppressed with corticosteroids or cytotoxics, are at increased risk of dying from perforated ulcer disease. Reperforation of an ulcer, following simple closure or conservative treatment, is also highly predictive of increased mortality.     

All perforated ulcers are not alike.

To determine if ulcer location and other clinical factors affect the hospital course and early outcome of patients with perforated peptic ulcers in the decade since the introduction of H2 receptor antagonists, the records of 80 patients with perforated peptic ulcers were analyzed. Demographic factors, clinical features, and the outcome of patients with duodenal ulcer perforation were similar to patients with prepyloric ulcer perforation. In contrast, patients with gastric ulcer perforation had differing characteristics from the group with perforated pyloroduodenal ulcers. Overall, NSAID use preceded perforation in one half of the patients; severe coexisting medical illness and a short interval of symptoms before perforation were seen in more than one half of patients. Gastric ulcer location, hemodynamic instability, greater degree of peritoneal contamination, and larger ulcer size were factors associated with increased rates of mortality. Overall mortality rate was 12.5% and rate of morbidity was 33%. Oversewing with or without omental patch was the operation most commonly employed by a diverse group of surgeons.     

Poor outcome and quality of life in female patients undergoing secondary surgery for recurrent peptic ulcer disease

Secondary peptic ulcer surgery is uncommon given the success of a wide variety of medical therapies, plus the good outcome expected after primary peptic ulcer surgery. Early reports of secondary peptic ulcer surgery in the 1950s and 1960s suggested good long-term outcome in most patients; however, recent data suggest that patients operated in the Helicobacter pylori era have a worse outcome. We have attempted to quantify the poor outcome in these patients and measure the effect of sex, a previously unrecognized risk factor for poor outcome after peptic ulcer surgery. We reviewed the outcomes of 35 patients who underwent secondary peptic ulcer surgery for symptoms of persistent or recurrent peptic ulcer symptoms or complications of the condition. These patients were compared to a "control" group of patients to determine long-term quality of life as measured by the SF-36 and Visick scores (average follow-up 60 months). Visick and SF-36 scores were obtained through telephone interviews. The two groups of patients were age matched to eliminate age as a variable in the SF-36 results. There were more females than males in the secondary peptic ulcer surgery group (4.5/1 female-to-male ratio). Although perioperative mortality was zero for both groups, patients undergoing secondary peptic ulcer surgery had a high number of complications (57% of patients had complications). Patients undergoing secondary peptic ulcer surgery scored lower in seven of the eight subclasses of the SF-36 questionnaire compared to their age-matched cohorts. In contrast, average Visick scores showed slight improvement for three out of four symptoms reported. Immediate postoperative complications were not related to long-term quality of life issues. Secondary peptic ulcer surgery is more prevalent in females than in males. Although secondary peptic ulcer surgery is partially effective in alleviating symptoms, quality of life is poor. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2001 (poster presentation).     

腹腔镜消化性溃疡穿孔修补术的临床应用

目的:探讨腹腔镜手术治疗消化性溃疡穿孔的可行性。方法:自2006年初,对上消化道溃疡穿孔患者进行前瞻性随机对照研究,按照手术方式分为开腹手术组和腹腔镜手术组,至2010年末,有效病例160例。对比分析两组患者术后疼痛指数、住院时间及术后并发症发生率。结果:腹腔镜组术后疼痛指数、住院时间低于开腹组(P<0.05),两组术后并发症发生率无明显差异,术后随访半年均无复发。结论:腹腔镜上消化道溃疡穿孔修补术是安全有效的微创术式,在一定程度上优于传统开腹手术。     

腹腔镜胃十二指肠溃疡穿孔修补术

目的:探讨腹腔镜胃十二指肠溃疡穿孔修补术的临床应用及手术操作要点。方法:腹腔镜下缝合修补溃疡穿孔18例。结果:腹腔镜下缝合修补溃疡穿孔均获成功,无并发症发生。结论:腹腔镜溃疡穿孔修补术创伤小,术后并发症少,操作简单,且集诊断及治疗于一体,显示了微创外科的优越性,是目前最适合普及的治疗溃疡穿孔的腹腔镜手术方法。     

消化性溃疡合并上消化道出血影响因素分析

目的探讨消化性溃疡合并上消化道出血的影响因素。方法收集笔者所在医院315例消化性溃疡合并上消化道出血患者为研究组;同期门诊选取656例消化性溃疡无上消化道出血并发症的患者为对照组。再根据研究组中HP阳性者根除HP后随访2年,观察上消化道再出血情况。所有入选患者均统计幽门螺杆菌检测结果、NSAIDs服用、性别、年龄、饮酒史、血小板计数等情况。结果 NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）;年龄对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.01）;合用不同种类NSAIDs对消化性溃疡合并上消化道出血的差异有统计学意义（P〈0.05）。结论 NSAIDs增加消化性溃疡合并上消化道出血的风险;年龄与消化性溃疡合并上消化道出血相关,大于60岁的老龄消化性溃疡患者更易合并上消化道出血;合用不同种类NSAIDs较单用NSAIDs者消化性溃疡更易合并上消化道出血。