急性上消化道出血的季节变化观察

目的探讨上消化道出血与季节变化的关系。方法对本院1995—1999年的210例急性上消化道出血住院病人的季节变化类型进行回顾分析。结果急性上消化道出血发病高峰在12~5月,低谷在6~7月。十二指肠溃疡检出高蜂在12~5月,低谷在6~11月。胃黏膜糜烂检出高峰在5~10月,低谷在11~4月。胃溃疡检出情况无明显规律性。结论急性上消化道出血发病冬春季明显高于夏秋季,十二指肠溃疡亦有类似的季节变化,胃黏膜糜烂发病夏秋季明显高于冬春季,胃溃疡发病无明显季节性。     

老年上消化道出血60例临床分析

目的 探讨老年上消化道出血的病因及治疗特点.方法 对2008年1月～ 2010年1月我院收治的老年上消化道出血病例进行分析.结果 胃溃疡出血26例(占43%),十二指肠球部溃疡出血8例(占13%),胃癌出血10例(占16%),食管静脉曲张破裂出血11例(占18%),Mallory-Weiss综合征2例(占3%),胆道出...     

两种三联疗法治疗幽门螺杆菌感染性胃溃疡合并复发性口腔溃疡疗效对比

目的对比观察克拉霉素三联疗法与甲硝唑三联疗法治疗幽门螺杆菌(helicobacter pylori,Hp)感染性胃溃疡合并复发性口腔溃疡的临床疗效。方法选取2015年1月至2019年1月信阳市中医院收治的56例Hp感染性胃溃疡合并复发性口腔溃疡患者作为研究对象,并按照随机数表法将其随机分为试验组(28例)和对照组(28例),其中试验组患者采用克拉霉素、奥美拉唑、阿莫西林三联疗法予以治疗,对照组患者采用甲硝唑、奥美拉唑、阿莫西林三联疗法予以治疗,对比观察两组患者的Hp清除情况、胃溃疡与口腔溃疡愈合情况以及免疫功能变化情况。结果试验组患者Hp清除率及胃溃疡愈合率显著高于对照组(χ~2=4.978、14.275,P=0.026、0.000)、胃溃疡复发率显著低于对照组(χ~2=12.600,P=0.000)、口腔溃疡治疗有效率显著高于对照组(Mann-Whitney U=216.500,Z=-3.104,P=0.002);治疗4周后,两组患者CD3^+、CD4^+ 、CD4^+ /CD8^+水平均显著高于治疗前(CD3^+:t=19.170、8.853,P=0.000、0.000;CD4^+ :t=12.892、4.430,P=0.000、0.000;CD4^+ /CD8^+:t’=20.192、9.040,P=0.000、0.000),CD8^+水平显著低于治疗前(t’=14.224、5.403,P=0.000、0.000),且治疗后试验组患者CD3^+、CD4^+ 、CD4^+ /CD8^+水平均显著高于对照组(t=9.397、7.789、9.551,P=0.000、0.000、0.000),CD8^+水平显著低于对照组(t=12.237,P=0.000)。结论克拉霉素三联疗法可明显增强Hp感染性胃溃疡合并复发性口腔溃疡患者的免疫功能,提高Hp清除率及胃溃疡与口腔溃疡愈合率,降低胃溃疡复发率,效果显著优于甲硝唑三联疗法,值得临床推广应用。     

胃安康口服液对鼠胃溃疡的药效学研究

目的：观察胃安康口服液对鼠的抗溃疡及镇痛作用。方法：采用小鼠束缚－冷冻应激性溃疡模型和无水乙醇致胃粘膜损伤模型；大鼠乙酸烧灼溃疡模型；幽门结扎法造成胃酸分泌模型；采用热板法和扭体法进行镇痛试验。结果：胃安康口服液可剂量依赖性的抑制束缚－冷冻应激和无水乙醇的胃粘膜损伤，促进醋酸型溃疡的愈合，抑制胃酸分泌，降低胃酸酸度和胃蛋白酶活性，减少热板引起的小鼠舔后足次数和乙酸引起的扭体次数。结论：胃安康口服液     

回肠末端良性溃疡的X线表现及其诊断价值

探讨结肠和小肠双对比造影X线检查对回肠末端溃疡的影像表现及其诊断价值。材料和方法22例经 结肠镜证实的回肠末端溃疡患者,其中18例结肠造影,16例小肠造影。将造影对病变的显示分为显示满意、显示较差和 未显示三组。结果结肠和小肠造影对病变的显示率分别为94.4％和93.8％。病变显示满意率分别为67％和50％。多 发溃疡占54.5％。54.5％的溃疡小于1cm。40.9％为纵行溃疡,31.8％为类圆形溃疡。36.4％的溃疡伴有肠管狭窄, 22.7％伴有假憩室形成。结论当临床怀疑回肠末端病变时,应首先选择结肠造影。     

Usefulness of percutaneous transesophageal gastrotubing for gastric outlet obstruction secondary to duodenal ulcer,a case report

Severe duodenal ulcer stenosis requires continuous decompression, which makes oral ingestion difficult, yet poor nutritional status before surgery increases the risk postoperative complications. Double percutaneous transesophageal gastrotubing (dPTEG) is a new treatment that provides both decompression and enteral nutrition. We report a case of duodenal ulcer scar stenosis in which dPTEG was used for preoperative management. A man in his 40s visited our hospital with vomiting as a chief complaint. CT scan showed duodenal ulcer stenosis. As the existence of malignant disease could not be ruled out, surgery was planned. Before surgery, dPTEG was inserted to achieve decompression and nutritional management. The patient''s gastric distension and nutritional status improved significantly, and laparoscopic distal gastrectomy was performed 22 days after the insertion. dPTEG may be an effective management method for patients with pyloric stenosis due to duodenal ulcer.     

胃线形溃疡X线诊断(附16例报告)

本文报告16例经胃低张双对比造影和胃镜证实的胃线形溃疡.X线表现为胃轮廓畸形,线形龛影,粘膜皱襞呈放射状向龛影集中。壁龛长0.8～3.6cm,宽0.1—0.3cm.胃小弯、胃体后壁与胃窦好发。 结合胃镜与X线追踪观察认为线形溃疡为圆形溃疡修复的演变,或一开始即呈线形溃疡。同时对线形溃疡与溃疡瘢痕的区别做了讨论。     

CT of gastric carcinoma: preliminary results with a new scanning technique.

Usefulness of computed tomography (CT) for the demonstration of gastric carcinoma was evaluated in 250 cases with surgical proof of diagnosis: advanced gastric carcinoma (n = 193), early gastric carcinoma (n = 47), gastric submucosal tumor (n = 8), gastric polyp (n = 1), and benign gastric ulcer (n = 1). CT was performed on prone patients after 400-600 mL of water was orally administered and a 100-mL bolus of nonionic contrast material was injected. Water provided optimal distention and satisfactory contrast to depict the normal gastric wall. Prone positioning allowed visualization of the whole gastric wall except for the fundus and prevented artifacts caused by gas during supine imaging. CT demonstrated gastric tumor as a thickened or abnormally enhanced gastric wall in 95% of advanced carcinomas, 93% of elevated early carcinomas, and 18% of depressed early carcinomas. The authors believe that CT performed with this method is useful and that it should be used in addition to barium and endoscopic studies before surgery is planned.     

十二指肠溃疡的螺旋CT诊断价值

目的：探讨螺旋CT诊断十二指肠溃疡的价值。材料和方法：回顾性分析1500例上腹部CT图像。结果：CT诊断十二指肠溃疡27例,经胃镜和胃肠双对比造影明确诊断18例,CT诊断准确率为66．7%。十二指肠溃疡常见的CT表现为肠壁增厚、管腔狭窄和球变形。结论：上腹部CT诊断十二指肠溃疡有一定价值,分析上腹部CT图像时,应注意十二指肠溃疡的可能。     

Current role of CT in imaging of the stomach.

Recent advances in computed tomographic (CT) technology and three-dimensional (3D) imaging software have sparked renewed interest in using CT to evaluate gastric disease. Multidetector row CT scanners allow thinner collimation, which improves the visualization of subtle tumors as well as the quality of the 3D data sets. When water is used as an oral contrast agent, subtle disease is easier to visualize, especially when a rapid contrast material bolus is intravenously administered. Adenocarcinoma is the most common gastric malignancy and typically appears as focal or segmental wall thickening or a discrete mass. Gastric lymphoma can have a CT appearance similar to that of adenocarcinoma. Both gastric adenocarcinoma and lymphoma may be associated with adenopathy. Gastrointestinal stromal tumors (GISTs) tend to appear as well-defined masses that arise from the gastric wall and may be exophytic when large. GISTs are usually not associated with significant adenopathy. In addition to gastric malignancies, CT can also help detect inflammatory conditions of the stomach, including gastritis and peptic ulcer disease. CT angiography is especially helpful for depicting the gastric vasculature, which may be affected by a variety of disease conditions. Copyright RSNA, 2003.     

奥美拉唑使用疗程对危重脑出血患者医院获得性肺炎发生率的影响

目的：观察急诊重症监护室中危重脑出血患者,使用不同时间奥美拉唑后医院获得性肺炎（ HAP）的发生率。方法急诊重症监护室96例危重脑出血的患者,根据奥美拉唑的使用时间随机分为A、B、C 3组,各组分别使用奥美拉唑（40 mg,静滴,1次/天）3天、7天、14天。患者每日于使用奥美拉唑1 h后抽取胃液测定pH值,实验开始后头3天每日留1次痰细菌培养和胃液细菌培养。结果 A、B、C各组应激性溃疡出血的发生率分别为18.8％、12.5％、6.3％。各组HAP发生率分别为31.3％、40.6％、46.9％。与其它组比较,使用奥美拉唑14天的C组胃液pH值更高（P＜0.05）,应激性溃疡出血发生率更低（P＜0.05）,但HAP发生率更高（P＜0.05）。结论对于危重脑出血患者,使用适当疗程的奥美拉唑能够通过维持适度胃液pH值,既减少应激性溃疡出血的发生,也减少HAP的发生。     

注射用奥美拉唑治疗胃溃疡出血的疗效分析

目的：探讨注射用奥美拉唑治疗胃溃疡出血的疗效。方法110例胃溃疡出血患者随机分为2组,观察组给予注射用奥美拉唑40 mg＋生理盐水100 mL静滴,每天2次,共治疗3天。对照组给予西咪替丁800-1200 mg静滴,每天1次,3天为一疗程。疗程结束后评价疗效及复查胃镜。结果奥美拉唑组的治疗有效率为90.9％,西咪替丁组的治疗有效率为76.4％,比较有统计学差异（ P＜0.05）。奥美拉唑组的溃疡愈合总有效率为85.5％,而西咪替丁组的总有效率为65.5％,两组溃疡愈合总有效率比较有统计学差异（ P＜0.05）。结论注射用奥美拉唑治疗胃溃疡出血疗效显著,明显改善溃疡愈合,是治疗胃溃疡出血的有效药物,值得临床推广。     

消化内镜联合四联疗法对胃溃疡伴活动性出血的疗效观察及再出血原因分析

目的观察消化内镜联合四联疗法对胃溃疡伴活动性出血的治疗效果,并分析其再出血的相关危险因素。方法选取2016年9月至2018年9月焦作煤业集团有限责任公司中央医院消化科收治的88例胃溃疡伴活动性出血患者作为研究对象,并按照随机数表法将其随机分为观察组与对照组,每组44例,观察组患者采用消化内镜联合四联疗法治疗,对照组患者单纯采用四联疗法治疗,对比两组患者的临床疗效,观察两组患者治疗后再出血的发生情况,并分析再出血的相关危险因素。结果治疗2周后,观察组患者的临床疗效明显优于对照组(Mann-Whitney U=708.500,Z=-2.380,P=0.017);经多因素Logistic回归分析发现,血红蛋白含量低、溃疡为A1期及未联合消化内镜治疗是患者再出血的独立危险因素(OR=1.792、1.165、1.879,P=0.015、0.022,0.031)。结论胃溃疡伴活动性出血患者应用消化内镜联合四联疗法治疗,可有效提高治疗效果,降低再出血发生率,且患者血红蛋白含量低及溃疡为A1期也是胃溃疡伴活动性出血患者再出血的独立危险因素,应加以重视。     

Splenic penetration by a benign gastric ulcer: Preoperative computed tomographic diagnosis

Penetration of the spleen is a rare complication of benign gastric ulcers, with fewer than 10 cases reported. The rareness is most likely due to the uncommon occurrence of benign ulcers in the areas of the stomach contiguous with the spleen, the fundus, and the proximal portion of the greater curvature. In none of the reported cases was the preoperative diagnosis of splenic penetration made on radiologic studies. We present a case of a benign gastric ulcer penetrating into the spleen which was diagnosed preoperatively on the basis of a computed tomographic (CT) examination supplemented with prone scanning.     

Vertebral column kyphoscoliosis and unexpected death

A case of spontaneous gastric perforation is reported in a 75-year-old woman due to massive hemorrhaging from a benign gastric ulcer. Blood was prevented from leaving the stomach due to posterior displacement and rotation of the stomach associated with marked underlying vertebral column kyphoscoliosis. Significant deformity of the spine had caused malpositioning of the stomach as a result of the abnormal shape of the peritoneal and chest cavities. This in turn had led to mechanical obstruction and prevented egress of blood arising from a bleeding arteriole in the base of a chronic gastric ulcer. Rapid distension had resulted from the inability to spontaneously decompress the stomach, which in turn had led to rupture.     

胃、十二指肠溃疡性穿孔的早期CT诊断

目的：探讨ＣＴ在胃、十二指肠溃疡穿孔的早期诊断征象及价值。方法：分析２６例起病６小时内腹部ＣＴ平扫病例,８例口服阳性造影剂。全部病例经手术病理证实。结果：２４例发现腹腔内位置、形态、大小不同的游离气体影,３例伴有造影剂外漏现象,２例仅见网膜囊内包裹征象。结论：结合临床,ＣＴ在穿孔早期依据腹腔游离气体能及时、正确地做出定性诊断,并根据造影剂外漏、包裹性病变的部位可提示定位诊断。     

螺旋CT诊断胃十二指肠溃疡穿孔的价值

目的：探讨螺旋CT扫描在消化性胃十二指肠溃疡穿孔的诊断价值。方法：回顾性分析经手术证实有完整临床资料的12例成年人胃十二指消化性溃疡穿孔的螺旋CT表现。结果：12例中男11例,女1例,其中胃溃疡穿孔2例,十二指肠球部及降段溃疡穿孔10例。螺旋CT表现剑突下隐窝积气8例,肝圆韧带间隙积气7例,腹膜后间隙积气2例,腹腔积液5例及单侧或双侧胸腔积液8例。结论：螺旋CT较X线片能更早更准确地判断胃十二指消化性溃疡穿孔的有无,并能为其定位和鉴别诊断提供更多有价值的信息。     

FDG-avid antrum-pylorus ulcer,adjacent lymph node,and abdominal wall nodule mimicking gastric cancer with metastases

Gastric cancer presents with similar clinical symptoms as gastric ulcer, and the morphologic features of gastroscopy overlap considerably. We report a 58-year-old man with the clinical presentation of recurrent gastric discomfort and black stools. A suspected malignant tumor of the gastric antrum-pylorus was observed on gastroscopy. Contrast-enhanced CT showed enhancement of the lesion. PET/CT revealed an FDG-avid lesion at the gastric antrum-pylorus, an intense FDG-uptake perigastric lymph node, and an enlarged nodule with high FDG uptake in the right abdominal wall. Subsequent surgical pathology revealed an inflammatory ulcer of the gastric antrum-pylorus with reactive hyperplastic lymph node, while the lesion in the right abdominal wall was a scar nodule. This case suggests that when multiple FDG-avid lesions accompany an atypical gastric ulcer, it can easily lead to misdiagnosis, and therefore more emphasis should be placed on histopathological analysis.     

胃恶性肿瘤术前CT诊断价值（附15例分析）

目的本文旨在探讨胃恶性肿物的CT表现及其术前诊断价值。方法选取纤维胃镜及活检病理证实15例胃恶性肿瘤作CT薄层及重叠扫描。结果 15例中,胃癌9例,胃恶性溃疡1例,胃底癌4例,胃恶性淋巴瘤1例。其中7例胃癌及1例胃恶性淋巴瘤无任何肿瘤转移及外侵征象,作了手术切除,术中发现与术前CT检查相符,7例已有肝转移及胃外侵,不宜手术治疗。结论 CT是胃恶性肿瘤手术前评估最有效方法,应作为外科术前常规。     

Benign and malignant gastric ulcer: CT findings]

PURPOSE: To evaluate the differential CT aspects of benign and malignant gastric ulcers. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 54 patients with gastric ulcerative lesions, 47 with malignant lesions (38 adenocarcinomas, 9 lymphomas) and 7 with benign lesions. All patients underwent histological examination. CT scanning was performed with a helical scanner Picker PQ 2000, before and after intravenous contrast material administration and after adequate stomach distension, achieved by drinking at least 400 ml of water; 2 ml/kg of intravenous contrast was injected at a rate of 3.5 ml/s. After contrast administration two-phase dynamic scans were performed with a scan delay of 30O and 50O. The parameters considered were: lesion size and localization, extension of the ulcer into or beyond the body of the stomach, focal wall thickness, contrast enhancement of the ulcer, perigastric tissue morphology, presence of lymphoadenopathies and liver metastases. RESULTS: The ulcer size and localization were not significative in the differential diagnosis of benign or malignant ulcers. In 46 patients the ulcer extended within the body of the stomach (38 adenocarcinomas and 8 lymphomas), in 8 cases beyond (7 benign ulcers and 1 initial lymphoma). In 46 cases of malignant ulcers there were focal wall thickenings (> 5mm), in 1 case of initial lymphoma and in all cases of benign ulcers the thickness of the wall was normal. Contrast enhancement of the lesion was observed in 25 cases, all of which were adenocarcinomas. 33 patients had perigastric tissue abnormalites (32 with malignant lesions and 1 with benign ulcer). Lymphoadenopathies and liver metastases were detected in 30 cases and always associated to malignant ulcers. DISCUSSION AND CONCLUSIONS: The improved CT technology allows to recognize gastric ulcer. Ulcer extension into stomach body; focal wall thickening; contrast enhancement of the lesion, lymphoadenopaties and liver metastases are significative in malignant gastric ulcers. The lack of these abnormalities is characteristic of benign gastric ulcers but can be also observed in early malignant lesions.