急性胃粘膜病变致上消化道出血的治疗

本院自1995年10月至1997年7月间,对62例急性胃粘膜病变上消化道出血患者的治疗,其中32例应用生长抑素治疗,另外30例应用甲氰咪胍静脉滴注等常规治疗的病例(对照组)进行对比观察,发现生长抑素组比对照组止血效果好,现报告如下。临床资料一、病例选择:全组均为住院患者,均有呕血、黑便或黑便病史。既往无胃病及肝病史。原发病高血压病合并脑出血10例,脑动脉硬化、脑梗塞5例,急性胰腺炎3例,胰腺癌术后2例,脑外伤术后4例,药物性损害26例,酒精性损害12例。出血后24ｈ内经急诊胃镜诊断上消化道出血原因为急性胃粘膜病。年龄28～78岁,平均(425±125…     

单孔道内镜套扎粘膜切除诊治上消化道粘膜病变25例分析

自１９９６年１月至１９９７年８月,我院应用单孔道内镜,以粘膜套扎后高频电切除,对２５例上消化道粘膜病变患者进行内镜下大块病变粘膜切除,现报告如下。一、临床资料１．一般资料：２５例中男１３例,女１２例;平均年龄４３．５岁。息肉患者１８例,其中食管息肉９例,上段１例,下段８例;胃内息肉８例,胃体、胃窦部各４例;十二指肠息肉１例。息肉最小为０．５ｃｍ×０．８ｃｍ,最大１．５ｃｍ×２．０ｃｍ,均为广基、无蒂、扁平型,表面光滑或轻度糜烂。上消化道大块粘膜活检７例,胃体下部２例,胃窦部５例,其中病变范围广,…     

急性非静脉曲张性上消化道出血常规内镜下止血后再出血的血管栓塞术治疗价值

2017年4月—2020年6月,因急性非静脉曲张性上消化道出血（acute non?variceal upper gastrointestinal bleeding,ANVUGIB）行内镜下止血治疗（包括局部注射药物、电凝、止血夹和套扎等）后再出血,于中国科学技术大学附属第一医院消化内科接受内镜下血管栓塞术（endoscopic vascular embolization,EVE）治疗的病例共46例。46例经EVE治疗后均即刻止血,即刻止血有效率为100.0%。术后出现腹痛13例（28.3%）,腹胀3例（6.5%）,发热2例（4.3%）。术后3、12个月复查胃镜,黏膜逐渐愈合。随访至2021年6月,无一例消化道再出血发生。由此可见,EVE对于初次内镜止血失败的ANVUGIB患者是一种安全、高效的方法,值得临床进一步研究和推广应用。     

非门脉高压上消化道出血的内镜下紧急止血治疗

非门脉高压上消化道出血的内镜下紧急止血治疗陈隆典牛桂军甸阝东华徐肇敏非门脉高压性上消化道出血为消化科常见病，大多为消化性溃疡。绝大多数出血为自限性，但约５％为持续性出血，２０％～２５％可有再出血，且大多发生于起病４８小时内。１９９４～１９９６年我们经...     

上消化道出血内镜检查567例分析

为提高急性上消化道出血的诊治水平,我们对因上消化道出血进行急诊内镜检查的４６９例患者资料进行分析,并与同期出血４８小时以后进行内镜检查的９８例资料进行比较,现报告如下。１．临床资料：本组男４２５例,女１４２例,年龄１５～７４岁,平均４２岁。其中黑便２...     

急性上消化道出血

急性上消化道出血为内科常见急症,近些年来对本症的诊断和治疗水平虽有很大的提高,但消化性溃疡出血的死亡率仍保持在10%左右。如何进一步提高对本症的诊治水平,降低死亡率是当前临床研究的重要课题。急性上消化道出血的病理生理所谓急性上消化道出血是指treitz氏韧带以上部位如食管、胃以及十二指肠等的急性出血,急性上消化道出血后可产生下列病理生理学改变: (一)脉搏与血压的变化由于血容量的急剧丧失,可产生血液动力学的改变,首先表现在脉搏的加速和血压的下降,脉搏的变化为监护出血情况简单而可靠的指标。出血开始后首先出现的是脉搏的加快,随后才出现血压下降,一般而言心率每分钟超过120次,血压在13.3kPa以下,或体位血压     

内镜下射频治疗上消化道动脉性出血

射频过去主要应用于心脏介入治疗。近年来，我们把该技术应用到上消化道动脉性出血的治疗，取得了十分满意的效果。１．临床资料：本组１１例均为１９９９年５月至２００１年２月我院消化内镜室检查发现的胃和十二指肠动脉性出血患者，均为男性，年龄２６～６８岁，主要出血原因为十二指肠球部溃疡３例，胃底平滑肌肉瘤１例，胃角溃疡３例，Ｄｉｅｕｌａｆｏｙ病４例。所有病例内镜下均见持续性喷射状出血。２．方法：选用四川绵阳立德ＬＤＲＦ－５０型多功能射频治疗仪，经内镜活检孔插入射频治疗导线，把电极头送至出血部位，根据不同部位…     

内镜治疗在急性非静脉曲张上消化道出血中的应用

急性非静脉曲张上消化道出血是临床常见的急危重症。内镜技术在急性非静脉曲张上消化道出血的治疗中有重要价值。近年此领域有了持续的新进展。本文即就内镜治疗对急性非静脉曲张上消化道出血的适宜治疗患者、治疗时机以及治疗方法和策略等方面给予简述。     

Prognostic factors for recurrence of gastrointestinal bleeding due to Dieulafoy's lesion

AIM: To analyze the effectiveness of the endoscopic therapy and to identify prognostic factors for recurrent bleeding.METHODS: Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy’s lesion (DL) from 2005 to 2011. We analyzed the demographic characteristics of the patients, risk factors for gastrointestinal bleeding, endoscopic findings, characteristics of the endoscopic treatment, and the recurrence of bleeding. We included cases in which endoscopy described a lesion compatible with Dieulafoy. We excluded patients who had potentially bleeding lesions such as angiodysplasia in other areas or had undergone other gastrointestinal endoscopic procedures.RESULTS: Twenty-nine patients with DL were identified. Most of them were men with an average age of 71.5 years. Fifty-five percent of the patients received antiaggregatory or anticoagulant therapy. The most common location for DL was the stomach (51.7%). The main type of bleeding was oozing in 65.5% of cases. In 27.6% of cases, there was arterial (spurting) bleeding, and 6.9% of the patients presented with an adherent clot. A single endoscopic treatment was applied to nine patients (31%); eight of them with adrenaline and one with argon, while 69% of the patients received combined treatment. Six patients (20.7%) presented with recurrent bleeding at a median of 4 d after endoscopy (interquartile range = 97.75). Within these six patients, the new endoscopic treatment obtained a therapeutic success of 100%. The presence of arterial bleeding at endoscopy was associated with a higher recurrence rate for bleeding (50% vs 33.3% for other type of bleeding) [P = 0.024, odds ratio (OR) = 8.5, 95% CI = 1.13-63.87]. The use of combined endoscopic treatment prevented the recurrence of bleeding (10% vs 44.4% of single treatment) (P = 0.034, OR = 0.14, 95% CI = 0.19-0.99).CONCLUSION: Endoscopic treatment of DL is safe and effective. Adrenaline monotherapy and arterial (spurting) bleeding are associated with a high rate of bleeding recurrence.     

阑尾黏膜血管增生致下消化道出血并文献复习

阑尾来源的下消化道出血（LGIB）临床罕见，虽然目前存在较多诊断方法，但结肠镜仍被认为是首选。本文报告一例首次结肠镜检查阴性，依次行胃镜及胶囊内镜检查无阳性发现，再次行结肠镜检查发现阑尾腔内活动性出血导致便血的病例。患者行腹腔镜阑尾切除术后恢复良好。病理证实阑尾黏膜血管增生病变并出血。最后，对相关文献进行了复习。     

Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy's lesion

AIM: To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy’s lesion.METHODS: One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy’s lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases).RESULTS: The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up.CONCLUSION: The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy’s lesion.     

微生态肠内营养治疗重症急性胰腺炎肠黏膜损伤的临床研究

目的观察微生态肠内营养对SAP肠黏膜损伤治疗和菌群紊乱的调节作用。方法40例SAP患者随机分为对照组和治疗组。对照组给予常规肠内营养,治疗组加用微生态制剂,治疗7d,检测患者血浆二胺氧化酶(DAO)、D-乳酸水平以及肠道菌群变化。结果治疗7d后,治疗组血浆DAO水平为(4.35±0.91)U/ml,较对照组的(5.45±2.19)U/ml明显下降(P<0.05);D-乳酸为(10.41±5.36)mg/L,与治疗前无显著性差异,但明显高于对照组的(5.53±2.05)mg/L(P<0.05);治疗组患者肠道双歧杆菌、乳杆菌的总数达(5.98±1.63)In/g和(7.23±1.94)In/g,较治疗前的(3.76±1.67)In/g和(3.91±1.82)In/g明显增加(P<0.05),肠道菌群比例接近正常,而对照组仍存在一定程度的菌群紊乱。结论微生态肠内营养具有减轻SAP肠黏膜损伤、调节肠道菌群微生态平衡、保护肠屏障功能的辅助治疗作用。     

Upper gastrointestinal bleeding in acute mesenteric thrombosis

We report an unusual case of upper gastrointestinal bleeding secondary to superior mesenteric vein thrombosis and review the literature to assess the frequency of upper GI bleeding in patients with superior mesenteric vascular disease. Clinical features and laboratory and radiological findings are nonspecific; endoscopy and abdominal angiograms are helpful to rule out the common causes of GI bleeding and to suspect the diagnoses of superior mesenteric vein thrombosis. Without early surgical intervention, mortality is close to 100%.     

Massive bleeding from a ruptured artery in jejunal diverticulosis without pre-existing mucosal inflammation or ulceration

A case of massive bleeding from a ruptured artery in jejunal diverticulosis without pre-existing mucosal inflammation or ulceration is presented. A 75-year-old bed-ridden man had massive gastrointestinal bleeding and deteriorated to a state of shock rapidly. Panendoscopy, selective abdominal angiography, and radionuclide scanning were performed, but none of these studies revealed the exact bleeding point. Emergent operation revealed a segment of jejunal diverticulosis with bleeding, and it was resected. Pathologic examination revealed tortuous veins in the submucosa of diverticula and a ruptured artery with evidence of active bleeding in a large diverticulum. No pre-existing mucosal inflammation or ulceration was seen. The bleeding cause is thought to be acquired false diverticular wall tearing of a submucosal artery by bowel distension or unknown moving content.