Roux-en-Y和间置空肠胆肠吻合术分析比较

关于胆管空肠Roux—en—Y吻合术是否引起胃酸分泌增高并继发消化性溃疡,以及间置空肠胆肠吻合术是否能够防止胃酸分泌增高和溃疡病的发生临床仍有争议。本文通过临床随访和大鼠动物实验,进行两种术式的临床和实验结果的分析比较表明:除Roux—en—Y组基础胃酸分泌量、(BAO)、高峰胃酸分泌量(PAO)略高于JICD组外余均无显著差异,两组中临床和动物实验亦均未见溃疡病。     

幽门螺杆菌感染患者胃泌素、IL-8、IL-10水平变化

目的：研究幽门螺杆菌（HP）感染与白介素-8（IL-8）、白介素-10（IL-10）和胃泌素（GAS）的关系。方法：108例患者均经^13C-尿素呼气实验和血清学检测HP,并于晨起空腹在胃镜检查前后取静脉血2mL,3000rpm离心10分钟,分离血清,测定血清中GAS、IL-8、IL-10的含量。结果：HP阳性组血清IL-8、IL-10、GAS含量分别为51．49±9．41pg／mL、312．84±47．91pg／mL、10．34±7．24ng／mL。HP阴性组血清IL-8、IL-10、GAS含量分别为37．44±9．05pg／mL、356．39±51．89pg／mL和5．12±3．51ng／L。HP阳性组血清IL-8、GAS含量分别高于阴性组（P〈0．01）,IL-10含量低于HP阴性组（P〈0．01）。HP阳性组血清IL-8与GAS间呈正相关（r=0．382,P〈0．01）,IL-10与GAS间呈负相关（r=-0．202,P〈0．05）。结论：HP感染的慢性胃炎和消化性溃疡患者IL-8、IL-10、GAS含量变化与HP感染有关,HP感染胃肠黏膜产生的炎症损伤与IL-8有关,血清IL-10对炎症有抑制作用。     

幽门螺杆菌感染及其根治对胃溃疡血清胃泌素的影响

目的：了解幽门螺杆菌（HP）相关性胃溃疡（GU）与胃泌素（GAS）的关系以及根除HP治疗对GAS的影响。方法：对42例GU（其中HP阳性31例，HP阴性11例）患进行空腹胃泌素测定、胃粘膜组织活检及快速尿素酶试验测定。用洛赛克丽珠得乐，阿莫西林及灭滴灵进行治疗。疗程2个月，停药1个月后重复上述检查。结果：⑴HP阳性GU患的GAS显高于HP阴性。⑵HP根除后GAS较治疗前显降低。结论：GAS在HP相关性胃溃疡中有重要意义。     

溃愈汤对消化性溃疡胃酸分泌的影响

对25例用溃愈汤治疗的消化性溃疡(活动期)患者治疗前后胃酸分泌变化分析,结果示治疗后基础胃液量、BAO和MAO有显著变化,说明溃愈汤具有抑制胃酸分泌作用,同时有双向调节可能。     

十二指肠溃疡病患者幽门螺旋菌感染与胃酸及胃泌素关系

４０例活动性十二指肠球部溃疡病人均伴有胃窦炎，２８例胃窦部幽门螺旋菌阳性，１２例阴性，基础胃酸分泌，五肽胃泌素刺激后的高峰胃酸分泌以及空腹和餐后１小时血清胃泌素水平。在ＨＰ＋）组均明显高于ＨＰ（－）组（Ｐ＜０．０１－０．０２）。经治疗，１０例ＨＰ（＋）患者复查，发现ＨＰ清除后空腹和餐后血清胃泌素均显著下降（＜０．０１），但平均ＢＡＯ和ＰＡＯ下降不明显（Ｐ＞０．０５）。研究结果提示，ＨＰ系通过刺激胃     

IL-lB基因多态性和H.pylori感染对胃酸分泌的影响

目的通过研究IL-1B基因多态性和幽门螺旋杆菌（Helicobacter pylori，H．pylori）感染对胃酸分泌的影响，探讨IL-1B基因多态性与胃癌发生的可能机制。方法（1）采用PCR-限制性片段长度多态性（restriction fragment length polymorphism，RFLP）分析法检测胃癌低发区广东省117名健康志愿者IL-IB-511基因多态性。（2）采用ELISA方法检测上述人群的H，pylori感染率。（3）胃液分析方法分别检测上述人群不同基因型个体胃酸分泌的差异。结果基础酸排量（basal acid output，BAO）和最大酸排量（maximal acid output，MAO）在H．pylori阳性组与阴性组间无明显差异；在IL-1B-511T／T和C／C和C／T各基因之间，MAO、BAO均无明显差异。结论本研究未发现IL-1B基因多态性、H．pylori感染与胃酸的关系，提示IL-1B基因多态性途径可能不是通过影响胃黏膜IL-1β的产生量进而影响胃内酸分泌的。     

十二指肠溃疡幽门螺旋菌病理检测

对220例胃窦和十二指肠球部粘膜活检组织作HE及Wurthin-Starry银染色进行幽门螺旋菌(HP)的病理学检查,同时对50例病理证实十二指肠球部溃疡病人进行血清胃泌素测定及基础胃酸测定。结果发现HP在消化性溃疡时检出率为79％,慢性胃炎为60％,在十二指肠溃疡病时的检出率又高于胃溃疡病,前者为86％,后者为72％。而在十二指肠球部溃疡合并胃型上皮化生者和活动性十二指肠炎者,HP检出率明显高于无胃型上皮化生和非活动性十二指肠炎者。平均空腹和餐后血清胃泌素浓度在HP阳性组高于HP阴性组。基础胃酸分泌在HP阳性组高于HP阴性组。     

扩大高选择性迷走神经切除术加溃疡局部切除术治疗十二指肠溃疡临床研究

目的 探讨扩大高选择性迷走神经切除术加溃疡局部切除术治疗十二指肠溃疡的临床疗效.方法 经确诊的106例十二指肠溃疡(或并发穿孔、出血),采用扩大高选择性迷走神经切断加溃疡局部切除术治疗,并设对照组90例.手术前、后进行基础胃酸分泌量(BAO)、最大胃酸分泌量(MAO)和高峰胃酸分泌量(PAO)测定.结果 治疗组均获治愈,获得12个月至10年随访者87例(82%),溃疡复发1例(0.94%).对照组术后近期死亡1例(1.10%),吻合口狭窄4例(4.40%),胃炎15例(16.60%),吻合口溃疡3例(3.30%),溃疡复发3例(3.30%).治疗组术后测定BAO、PAO和MAO较术前下降显著(P＜0.01).结论 扩大高选择性迷走神经切除术加溃疡局部切除术治疗十二指肠溃疡,达到病因、病灶双治疗,且不改变其正常解剖位置和胃的正常容积,疗效显著,是治疗十二指肠溃疡(或并发穿孔、出血)的优选术式.     

胃酸分泌对胃-食管反流的影响

通过对30例慢性胃炎患者进行胃酸分泌及胃-食管反流的测定,以观察胃酸分泌对胃-食管反流的影响。其中胃-食管反流阳性组18例,胃-食管反流阴性组12例,胃液分析结果显示的基础胃酸排泌量(BAO)、最大胃酸排泌量(MAO)及高峰胃酸排泌量(PAO),两组之间均无显著性差异(P>0.05)。表明胃酸分泌和胃-食管反流无关,提示胃酸过高不是胃-食管反流的诱发因素,有烧心、反酸症状出现者可能有胃-食管反流的存在,但并不能反映胃内泌酸及胃酸分泌亢进。     

庆大霉素与雷尼替丁合用治疗消化性溃疡24例

幽门螺杆菌（HP）是慢性胃炎的主要病因，而消化性溃疡是在慢性胃炎的基础上发生的，庆大霉素可用于治疗慢性胃炎及消化性溃疡的HP感染，有效而且安全。雷尼替丁可有效地抑制基础和夜间胃酸的分泌。为此，我院自2004～2007年，用庆大霉素与雷尼替丁合用治疗消化性溃疡，结果报告如下：     

Effects of Cimetidine with or without Concomitant Vitamin C Intake on Intragastric Milieu

The intragastric changes especially the changes of nitrite levelafter the cimetidine treatment with or without concomitant adminis-tration of vitamin C were studied in 34 patients with peptic ulcer.The pH value,nitrite level,and bacterial count of the gastric juiceafter cimetidine treatment were significantly higher than those priorto the treatment(P<0.01).If vitamin C was given simultaneouslywith cimetidine,then the nitrite level would not be elevated afterthe treatment(P>0.05).Besides,the reduction of BAO,PAO,andMAO was not influenced by vitamin C intake.It is believed thatvitamin C can reduce the nitrite concentration elevated by cimetidinetreatment,but it will not affect the acid-inhibitory function ofcimetidine.This fact is of importance for the safe application ofcimetidine.     

GASTRIC SECRETORY TESTING WITH PENTAGASTRIN AN OBSERVATION OF 138 CASES

Pentagastrin gastric secretory testing is studied in a total 138 subjects including normal {:ontrols and patients with various gastric and duodenal diseases. Our results show that the basal acid output (BAO) and the maximal acid output (MAO) of patients with duodenal ulcer are higher than that of the control group. The gastric acid concentration is also high. There is iio significant difference between gastric ulcer patients and normal controls. BAO and MAO are lower than normal in patients with atrophic gastritis and gastric carcinoma, their gastric aci- dity is also low. Since superficial gastritis and antritis are usually not simple and are usually secondary to peptic ulcer and other lesions, they present no typical pattern on testing. In this latter group of patients, interpretation of gastric secretory testing should be combined with the other clinical data.. This study proves that pentagastrin as a gastric secretory stimulant has many advantages, including creating a strong response, early ap- pearance of peak value and few side effects, so it is superior to the conventional histamine drugs. It is the stimulant of choice in clinical gastric secretory testing. We recommend the hypodermic route at 6 µg/kg. The indications for the procedure and pre- cautions entailed in the test and its elicitations in some gastric and duodenal diseases are dis- cussed.     

Transgastric vagotomy with selective proximal vagotomy for duodenal ulcer

To improve surgical results of duodenal ulcer, transgastric myotomy (TGM) was added to the traditional selective proximal vagotomy (SPV) and its efficacy was evaluated clinically in 40 patients. 35 men and 5 women were involved, with a mean age of 33.07 +/- 14.25 years. Pyloroplasty was added in 12 operations for stenosis and perforation. 28 patients in this series underwent TGM with SPV without drainage. In the 36 patients, basal and maximal acid output (BAO and MAO) was compared preoperatively and at 6 months postoperatively. A satisfactory reduction of acid output was achieved, with a mean reduction rate of 71.4% in BAO and of 79.9% in MAO. All 40 patients were negative in Hollander's insulin stimulation test at 6 months postoperatively. The gastric mucosa was injured during myotomy in 2 of the patients (5.0%), and was simply sutured using 3-0 Dexon, without causing any problems. No other early or late postoperative complication was present. In addition, no peptic ulcer recurrence has been noted over a maximal follow-up of 8 years. The present results suggest the completeness of gastric denervation by TGM+SPV, and establish the efficacy of TGM with SPV, and therefore this method is recommended in the surgical treatment of duodenal ulcer.     

口服甲氰咪胍对胃内环境的影响及口服维生素C的作用

本文报导34例溃疡病人服用甲氰咪胍后胃内环境的变化以及甲氰咪胍和维生素C同服对胃内环境、特别是对亚硝酸盐含量的影响。结果显示:服甲氰咪胍后,胃液pH值、亚硝酸盐及细菌总数明显增加(P<0.01);而甲氰咪胍和维生素C同时服用,亚硝酸盐无明显增加(P>0.05),且两个治疗组的BAO、PAO和MAO无明显差异。说明在服用甲氰咪胍时,同时服用维生素C可以防止由于甲氰咪胍引起的亚硝酸盐含量增高的现象,而对甲氰咪胍的抑酸作用无明显影响,这对甲氰咪胍及其它强抑酸剂可能具有重要的意义。     

GASTRIC SECRETORY TEST WITH PENTAGASTRIN. STIMULANT REPORT OF A MULTICENTER STUDYIN PATIENTS WITH VARIOUS GASTRODUODENAL DISEASES

Pentagastrin stimulated gastric secretory tests (PSGST) were performed in 31 normal subjects and 569 patients with various gastro- duodenal diseas.es The mean basal acid output (BAO) and peak acid output (PAO) were higher in patients wi.th duodenal ulcer and[ combined ulcers, lower in patients with chronic atrophic gastritis and gastric carcinoma as compared with normal;s. The PSGST results in patients with chronic superficial gastritis and gastric ulcer were similar to those in normal subjects. Pa- tients with stomal ulcer had a higher PAO than those without stomal ulcer. The clinical value and significance of the test are discussed.     

胃酸分泌过多对反流性食管炎影响的评价

目的 评价胃酸分泌增加对反流性食管炎的影响。方法 内镜检查和食管内24h pH监测确诊的食管炎患者（E组）72例,食管炎伴发十二指肠球部溃疡患者（E＋DU组）45例,30名健康对照者接受胃酸分泌试验、下食管括约肌测压、反流性食管炎相关致病因素多元归逐步删除,自变量对因变量的作用分析。结果 E组患者BAO,MAO,PAO低于E＋DU组患者,E组下食管括约肌压力高于E＋DU组,而括约肌松弛率低于E＋DU组。影响反流性食管炎的3个主要因素排序,E组患者依次为下食管括约肌压力（78．5％）,白天反流（9．2％）和食管裂孔疝（8．7％）。E＋DU组患者三个主要影响因素依次为下食管括约肌（44．8％）,基础胃酸（41．5％）和夜间反流（8．6％）。结论 胃酸分泌过多时,下食管括约肌功能障碍和基础胃酸分泌量增加是导致反流性食管炎的两个重要因素。     

幽门螺杆菌感染与血浆内皮素、胃泌素及组胺关系的研究

目的 探讨HP感染诱发的胃肠疾病与血中内皮素（ET）、胃泌素（GAS）、组胺（HTM）的关系及对病情转归和预后的影响。方法 用荧光分光光度法与放免法测定瑞贝克（SBC）治疗前、中、后期ET、GAS、HTM水平的变化。结果 HP诱发的慢性胃炎、消化性溃疡患者血浆ET、GAS、HTM水平不同程度升高。SBC杀灭HP后ET、GAS水平下降，而HTM在治疗中期仍升高。血中ET、GAS及HTM水平与慢性胃炎、消化性溃疡的HP感染阳性率分别有高度正相关（r=0.9987）、中度正相关（r=0.7882）和无相关。结论 HTM在治疗中期持续升高，可能与HP产生的毒素刺激肥大细胞释诬蔑入HTM有关。HP感染与ET、GAS 及HTM水平的关系可能对研究慢性胃炎、消化性溃疡的病因、病理生理及病情转归等方面有重要临床意义。     

Ⅱ型糖尿病并消化性溃疡的临床研究

目的探讨Ⅱ型糖尿病（T2DM）并消化性溃疡（PU）的临床特点、根除幽门螺杆菌（HP）感染率及根除HP治疗效果。方法 T2DM并PU56例为观察组,对照组为随机选择与观察组同期内非糖尿病经胃镜检出的PU患者62例,2组均按常规进行胃镜检查和HP感染检测,分析2组的临床特点、溃疡部位、HP阳性率,HP阳性者采用奥美拉唑20mgbid,阿莫西林1000mgbid,甲硝唑400mgbid一周疗法,停用抗菌素后4周复查14C-尿素呼气试验,计算其根除率,比较2组差异。结果 2组在节律性疼痛症状,胃溃疡的检出有显著差异性（P〈0.05）,2组HP感染率无显著差异性（P〉0.05）,T2DM并PU的HP根除率为61.5%（24/39）,显著低于对照组根除率88.0%（44/50）（P〈0.05）。结论 2组临床症状、溃疡发生部位有所不同,而HP感染率却无差异;T2DM组的PU患者三联根除HP治疗的根除率低于非糖尿病组。     

幽门螺杆菌在成人消化性溃疡检出的探讨

目的：探讨幽门螺杆菌（HP）感染与消化性溃疡（PU）及年龄、性别的关系。方法：采用快速尿素酶和组织H-E染色法对119例PU病人进行HP感染检测，其中男性96例、女性23例，以上二种方法测定结果均阳性定为HP感染。然后将这些病例按年龄分为三组，即青年组33例，中年组78例和老年组8例。结果：HP总感染率：胃溃疡78．6％，十二指肠球溃疡63．6％，幽门管溃疡66．7％及复合溃疡62．5％，该结果与以前报道相同。各种溃疡的HP感染率在各年龄组间比较及男、女性别间比较无显著性差异（P均＞0．05）。结论：HP感染与PU关系密切，与性别无关，并不与年龄成正比上升。     

儿童消化性溃疡64例临床分析

目的:总结分析本地区儿童消化性溃疡的临床表现、并发症、胃镜表现,以及其与幽门螺旋杆菌(helicobacter pylori,HP)感染及非甾体类抗炎药(NSAID)的关系。方法:对64例儿童消化性溃疡的资料进行回顾性分析。结果:儿童消化性溃疡临床症状具有不典型性,且个体差异较大,儿童年龄愈大消化性溃疡患病率愈高;并发症以上消化道出血为主,胃镜检查十二指肠溃疡发病率较胃溃疡高,且发病与幽门螺杆菌感染及NSAID关系密切。结论:对临床上原因不明的反复发作性腹痛患儿均应作胃镜和幽门螺杆菌等相关检查,以免误诊或漏诊;根除HP、正确使用NSAID及良好生活习惯是防治儿童PU的重要手段。