The prognostic value of gastrointestinal morbidity for gastric cancer.

OBJECTIVE: A history of gastrointestinal disease is a risk factor for organic gastrointestinal disorders overall. We conducted a retrospective case-control study to explore whether a history of gastrointestinal disease is of prognostic value for gastric cancer. METHODS: Forty-six patients with gastric cancer were identified from a dynamic population of approximately 12,000 patients followed since 1971 in four general practices. The control subjects without gastric cancer were matched one-on-one according to age, general practice, sex and observation period. Data on gastrointestinal morbidity in the period before gastric cancer was diagnosed were obtained from the Continuous Morbidity Registration. RESULTS: The mean observation period between the date of enrolment in the registration and the first diagnosis of gastric carcinoma was 12 years. Although every patient with gastric cancer ultimately will develop gastrointestinal complaints, 28 of these patients had no previous gastrointestinal morbidity, in comparison with 26 control subjects. Furthermore, patients who developed gastric cancer did not have more frequent gastrointestinal morbidity in their past than the control subjects (odds ratio 0.80, 95% CI 0.32-2.03). CONCLUSIONS: Our results suggest that a history of gastrointestinal morbidity is not of prognostic value for gastric cancer. Focusing attention on patients with a past history of gastrointestinal symptoms to detect gastric cancer may be of little value.     

Results of screening for cancer in Japanese in the prime of life--an analysis of nationwide MHTS and human dry dock statistics--Preventive Medicine Committee of the Japan Hospital Association.

The nationwide survey of institutions with MHTS and human dry dock capabilities was analyzed and the following results have been obtained. 1) The relative rates of cancer detection by sex and organ were the stomach > colon > rectum > lung > kidney > esophagus for men and the stomach > breast > uterus > colon > thyroid > lung for women. 2) Gastric cancer takes first place in the ranking of rates of cancer detection in the population of both sexes, followed by colon cancer. The difference in rate of detection between these cancers has been narrowed from year to year. In 1997, the ratio of gastric to colon cancers was 10:7. 3) Early cancers account for 74% of gastric cancer patients and 75% of colon cancer patients. 4) Since gastric and colon cancers are detected early, the proportions of persons with gastrointestinal symptoms are as low as 28% for gastric cancer patients and 26% for colon cancer patients. 5) The relative rates of cancer detection by the degree obesity are normal > obese > lean person. The rates of gastric and colon cancers are 2- and 3-fold higher for obese persons than for lean persons, respectively. Gastric and colon cancers are detected with higher frequency in well-nourished persons. The present review of the national MHTS and human dry dock statistics has confirmed the efficacy of MHTS and human dry dock, especially in the examination for gastrointestinal cancers.     

新生儿和小婴儿胃肠道气体减少的X线诊断

目的:探讨新生儿和小婴儿胃肠道气体减少的临床意义和X线诊断。方法:对20例X线腹部平片表现为胃肠道气体减少并经造影、穿刺、手术、病理等手段检查证实的病例进行回顾性分析。结果:20例中,男11例,女9例,年龄从1天～8个月。X线腹部平片表现为腹腔密度普遍增高,伴有或不伴有腹部膨隆,小肠、结肠内气体均明显减少或无气,其中梗阻性病变10例,胃肠经膈疝出疾病2例,占位性病变6例,功能性病变2例。结论:新生儿和小婴儿胃肠道气体减少可由多种类型病变引起,应特别警惕消化道梗阻。     

探讨消化道穿孔的X线、CT检查方法及不同的影像表现

目的：探讨消化道穿孔的X线、CT检查方法及不同的影像表现。方法选取来我院进行诊治的消化道穿孔患者96例,其中男60例,女26例,患者的年龄为22-68岁,患者平均年龄为（46.2±12.4）岁。96例患者均先采取X线检查进行临床诊断,然后再进行CT检查进行临床诊断。观察记录患者采取X线检查的影像学表现、采取CT检查的影像学表现,并且对比分析两种诊断方式的临床诊断符合率。结果 CT检查诊断与手术结果相符合的患者有89例,诊断准确率为92.7%,CT检查诊断与手术结果相符合的患者有68例,诊断准确率为70.8%。术前X线检查的诊断符合率显著高于X线检查,比较差异具有统计学意义（χ2=4.092,P〈0.05）。结论临床建议,对于消化道穿孔的诊断可采取多种检查手段综合利用,优先考虑CT扫描的方式进行诊断,以此来提高消化道穿孔的检出率和临床诊断准确率。     

Early gastric cancer--two case reports

Gastric cancer is a serious disease with a high mortality rate. Early diagnosis of the disease improves its prognosis. We report two cases of early gastric cancer and we specify the clinical, endoscopic, histologic and therapeutic aspects of the disease. This study is about two female patients, respectively, 36 and 70 years old. The diagnosis of early gastric cancer was based on pathologic examination of the resected stomach. The two patients are in remission 2 years and 6 months later, respectively. The diagnosis of early gastric cancer is often made on nonspecific symptoms. Oeso-gastro-duodenoscopy shows gastric mucosal anomalies. Pathologic examination of gastric biopsies confirm the diagnosis of adenocarcinoma. Endoscopic ultrasound is essential; it specifies the submucosal infiltration and evaluates the lymph node invasion. Surgery is the primary treatment but in some cases endoscopic mucosal resection provides good long-term results. Early diagnosis of adenocarcinoma improves the prognosis of the disease, which remains poor nowadays.     

96例结肠癌患者围手术期的护理

目的探讨护理干预对结肠癌患者围手术期的临床效果。方法将我院96例结肠癌围手术期患者随机分成实验组和观察组各48例。观察组患者按结肠癌围手术期护理常规护理;实验组在常规护理的基础上,针对患者具体情况采用心理疏导、健康教育、饮食护理、胃肠道及管道护理、病情观察、及有效的术后护理等措施。结果实验组比观察组患者住院时间短、住院费用少,且并发症发生率低、满意率高,差异有统计学意义(p<0.05)。结论对结肠癌患者围手术期实施有效的健康教育和护理干预,可以提高患者的治疗效果,有利于患者康复,提高患者的生活质量。     

低剂量CT结肠成像的应用进展

结直肠癌是胃肠道常见的恶性肿瘤,其发病率及病死率逐年攀升,早期发现及早治疗是提高治愈率和延长生存期的关键。CT结肠成像(CTC)将CT仿真内镜结合三维CT成像用于结肠疾病检查,具有检查时间短、定位准确、患者易耐受及安全无创等优势。通过阐述低剂量CTC的应用进展,使其在结肠疾病检查中得到更广泛的临床应用。     

上消化道疾病患者幽门螺杆菌感染情况分析

目的 分析上消化道疾病患者幽门螺杆菌(Hp)的感染情况,为临床防治提供依据.方法 对医院2011年3月-2011年6月1280例上消化道疾病患者的检测资料进行分析.结果 1280例患者Hp感染744例,感染率为58.1％;各年龄段比较差异无统计学意义;慢性浅表性胃炎Hp阳性率为43.9％、慢性萎缩性胃炎为63.8％、慢性胃炎为48.4％、十二指肠溃疡为94.7％、胃溃疡为72.1％、复合性溃疡为100.0％、消化性溃疡为86.1％、胃癌Hp为60.7％,其中消化性溃疡Hp感染最高,慢性胃炎最低.结论 上消化道疾病与Hp感染有密切关系,临床应注意进行积极防治.     

我国上消化道癌筛查卫生经济学研究的系统评价

目的 系统评价我国人群上消化道癌筛查项目的卫生经济学研究现状。方法 在中国知网、万方、维普网、The Cochrane Library、PubMed和EMbase中检索关于我国人群上消化道癌筛查卫生经济学评价的研究,提取纳入研究的数据资料,评价研究质量,并对筛查效果、卫生经济学结果进行分析。结果 共纳入8个相关研究。研究整体质量尚可。筛查项目的卫生经济学评价结果用成本-效果比与GDP的比值来测量。结果表明,内窥镜方法筛查项目为0.02～0.15;血ELISA抗体方法的结果为0.01～0.21;血清胃蛋白酶原方法为0.04;高危人群与普通人群筛查的成本-效果比与GDP的比值结果相似,但普通人群的筛查成本较高;不同癌症类型间筛查的卫生经济学结果显示,胃癌筛查效果较好。结论 我国高危地区采用内窥镜方法进行上消化道癌筛查的卫生经济学效果良好,尤其针对胃癌的筛查经济效果较好。     

Fungal esophagitis

The gastrointestinal mucosa is one of the principal portal of entry in systemic fungal infections. Esophagitis is the most frequent among the fungal infections of the gastrointestinal tract. The etiologic factors of fungal infections are various Candida species, most frequently Candida albicans. Due to the large number of asymptomatic patients, great attention should be paid to the predisposing factors (AIDS, cancer, antibiotic or steroid therapy). The diagnosis is based on the endoscopic picture, microscopic examination and culture of the mucosal brushings, and histological examination of the esophageal mucosa. The treatment is based on azol derivates, mainly fluconazole. In fluconazole resistant cases amphotericin B is the drug of choice. The rare complications are perforation, bleeding and stricture.     

The causes of dysphagia in carcinoma of the lung

Dysphagia occurs in only a small percentage of patients with lung cancer, but the frequency of this cancer means that large numbers are affected. Non-quantitative analysis of a large Scottish series of lung cancer cases indicates the following eight broad categories of dysphagia according to underlying mechanisms: mediastinal disease; cervical lymphadenopathy; brainstem lesions; gastrointestinal tract metastases; associated systemic disorders; second primaries; oropharyngeal and oesophageal infections; and radiation-induced oesophageal toxicity.     

Salt preference and the risk of gastrointestinal cancers

The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case‐control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0–1.8) and 1.2 (0.8–1.7) for stomach, 1.0 (0.8–1.3) and 1.1 (0.8–1.5) for colon, and 1.2 (0.9–1.6) and 0.9 (0.6–1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.     

多层螺旋CT在消化道肿瘤诊断中的临床应用

目的：探讨多层螺旋CT在胃肠道肿瘤诊断中的价值。方法：通过对48例胃肠道肿瘤患者的多层螺旋CT轴位图像和重建的3D、MIP及仿真内镜图像进行观察分析,分别对胃肠道肿瘤进行诊断。结果：（1）肿瘤部位及组织学类型：直肠癌14例,结肠癌21例,胃癌13例;中低分化腺癌41例,黏液腺癌4例,类癌3例。（2）CT表现：胃壁及肠壁增厚35例、胃腔及肠腔内肿块23例、肠腔变窄伴不同程度梗阻26例、浆膜面模糊35例、淋巴结转移24例、远处器官转移11例、腹水8例。结论：多层螺旋CT在胃肠道肿瘤的诊断中,具有一定的优越性。     

Salt preference and the risk of gastrointestinal cancers

The relationship between the consumption of salt and the risk of gastrointestinal cancer was examined using data from a case-control study conducted in northern Italy. The study was conducted on 526 incident cases of gastric cancer, 621 of colon cancers, 382 of rectal cancers, and 1,223 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Compared with those for people with low salt intakes, the relative risks (and 95% confidence intervals) for those with intermediate and high salt intakes were 1.3 (1.0-1.8) and 1.2 (0.8-1.7) for stomach, 1.0 (0.8-1.3) and 1.1 (0.8-1.5) for colon, and 1.2 (0.9-1.6) and 0.9 (0.6-1.3) for rectum. None of the trends in risk were statistically significant, and the risk estimates were not materially modified by allowance for major identified potential confounding factors. Thus, this study gives little support to the existence of any strong association between salt intake and gastrointestinal cancers. However, in view of the results obtained and of the uncertainties of salt intake measurement, the possibility exists of a real, although moderate, association of salt intake with gastric cancer.     

系统性红斑狼疮并发胃肠血管炎44例临床回顾性分析

[目的]探讨系统性红斑狼疮合并消化道损害的临床特征。[方法]回顾性分析249例SLE合并消化道损害的44例患者,收集整理其临床资料、血清学及影像资料,分析其临床特点、生存危险因素。[结果]胃肠道受累并发血管炎者44例(17.6%)。[结论]SLE是一多系统受累性疾病,可累及消化系统发生胃肠血管炎,其发生率高,误诊率高,死亡率高,容易误诊误治。临床应引起高度重视。     

Three decades of roentgen-diagnosis of the upper digestive tract in the light of modern endoscopy]

The author commemorating professor Géza Hetényi, discusses the relation of endoscopy and x-ray diagnostic. He observes that the spreading of recent fibre optical endoscopes did not solve the problem of the early gastric cancer diagnosis. The experiences of the author based on his practice for several decades, data from the literature and, especially, the Japanese results show that x-ray did not lose its position but rather strengthened it in the diagnostics of the upper gastrointestinal tract. For examinations at identical levels, both diagnostic methods have equal opportunities to reveal gastric cancer at an early stage. In accordance with the type variety of early gastric cancer, the author discusses the relationship between early gastric cancer and gastric ulcer, and he proposes a rational algorithm for its diagnosis and follow-up. He shows that the most effective method for the diagnosis of the upper gastrointestinal tract is a reasonable combination of all available methods, and "primus inter pares" of them is x-ray examination, in addition to endoscopy.     

胃管负压引流在上消化道出血47例中的应用与护理

目的：探讨胃管负压引流在上消化道出血中的应用效果与护理要点。方法：选取本院2011年3月-2014年1月47例上消化道出血患者配合使用胃管负压引流治疗,对其临床资料进行回顾性分析。结果：47例上消化道出血患者保守治疗治愈41例,1例胃溃疡出血患者拔除胃管后行胃镜检查时再次出血行急诊手术治疗,2例肝硬化胃食管静脉曲张破裂出血患者保守治疗无效行手术治疗,2例转上级医院,1例肝癌并上消化道大出血患者死亡。结论：上消化道出血患者配合使用胃管负压引流治疗、实施精心护理具有缩短止血时间,提高止血效果,减少胃肠反应,利于胃腔给药,随时观察出血量,明确病情等优点。     

急诊胃镜在不同年龄段上消化道出血患者中的诊治意义

目的分析急诊胃镜在不同年龄段上消化道出血患者中的诊治意义。方法选择2017年9月至2019年8月我院收治的100例上消化道出血患者,均行胃镜检查。记录胃镜诊断病因结果,分析不同年龄段患者的病因分布差异,并对比急诊胃镜治疗与非急诊胃镜治疗患者的恢复情况。结果经胃镜分析病因显示消化性溃疡52例,急性胃黏膜病变19例,肝硬化食管胃底静脉曲张破裂出血14例,消化道肿瘤9例,其他6例,确诊率为100.00%。中青年组与老年组的消化性溃疡、消化道肿瘤病因分布比较有统计学差异(P<0.05)。100例患者经胃镜下治疗,均治疗成功。急诊胃镜患者的止血时间、住院时间短于非急诊胃镜患者(P<0.05)。结论中青年与老年上消化道出血病因分布有一定差异,可通过胃镜明确病因并进行急诊胃镜下治疗,快速止血。     

临床护理路径对结肠癌术后造口患者焦虑情绪及胃肠功能恢复的影响

目的探讨临床护理路径对结肠癌术后造口患者焦虑情绪及胃肠功能恢复的影响。方法 78例结肠癌术后造口患者随机分为两组各39例,对照组给予常规护理,观察组给予临床护理路径,比较两组的焦虑自评量表(SAS)评分及胃肠功能恢复情况。结果观察组护理后的SAS评分显著低于对照组(P<0.05)。观察组的初次排气时间、首次进食时间、首次肠鸣音恢复时间均显著短于对照组(P<0.05)。结论临床护理路径可缓解结肠癌术后造口患者的焦虑情绪,利于胃肠功能的恢复。     

胶囊内镜适应症的初步探讨

【目的】评价胶囊内镜对不同症状和消化道不同部位的临床诊断价值。【方法】于2010年8月-2011年8月期间,对53例患者进行了胶囊内镜检查。将受检者分为不明原因的消化道出血、疑为功能性胃肠病、腹痛腹泻腹胀、便秘、体检等共5组。【结果】1例因吞服胶囊后无图像信号,1例因个人原因吞咽胶囊失败,其余51例均顺利到达结肠,胶囊内镜小肠病变总的诊断率为92.15%(47/51);空肠及回肠阳性诊断率为52.94%【结论】胶囊内镜是一种非侵入性的检查手段,检查安全,顺应性好,诊断价值也较高。