内镜注射治疗十二指肠溃疡出血失败的相关因素分析

目的：评价内镜注射治疗十二指肠溃疡出血患者的失败因素,方法：对132例有活动性出血或裸露出管的十二指肠溃疡出血患者进行内镜注射治疗,并从临床和内镜方面分析注射治疗失败的相关因素。结果：内镜注射治疗的有效止血率为83．3％（110／132）,22例（16．7％）,患者注射治疗失败,其中17例患者治疗后继续出血或再出血,5例因出血部位难接近而失败。内镜治疗失败与患者休克表现,低血红蛋白浓度,活动性出血,直径＞2cm溃疡及十二指肠球部后壁溃疡等因素明显相关,结论：这些与治疗失败有关的因素有利于临床上识别对内镜注射治疗效果差的十二指肠溃疡出血患者。     

107例小儿消化道出血胃镜检查结果分析

目的：了解不同年龄组消化道出血的病因和合理的胃镜检查时间。方法：对107例临床疑似上消化道出血的患儿进行纤维胃镜检查。结果：确诊为上消化道出血的79例（十二指肠溃疡61例,胃溃疡7例,食道静脉曲张3例,食管炎1例,贲门粘膜撕裂症3例,十二指肠憩室2例,脑疝2例）,小肠出血6例（3例小肠憩室、2例克隆氏病,1例小肠结核） ,咽血综合症3例,未检查出病因19例。结论：十二指肠球部溃疡、胃溃疡是年龄较大儿童消化道出血最常见的原因,先天性消化道畸形是婴幼儿消化道出血的另一个重要原因,患儿在出血48h内纤维胃镜检查阳性率最高,小儿上消化道出血急症胃镜检查是一种快速、准确、较安全的检查方法。     

Giant duodenal ulcers

Twenty-six giant duodenal ulcers, all correctly diagnosed prior to endoscopy, are presented. The concept of the ulcer/bulb ratio (ratio of longest diameter of the ulcer to that of the total bulb including the ulcer) is introduced. In all cases this ratio was 0.8 or greater; in 18 cases (69%) the ulcer completely replaced the duodenal bulb. An ulcer within an ulcer appearance, representing a small area of deeper ulceration within the giant ulcer, was noted in 8 (31%). Half of the patients have remained symptom-free on medical therapy alone. Only two patients in our series (8%) died of complications of giant duodenal ulcer.     

上消化道溃疡伴出血患者危险因素分析

目的：探讨上消化道溃疡伴出血患者的危险因素。方法：回顾性分析我院2008年1月-2012年1月确诊为胃十二指肠溃疡患者300例的临床资料,其中出现上消化道出血80例,不伴上消化道溃疡出血220例。结果：溃疡患者出血的危险因素包括性别、年龄、使用乙酰水杨酸类药物、使用非甾体类消炎药、冠心病。结论：冠心病、高龄、男性、乙酰水杨酸或非甾体类消炎药的使用是导致上消化道溃疡出血的主要危险因素,尤其是乙酰水杨酸类药物的使用可加大上消化道溃疡出血的风险。     

Base line tenting: A sign of duodenal ulcer disease

Indirect signs such as clover-leaf deformity, pseudodiverticulum formation, eccentric location of pyloric channel, and flattening of the fornix are of considerable value in the radiologic detection of an ulcer crater. We have found another indirect sign, base line tenting (BLT) to be very useful in the detection and diagnosis of duodenal ulcer disease. This is characterized by interruption of the base line of the bulb, with 2 associated perpendicular lines extending from the base and converging to a point in the duodenal bulb. After we observed this sign in various patients with peptic ulcer disease, a prospective investigation was performed involving 62 patients with duodenal ulcer disease over a period of 2 years. We found the BLT sign in 52 (83.8%). To date, no false-positive incidence has been identified. We concluded that BLT is a most valuable sign in the radiologic identification of duodenal ulcer disease.     

Simple hemostatic procedure for hemorrhagic duodenal ulcer: two cases of arterial hemorrhage quickly controlled by balloon compression

We utilized balloon compression in two cases of arterial hemorrhage from duodenal ulcers. The bleeding was quickly controlled in both cases. The advantages of this technique are its simplicity and ease of performance, and the fact that it does not require precise identification of the bleeding point in the duodenal bulb. No serious complications, such as perforation or stenosis, are associated with this technique. During the healing of the ulcer, balloon expansion may result in decreased duodenal bulb deformity. The following points, however, should be clarified in future studies: a) the stability of the duodenal bulb after longer-term balloon compression, and b) the optimum amount of cold water to be injected into the balloon and the optimum compression time.     

幽门螺杆菌多部位检测与临床及组织学表现的关系

目的 观察幽门螺杆菌（Hp）与胃及十二指肠粘膜病理组织学表现之间的关系。方法 对60例慢性胃炎和22例十二指肠溃疡患者经胃镜分别从胃窦、胃体、十二肠球部取活检,进行组织学检测。结果 在活动性胃炎中无论是胃窦部或胃体部Hp检出率近100％,显著地活动性十二指肠球炎的球部Hp的检出率,胃窦部Hp总检出率及活动性上的发生率均显著高于胃体部及十二指肠球部。22例十二指肠球部溃疡Hp在球部的检出率为54％,显著低于其在胃窦部组织中Hp100％的检出率。结论 Hp感染是胃粘膜活动性炎症的重要原因,并以此为基础发展为重度粘膜炎及溃疡病,因此,对某些慢性胃炎患者应及早进行Hp根除治疗。     

腹腔镜治疗十二指肠球部溃疡穿孔的临床应用

目的评价腹腔镜下修补治疗十二指肠球部溃疡穿孔的临床应用价值。方法对南昌市中西医结合医院2003年1月-2008年4月收治的142例十二指肠球部溃疡穿孔病例随机分组,腹腔镜手术组84例接受腹腔镜下修补治疗,开腹手术组58例接受传统开腹修补。结果2组术后胃肠功能恢复情况、平均住院时间差异均有显著性（P〈0．05）,2组术后均无出血、腹腔感染、再穿孔等并发症。结论腹腔镜下修补治疗十二指肠球部溃疡穿孔临床安全可行,应该作为首选方法在临床上推广应用。     

Evaluation of the quality of curation of patients with peptic ulcer in an outpatient department

The data of a five-year observation of 126 outpatients with peptic ulcer were analyzed. A hundred patients had been observed by a gastroenterologist, and 26 had been observed by a general practitioner. The study found that the economic effect of the observation of this category of patients by a gastroenterologist vs. a general practitioner was 16 days of temporary inability to work in cases of gastric ulcer, and 73 days in cases of duodenal ulcer.     

十二指肠球部充盈缺损影像分析(附12例报告并文献复习)

目的：讨论十二指肠球部充盈缺损的诊断和鉴别诊断。方法：共１２例患者，均进行钡餐造影检查，其中６例进行ＣＴ检查。结果：分别对１２例球部充盈缺损的影像表现进行分析。其中包括球部异物２例；淋巴瘤２例；腺瘤４例；低分化腺癌、类癌、胃窦癌脱入球部、胃息肉脱入球部各１例。钡餐造影显示了１２个病变；ＣＴ检查的６例中，显示５个病变，其中１个漏诊因病变小于１０ｍｍ。结论：十二指肠球部充盈缺损少见，钡餐造影对发现球部病变的大小、形态及腔内结构有重要作用，ＣＴ在病灶的性质病灶周围情况，腔内外侵犯的程度及远处转移方面起着重要的辅助价值     

内镜下综合治疗十二指肠球部溃疡出血65例疗效分析

目的探讨经内镜下综合治疗十二指肠球部溃疡出血的临床价值。方法对2005年1月至2008年7月共65例经内镜综合治疗的十二指肠球部溃疡出血患者的临床资料进行回顾性分析。结果65例患者止血成功57例，初次治疗成功率为87．6％。再出血8例，再次内镜下止血4例成功，4例治疗无效转外科手术治疗，总有效率为95．3％。结论内镜下综合治疗十二指肠球部溃疡出血是一种安全、有效的方法，应该作为首选方法在临床上推广应用。     

Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS: Excessive blood covering the examination field is a frequent cause of diagnostic failure in emergency endoscopy for acute upper gastrointestinal bleeding. The implications and outcome in these patients have not been well described. PATIENTS AND METHODS: The records for 1459 consecutive patients who presented at our medical center with acute nonvariceal upper gastrointestinal bleeding during a 15-month period were reviewed. All of the patients underwent emergency endoscopy within 24 h of initial presentation. Patients in whom an identifiable bleeding source was not found in spite of an overtly bloody lumen were designated as having a failure of diagnosis, and these cases were analyzed further. RESULTS: Diagnosis failed in 25 patients (1.7 %), 16 of whom underwent repeat endoscopy or surgical intervention. Bleeding vessels were identified in 13 of these patients. Gastric and duodenal ulcers were the most commonly overlooked lesions, with locations in the cardia (n = 3), fundus (n = 2), posterior wall of the antrum (n = 1), duodenal bulb (n = 3), second part of the duodenum (n = 2), and in the stoma of a Billroth II gastrectomy (n = 2). The rates for endoscopic complications, recurrent bleeding, surgery, and mortality were significantly higher in the group with diagnostic failure than in patients with acute upper gastrointestinal bleeding in whom diagnosis did not fail (8 % vs. 0.4 %; 20 % vs. 3.1 %; 16 % vs. 2.9 %; and 20 % vs. 3.6 %, respectively). CONCLUSIONS: In acute nonvariceal upper gastrointestinal bleeding, diagnostic failure is associated with higher morbidity and mortality. The data from this study emphasize the importance of good preparation before the procedure and adequate removal of blood during emergency endoscopy procedures.     

Mesenteric venous infarction presenting as an upper GI bleeding and diagnosed by upper GI endoscopy

A case of primary mesenteric vein thrombosis with extensive small bowel infarct beginning at the ligament of Treitz presented as upper gastrointestinal bleeding. Although endoscopy of the upper GI tract disclosed erosive gastritis this finding was considered insufficient to explain the hematemesis; therefore the endoscope was advanced further until a necrotic and aperistaltic-looking mucosa was found in the area of the ligament of Treitz. This paper describes the endoscopic picture of necrotic duodenal mucosa, and stresses the importance of a deeper examination into the duodenum when a clear-cut cause for the bleeding is not found in the stomach or duodenal bulb.     

电子胃肠镜在小儿消化道出血中的临床应用

目的回顾性分析进行内镜检查的14岁以下儿童消化道出血的发病年龄、出血原因和出血部位,进一步研究不同原因的消化道出血对外周血红细胞(RBC)、血红蛋白(Hb)和红细胞压积(HCT)的影响。方法选择2012年1月-2018年9月该院消化科因消化道出血住院的123例患儿,对发病年龄、临床表现、出血病因、出血部位以及RBC、Hb和HCT进行归纳总结。结果儿童消化道出血多见于学龄前期儿童,平均发病年龄(4.55±3.90)岁,临床以呕血73例、便血50例、腹痛17例为主要表现,上消化道出血105例,下消化道出血18例。上消化道出血原因为胃溃疡28例、出血性或糜烂性胃炎27例和十二指肠球部溃疡19例等,出血部位于胃体43处、胃窦39处和十二指肠球部16处等。下消化道出血原因为Meckel憩室7例、直肠结肠炎5例、肠息肉4例,出血部位于小肠处7例、直肠处7例和乙状结肠处6例。十二指肠球部溃疡、Meckel憩室、食道胃底静脉曲张导致的消化道出血,其RBC、Hb和HCT影响较大(P 0.05)。结论儿童上消化道出血发病率明显高于下消化道出血;上消化道出血原因以胃溃疡、出血性或糜烂性胃炎、十二指肠球部溃疡最为常见,出血部位以胃体、胃窦、十二指肠球部最常见。下消化道出血原因以Meckel憩室、直肠结肠炎、结肠息肉最为常见,出血部位以小肠、直肠、乙状结肠最常见,而十二指肠球部溃疡、Meckel憩室、食道胃底静脉曲张导致消化道出血对患儿临床危害较大,风险较高。     

霜斑样病变与胃上皮化生及Hp感染关系的研究

目的 :了解霜斑样病变与幽门螺杆菌感染及十二指肠溃疡的关系。方法 :比较胃镜下十二指肠溃疡、霜斑样病变、十二指肠炎、正常球粘膜的炎症、胃化生程度及其胃窦幽门螺杆菌密度 ;把接受胃镜复查的霜斑样病变随机分为抗幽门螺杆菌治疗与抑酸治疗两组 ,观察治疗结果。结果 :十二指肠球部不同病变的组织学炎症程度各不相同 (P <0 0 5 ) ,以霜斑样病变最重 ;胃化生程度及胃窦Hp密度均以十二指肠溃疡与霜斑样病变为高 ,但后二者间无显著差别 (P >0 0 5 ) ;4 2例霜斑样病变患者中 4周治疗后内镜复查 2 6例 ,抗Hp治疗组 1 2例均恢复正常 ,单纯抑酸治疗组 1 4例仍有 5例霜斑样病变且 1例伴发溃疡 (P <0 0 4 2 5 )。结论 :幽门螺杆菌感染的重度活动性十二指肠炎是十二指肠溃疡的病理基础 ,霜斑样病变可能是十二指肠溃疡的前驱病变     

Bleeding duodenal ulcer after gastric bypass procedure for obesity

A patient without previous history of peptic ulcer disease had gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity. The use of the technetium-labeled red blood cell scan helped localize the source of bleeding in this patient after routine endoscopy and barium studies failed to show any abnormality of the upper and lower gastrointestinal tracts. The patient has done well after subtotal gastrectomy for treatment of this disorder.     

Primary adenocarcinoma of the duodenal bulb: Radiographic and pathologic findings in two cases

We reviewed the radiographic and pathologic findings in 2 patients with primary adenocarcinoma of the duodenal bulb. Barium studies provided important information, characterizing the nature and extent of the lesion, as well as complete evaluation of the descending and horizontal segments of the duodenum before surgical therapy. Early endoscopy is recommended for nonhealing duodenal ulcers, especially if suggestive malignant changes are present.     

3042例上消化道出血患者病因分析及护理对策

目的 探讨3042例上消化道出血患者的病因,并提出护理对策.方法 回顾性分析本院1991年3月～2009年3月3042例上消化道出血住院患者的病因,并提出对策.结果 消化性溃疡出血为上消化道出血的主要病因,占46.96％,其中十二指肠溃疡呈下降趋势;急性胃黏膜病变为上消化道出血的第2病因,占28.76％,呈上升趋势;年龄＜60岁组患者十二指肠溃疡是上消化道出血的主要病因(占44.35％),年龄≥60岁组患者急性胃黏膜病变为上消化道出血的主要病因(41.21％).结论 消化性溃疡出血与急性胃黏膜病是上消化道出血的主要病因,其中十二指肠溃疡呈下降趋势,其也是年龄＜ 60岁组患者的主要病因;急性胃黏膜病变呈上升趋势,其也是年龄≥60岁患者的主要病因.在护理工作中,应针对不同年龄患者病因与疾病谱变化情况,开展针对性的健康教育,促进患者行为改变,从而达到防病、治病的目的.     

How can we maximize skills for non-variceal upper gastrointestinal bleeding: injection, clipping, burning, or others?

Endoscopy has its role in the primary diagnosis and management of acute non-variceal upper gastrointestinal bleeding. Main roles of endoscopy are identifying high risk stigmata lesion, and performing endoscopic hemostasis to lower the rebleeding and mortality risks. Early endoscopy within the first 24 hours enables risk classification according to clinical and endoscopic criteria, which guide safe and prompt discharge of low risk patients, and improve outcomes of high risk patients. Techniques including injection therapy, ablative therapy and mechanical therapy have been studied over the recent decades. Combined treatment is more effective than injection treatment, and single treatment with mechanical or thermal method is safe and effective in peptic ulcer bleeding. Specific treatment and correct decisions are needed in various situations depending on the site, location, specific characteristics of lesion and patient's clinical conditions.     

79例老年上消化道出血临床分析

目的 :探讨老年上消化道出血的原因和不同制酸剂对出血的治疗效果。方法 :对我院 1998年 1月至2 0 0 4年 6月共 79例老年上消化道出血患者的临床资料进行回顾性分析。男 4 5例 ,女 34例 ,年龄 6 0～ 85岁 ,平均 6 7 6岁 ,患者被随机分为两组分别接受洛赛克和法莫替丁治疗。统计治疗 3天的总有效率和引起出血的原发疾病百分比。结果 :引起出血的原发疾病中 ,胃、十二指肠溃疡 30例 (38 0 %) ,胃黏膜病变 2 8例 (35 4 %) ,门静脉高压症并发食管静脉曲张破裂出血 14例 (17 7%) ,上消化道肿瘤 5例 (6 3%) ,其他 2例 (2 5 %)。洛赛克组总有效率 95 2 %,法莫替丁组总有效率 78 4 %(P <0 0 5 )。结论 :老年上消化道出血主要由胃、十二指肠溃疡和胃黏膜病变引起。质子泵抑制剂洛赛克治疗老年上消化道出血疗效显著。