生物胶黏堵法在腹腔镜消化性溃疡穿孔修补术中可以应用

目的对用腹腔镜生物胶黏堵法治疗消化性溃疡穿孔的手术方法和疗效进行探讨。方法对承德医学院附属医院1998年2月至2006年4月，应用腹腔镜生物胶黏堵法治疗32例胃十二指肠溃疡穿孔病例资料进行回顾性分析。结果31例成功，1例失败，术后2d再次穿孔，行开腹修补术。2例出现膈下感染，综合治疗痊愈。结论用腹腔镜黏堵法治疗胃十二指肠溃疡穿孔操作简单，疗效满意。     

腹腔镜下治疗胃十二指肠疾病42例临床分析

目的探讨腹腔镜下手术治疗胃十二：指肠疾病的临床价值、手术方法、适应证及优缺点。方法腹腔镜手术组为胃十二指肠疾病患者42例，其中胃壁良性肿瘤切除术14例、胃十二指肠溃疡穿孔修补术11例、胃大部切除术10例、高选择性迷走神经切断术7例，应用腹腔镜技术行手术治疗。对照组为不经过腹腔镜进行同类型手术治疗的患者，每种类型手术患者10例。统计手术时间、住院时间、术中出血量和并发症。结果腹腔镜手术组肿瘤切除、穿孔修补、胃大部切除和迷走神经切断术的手术时间、术中出血量、住院时间和并发症等指标，均显著优于同类型手术的对照组。结论腹腔镜下治疗胃十二指肠疾病具有创伤小、手术时间短、术后恢复快及术后并发症少的特点。胃壁良性肿瘤切除、胃十二指肠溃疡穿孔修补、胃大部切除、高选迷走神经切断均是腹腔镜手术治疗的适应证。     

应用新型缝合器经腹腔镜行溃疡穿孔修补术

1995年3月。我们应用一种新型缝合器为6例消化性溃疡穿孔病人进行了囊腔镜穿孔修补术，初步经验表明，这是一种适用、易掌握和操作的器械。可显著地缩短手术时间。     

腹腔镜溃疡穿孔修补术的临床研究（摘要）

从1995年5月～1996年4月,行腹腔镜溃疡穿孔修补术10例,与同期开腹溃疡穿孔修补术14例作对照研究,两组均为十二指肠球部溃疡穿孔,在年龄、性别、穿孔至手术时间、穿孔大小方面均相似,具有可比性,手术方法特点:只需腹腔镜胆囊切除术的基本操作器械,采用非缝合修补方法,粘合材料为广州医用胶总公司生产的工厂医用粘涂胶,持续硬膜外麻醉或气管内插管全麻,只需2个创口(5例)或3个创口(5例),手术过程顺利,术中生命征稳定,出血很少,手术全部成功,无发生十二指肠漏,切口均一     

326例上消化道溃疡穿孔诊治体会

目的探讨胃十二指肠溃疡穿孔的特征和治疗方法。方法回顾本院1995-2009年收治的胃十二指肠溃疡穿孔患者病例资料,对年龄、发病至就诊时间、治疗等进行分析。结果共收治胃十二指肠溃疡穿孔患者共326人。有240例可见不同程度的隔下游离气体,其中25例经胃管注气后再行腹部立卧位X线检查发现隔下游离气体,阳性率为81.29%。消化性溃疡患者中,35岁以下所占比重逐渐下降,而55岁以上患者的比率逐渐增加,老年性患者使用非甾体类消炎药的比率随时间的推移逐渐增加。269例行单纯穿孔缝合术,18例行胃大部分切除术,穿孔缝合＋高选迷走神经切断6例,保守治疗33例。结论根据病史、体征和积极的腹部X线一般可诊断。消化性溃疡的患者中,老年人的比率呈现逐渐增高的趋势,可能与老年性患者非甾体类消炎药使用机率的增加有关。上消化道溃疡穿孔行单纯缝合修补操作简单、安全、并发症少,术后结合正规内科治疗,效果满意。     

腹腔镜下医用生物蛋白胶粘堵治疗上消化道溃疡穿孔18例报告

目的：探讨腹腔镜下医用生物蛋白胶（biomedical fibrin sealant,BFS）粘堵胃、十二指肠球部溃疡穿孔的应用价值。方法：腹腔镜下手术治疗上消化道溃疡穿孔18例。先将明胶海绵填塞入穿孔处,再在其表面和周围浆膜面喷洒医用生物蛋白胶1.5～2.0 mL。结果：18例均痊愈出院。手术时间30～90 min,平均45 min,术后住院4～8 d,平均5.5 d。结论：腹腔镜下应用医用生物蛋白胶粘堵治疗胃、十二指肠球部溃疡穿孔方法,具有疗效可靠,痛苦小、恢复快、并发症少、住院时间短和操作简便等优点,值得推广使用。     

150例胃十二指肠溃疡急性穿孔手术的临床疗效——单纯修补和胃大部切除对比分析

目的 分析比较单纯修补和胃大部切除手术治疗胃十二指肠急性穿孔的效果。方法 对东莞市石碣人民医院近10年来收治的150例胃十二指肠溃疡穿孔中采用单纯修补术（90例）和胃大部切除术（60例）患者的临床资料进行比较分析。结果 两组均无死亡病例。临床治愈率100％，平均随访4年4个月．获得随访的138例患者中，接受穿孔修补术83例，效果优良67例，效果优良率为80．7％。胃大部切除手术55例，效果优良44例，效果优良率80．0％。结论 在术后辅以正规内科治疗的情况下，穿孔修补术与大部切除术的远期疗效无显著性差别，排除梗阻、出血、疑有恶变等情况后，穿孔修补术可作为治疗溃疡穿孔的首选手术。     

膜解剖在腹腔镜腹股沟疝修补术中的特点及临床应用

目的探讨腹腔镜腹股沟疝修补术的膜解剖特点及临床应用。方法对我院47例腹股沟疝患者行腹腔镜腹股沟疝修补术时观察前腹壁的解剖及术后对手术视频分析,描述手术径路及解剖层次。结果腹腔镜腹股沟疝修补术在腹横筋膜及腹膜前筋膜之间操作,可解剖分离出无血管的平面,手术出血最少。壁平面与脏平面相互之间贯通需离断腹膜前筋膜。结论膜解剖指引下的腹腔镜腹股沟疝修补术可让手术更加精细,减少手术并发症的发生。     

老年消化性溃疡病穿孔的特征及其治疗体会

消化性溃疡主要指胃、十二指肠溃疡，是一种常见病。据统计，全国约有10％的人患过此病，其中消化性溃疡穿孔是其常见并非常严重的并发症，尤其老年患者消化性溃疡病穿孔的诊断及治疗有其自身的特点。我院自1998年7月至2003年7月间，共收治老年溃疡病穿孔患者（年龄〉60岁）29例，现就老年患者溃疡穿孔的特征及其治疗体会报告如下。     

腹腔镜支持手术与开腹手术治疗上消化道穿孔的并发症发生及预后对比

目的:比较腹腔镜支持手术与开腹手术治疗上消化道穿孔的疗效及安全性差异。方法:根据治疗方式的不同将2012年3月至2017年3月收治的50例上消化道穿孔患者分为两组(n=25),观察组在腹腔镜下行消化道穿孔修补术,对照组开腹后行消化道穿孔修补术,对比两组的手术效果及术后1w的并发症发生情况。结果:观察组患者的手术时间、术后排气时间、术后下地时间、住院时间均显著短于对照组(P0.05),术中出血量显著少于对照组(P0.05)。观察组术后的并发症总发生率为8.00%,显著低于对照组(24.00%,P0.05)。观察组患者术后1、2、3d疼痛评分均显著低于对照组(P0.05)。结论:与开腹手术相比,腹腔镜手术治疗上消化道穿孔的术后并发症更少、疼痛更轻、恢复更快,患者的预后更好。     

A randomized trial of nonoperative treatment for perforated peptic ulcer

To determine whether surgery could be avoided in some patients with perforated peptic ulcer, we conducted a prospective randomized trial comparing the outcome of nonoperative treatment with that of emergency surgery in patients with a clinical diagnosis of perforated peptic ulcer. Of the 83 patients entered in the study over a 13-month period, 40 were randomly assigned to conservative treatment, which consisted of resuscitation with intravenous fluids, institution of nasogastric suction, and intravenous administration of antibiotics (cefuroxime, ampicillin, and metronidazole) and ranitidine. Eleven of these patients (28 percent) had no clinical improvement after 12 hours and required an operation. Two of the 11 had a perforated gastric carcinoma, and 1 had a perforated sigmoid carcinoma. The other 43 patients were assigned to immediate laparotomy and repair of the perforation. One of these patients was found to have a perforated gastric carcinoma. The overall mortality rates in the two groups were similar (two deaths in each, 5 percent), and did not differ significantly in the morbidity (infection, cardiac failure, or renal failure) rates (40 percent in the surgical group and 50 percent in the nonsurgical group). The hospital stay was 35 percent longer in the group treated conservatively. Patients over 70 years old were less likely to respond to conservative treatment than younger patients (P less than 0.05). We conclude that in patients with perforated peptic ulcer, an initial period of nonoperative treatment with careful observation may be safely allowed except in patients over 70 years old, and that the use of such an observation period can obviate the need for emergency surgery in more than 70 percent of patients.     

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Background

Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.

Objective

To determine the patterns of presentation and mode of management of duodenal ulcer perforations.

Methods

Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients'' records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.

Result

Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15–78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham''s omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities.

Conclusion

Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham''s omentopexy with broad spectrum antibiotics is still commonly practiced.     

PDCA护理模式应用于腹腔镜胃穿孔修补术中的临床效果观察

目的 探讨PDCA护理模式应用于腹腔镜胃穿孔修补术中的效果。方法 选择2015年12月~2017年12月在我院进行腹腔镜胃穿孔修补术的患者40例,分为观察组与对照组各20例。对照组采用常规护理,观察组采用PDCA护理模式进行护理,比较两组住院时间、排气时间及肠鸣音恢复时间、并发症发生情况,并采用VAS疼痛评分评价术后疼痛情况。结果 观察组护理后平均排气、肠鸣音恢复、住院时间及并发症发生率分别为（23.65±1.97）h、（22.18±2.13）h、（6.05±1.43）d、15.00%,均低于对照组的（29.71±2.28）h、（28.65±2.09）h、（8.73±1.82）d、40.00%,差异有统计学意义（P＜0.05）;观察组术后1 d和3 d的VAS评分为（4.97±0.94）分、（3.85±0.72）分均低于对照组（6.83±1.30）分、（5.81±0.86）分,差异有统计学意义（P＜0.05）。结论 行腹腔镜胃穿孔修补术治疗的胃穿孔患者实施PDCA护理模式,能够有效降低痛感,减少围术期不良事件的发生,促进患者康复。     

103例老年消化性溃疡临床特征分析

目的探讨老年消化性溃疡的临床特征。方法回顾性分析231例同期收治的消化性溃疡患者的临床资料,分为老年组（n=103）和中青年组（n=128）,比较两组溃疡诱发因素、临床表现、溃疡部位及大小、并发症及伴随疾病、治疗和预后情况。结果老年组与中青年组中与非甾体类抗炎药（NSAIDS）有关的溃疡分别为21.4%和6.2%,P〈0.01;与家族及精神因素有关的老年组中占7.7%较中青年组的3.1%明显增高,P〈0.01。两组节律性腹痛发生率11.7%与26.6%（P〈0.01）;老年组中有54.4%溃疡发生于胃,而中青年组有28.9%,P〈0.01。溃疡发生于十二指肠者老年组中有36例（35.0%）,中青年组有83例（64.8%）,P〈0.01。老年组中溃疡直径小于或等于1 cm的比例（33.0%）较中青年组（60.1%）明显降低（P〈0.01）。老年组中溃疡直径大于2 cm的比例（22.3%）较中青年组（14.1%）明显升高（P〈0.01）。老年组出血、癌变、穿孔、梗阻的发生率较中青年组明显增高。老年组死亡率和复发率均高于中青年组。结论老年消化性溃疡临床表现不典型,胃溃疡较多,并发症多发,复发率和死亡率高,因此,临床上应引起高度重视。     

Hereditary aspects of duodenal ulceration: pepsin 1 secretion in relation to ABO blood groups and ABH secretor status.

Pepsin 1, the ulcer-associated pepsin, occurred significantly more frequently in the gastric juice of those patients with duodenal ulcer who did not secrete A, B, or H antigens into gastric juice than in those secreting these antigens. This observation may explain the increased proportion of such non-secretors among patients with duodenal ulceration. In patients with gastric ulcer and non-ulcer dyspepsia, and in a miscellaneous group of patients, there was no association of pepsin 1 secretion with secretor status, suggesting that the association noted in duodenal ulceration is an indirect rather than a direct one. No increase of pepsin 1 occurred in group O patients with peptic ulcer, so that the increased proportion of such patients in peptic ulcer does not arise from differences in pepsin 1 secretion.     

幽门螺杆菌感染对消化性溃疡患者胃肠动力及胃肠激素的影响

为探讨幽门螺杆菌（Hp)感染对消化性溃疡患者胃肠动力及胃肠激素的影响，对85例消化性溃疡患者进行了胃肠测压和血浆胃动素（MTL）及血浆生长抑素（SS）的测定，结果显示消化性溃疡患者与正常对照组相比消化间期胃肠动力明显减低，主要表现为消化间期移行性复合运动（MMC）Ⅲ期缺失和收缩波振幅减低，血中SS水平也明显低于正常对照组；在Hp阳性和Hp阴性的两组之间胃肠动力和SS水平均无显著差异，在血中MTL水平，Hp阳性组明显高于Hp阴性组，也高于正常对照组，结果表明消化性溃疡患者存在胃肠动力障碍和胃肠激素的异常改变。Hp感染对胃肠动力和SS水平无明显影响，但可促进MTL的分泌或释放。     

Collagen diseases with gastrointestinal manifestations]

Collagen vascular diseases are known to present with a diverse array of gastrointestinal manifestations. These can be classified as: 1) gastrointestinal damage due to the collagen vascular disease itself; 2) adverse events caused by pharmacotherapies; or 3) gastrointestinal infections following immunosuppression due to corticosteroid (CS) administration. The first group includes lupus enteritis and protein-losing gastroenteropathy in systemic lupus erythematosus (SLE), reflux esophagitis, chronic intestinal pseudo-obstruction, and pneumatosis cystoids intestinalis in systemic sclerosis, amyloidosis in rheumatoid arthritis, bowel ulcer and bleeding in rheumatoid vasculitis and microscopic polyangiitis, and ileocecal ulcer in Behcet disease. In particular, colonic ulcers associated with SLE represent refractory lesions resistant to CS. Analysis of reported cases showing colonic lesions with SLE (22 cases in Japan) revealed that mean duration of SLE was 9.9 years and 77% of colonic lesions were observed in the rectum and sigmoid colon. Half of the patients developed intestinal perforation or penetration, and 6 of the 11 patients with perforation died. The second group includes lesions in the small and large intestine due to nonsteroidal anti-inflammatory drugs (NSAIDs) and CSs, in addition to peptic ulcers. As perforation in CS-treated patients displays relatively high incidence with poor prognosis, careful attention to such complications is needed. The third group includes candidal esophagitis and cytomegalovirus (CMV) enteritis. Prompt diagnosis is required to prevent colonic bleeding and perforation due to CMV.     

Association of cagA and vacA Genotypes of Helicobacter pylori with Gastric Diseases in Estonia

Gastric biopsy specimens from 156 adult patients from southern Estonia suffering from chronic gastritis, peptic ulcer disease, and perforated peptic ulcer were analyzed by PCR. The cagA gene was evenly distributed throughout 87% of the specimens from the patients with the different gastric diseases. The presence of the cagA gene correlated with that of vacA signal sequence type s1a (99%). However, no clear differences were found in the distribution of cagA and vacA genotypes among patients in Estonia with severe perforated peptic ulcer, uncomplicated peptic ulcer, or chronic gastritis.