正常人及胃、十二指肠溃疡病人的一小时基础胃液

<正> 虽然目前已比较普遍使用纤维胃镜早期诊断胃、十二指肠疾病,但测定胃液分泌功能特别是游离酸排出量仍然是必要的常规检查方法之一。胃游离酸的排出量与壁细胞数及其分泌功能状态有关。壁细胞分泌受神经及体液因素的支配。在安静状态下仅有部分壁细胞进行分泌活动,基础胃液就是测定在安静状态下受试者一小时胃液分泌量及游离酸排出量(以下简     

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.     

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。     

保留交感神经的壁细胞迷走神经切断术

提要自1991年10月以来,我们采用了保留交感神经的壁细胞迷走神经切断术(PCV-AP)治疗十二指肠溃疡,临床结果表明,PCV-AP针对性切断了支配壁细胞区域的迷走神经,同时保留了交感神经的支配,减少了对机体的损伤,其降酸作用与PCV手术相比更为显著,手术近期效果良好。术后2～3周胃镜复查溃疡基本愈合;胃酸分泌试验结果,平均BAO下降77.9％,PMPO下降56.3％,IMAOi及IMAO_2分别下降80.4％和71.4％。但是,PCV-AP手术操作比PCV更为精细。本文主要介绍了PCV-AP的手术方法和初步治疗结果。     

HP相关性溃疡病胃酸分泌功能的研究

目的：探讨幽门螺旋杆菌（HP）感染对溃疡病胃酸分泌功能的影响。方法：对19例HP阳性的溃疡病患者于治疗前后进行了胃镜、HP、空腹血清鲁泌素（GAS）及五肽胃泌素胃液分析。并与10例HP阴性溃疡病的结果对比。结果：HP相关性溃疡HP清除前空腹血清GAS，基础胃酸分泌量（BAO）、最大胃酸分泌量（MAO）、高峰胃酸分泌量（PAO）均明显提高，清除HP后均明显降低。而HP阴性溃疡组GAS治疗前后无明显差异，BAO、MAO及PAO治疗前虽亦高于正常，治疗后亦有降低，但均无HP阳性组显著，有统计学意义。提示HP感染可使GAS及胃酸分泌增加，可能是HP相关性溃疡的重要病因之一。     

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     

Changes in gastric mucosa after vagotomy and gastrojejunostomy for duodenal ulcer

Gastric mucosa was studied histologically in 141 patients. Eighty two had undergone vagotomy and gastrojejunostomy between 15 and 25 years previously for duodenal ulcer, and 59 control patients had a long history (minimum 15 years) of duodenal ulcer treated medically. No carcinoma was found in either group. Two patients with severe dysplasia and 13 patients with moderate dysplasia were found in the study group, compared with none in the control group (p less than 0.01). Intestinal metaplasia was seen in 44 (53%) of the study group and 16 (27%) of the control group (p less than 0.01). Atrophy and gastritis were more severe (p less than 0.01 for atrophy; p = 0.05 for gastritis) in the study group. Gastric mucosal changes were more severe after surgical treatment for duodenal ulcer than after medical treatment, and possibly a high incidence of gastric carcinoma may occur 25 years after vagotomy and gastrojejunostomy.     

Comparative study on highly selective vagotomy and its combination with mucosal antrectomy in treatment of duodenal ulcer

Inthetreatmentofduodenalulcer,highlyselec-tivevagotomy(HSV)hasgoodclinicaleffects[1,.2]withlowfrequencyofpostoperativecomplicationsandse-quelaesuchasdumpinganddiarrheaｅｔｃ[2,3].However,manysurgeonshavenoticedthatthefataldrawbackofHSVisthehighlong-termrecurrencerateofulcerthataverages2%to10%inthepatients[4,5].InordertodecreasetherecurrencerateofulcerafterHSV,Am-drupｅｔａｌ[6]introducedHSVincombinationwithmucosalantrectomy(HSV-MA).Wefirstappliedthistech-niquetoclinicalpracticein1987.T…     

用高选迷切术治疗急性十二指肠溃疡穿孔

高选择性迷走神经切断术治疗十二指肠溃疡病,比较符合生理,并发症少。本文报道15例急性十二指肠溃疡穿孔行高选迷切术治疗效果满意。术后作胃液分析:BAC:在注射组织胺前为0～24u,注射后为56～70u;MAO_1注射前为1～23u,注射后为70～90u。通过胃镜和GI检查,无1例溃疡复发。     

Endoscopic electrocoagulation of upper gastrointestinal hemorrhage.

Endoscopic electrocoagulation was performed on 40 occasions for 38 patients with bleeding gastrointestinal lesions. Cessation of bleeding was achieved in 95%. Fifteen gastric ulcers, 14 duodenal ulcers, six Mallory-Weiss tears, one gastric varix, one hemorrhagic antral gastritis, and one esophageal ulcer were successfully electrocoagulated. Three duodenal and three gastric ulcers rebled. One duodenal ulcer and one gastric ulcer were successfully reelectrocoagulated. Failure to stop bleeding by electrocoagulation occurred in one Mallory-Weiss tear and one duodenal ulcer. There was no morbidity nor mortality attributed to endoscopic electrocoagulation. A retrospective cost analysis showed that the cost of hospitalization was less in patients treated by electrocoagulation. Patients so treated were hospitalized for a shorter duration.     

慢性浅表性胃炎、消化性溃疡、胃癌与促胃液素的相关性研究

目的研究促胃液素在胃癌及消化性溃疡患者血浆中含量变化及它们之间的相关性。方法内镜及活检确诊的慢性浅表性胃炎（CSG）40例,十二指肠溃疡（DU）40例,胃溃疡（GU）40例,胃癌（GC）40例,用放免法同期进行血中促胃液素水平测定。结果胃癌患者空腹血浆中促胃液素的含量（157.6±50.3）pg/mL,明显高于DU（87.2±19.6）pg/mL,GU（90.3±22.8）pg/mL及CSG（72.3±21.5）pg/mL,组（P〈0.05）。同时也发现促胃液素在DU及GU组的含量亦明显高于CSG组（P〈0.05）。结论促胃液素可能参与了胃癌的发生、发展,并与溃疡的形成相关。     

Gastric acid secretion in Helicobacter pylori positive and negative dyspeptic Nigerians

The pathological role of Helicobacter pylori is largely unproven in our region of high incidence of infection but very low incidence of serious gastroduodenal lesions. The aim of this study was to investigate the effect of H. pylori infection on gastric acid secretion. One week after gastroduodenoscopy, basal and pentagastrin (8 micrograms/kg) stimulated gastric acid secretion were measured in 39 dyspeptic Nigerians. H. pylori status was determined using urease test, culture, histology and serology, while gastritis was assessed using the Sydney system criteria. The median maximal acid output (MAO) and peak acid output (PAO) in mmol/h were significantly higher in H. pylori positive (29.3, range 7.4-81.6 and 34.4, range 7.6-144.0) than in H. pylori negative (16.6, range 4.2-44.1 and 22.4, range 5.6-48.6) patients, p = 0.019 and p = 0.029, respectively. Stimulated gastric acid secretion was significantly higher in patients with duodenal ulcer (n = 8) than in H. pylori negative (n = 11) patients, but was similar in non-ulcer dyspeptics (n = 20) and H. pylori negative patients. The median basal acid output was not significantly different between the groups of patients. Our patients (median age 32 years) had normal mucosa (12.1%), pangastritis with corpus predominance (12.1%), antrum-only gastritis (24.3%) and pangastritis with antral predominance (51.5%). In the subset of H. pylori positive patients (n = 28, 71.8%), there were no significant correlations between grade of antral chronic inflammation, gastritis index score, anti-H. pylori IgG titre and gastric acid secretion, p > 0.05. H. pylori infection increases MAO and PAO in our relatively young patients with antral predominant chronic gastritis.     

老年人消化性溃疡476例临床分析

目的：分析老年人消化性溃疡的临床特点、溃疡大小与部位、溃疡大小与良恶性的关系以及溃疡部位与良恶性的关系。方法：以我院１９８０年１月至１９９６年１２月间经胃镜和手术证实的４７６例６０岁以上消化性溃疡病人为研究对象。结果：老年消化性溃疡６３．０３％的临床症状无明显规律性及节律性，无症状者占６．９３％，以并发症就诊者占１１．７６％，并发症中以消化道出血多见，占４３． ０７％。老年人胃溃疡的患病率高于十二指肠溃疡。小于２ｃｍ的溃疡， ８５． １４％位于十二指肠球部，大于２ｃｍ的溃疡，４７．０６％位于胃体。恶性溃疡主要发生在胃窦及胃体部，尤其是胃窦部及大于２ｃｍ的大溃疡中。结论：老年人消化性溃疡临床症状不典型，小于２ｃｍ的溃疡以球部为多，大与２ｃｍ的溃疡以胃体多见，恶性溃疡以胃体及胃窦多见，大多数直径大于２ｃｍ。     

盐亭县消化性溃疡流行病学特点分析

目的了解四川省盐亭县消化性溃疡的流行病学特点,制定防范措施。方法分析2004年—2011年我院早诊早治科2629例40岁~69岁胃镜检查患者的临床资料。结果在所有被检查患者中检出消化性溃疡2629例,我县消化性溃疡发病率为24.65%,同广东省乐昌市的24.1%接近,介于广州市发病率（32.58%）和哈尔滨市发病率（10.33%）之间。2629例消化性溃疡中十二指肠溃疡2140例,胃溃疡372例,复合性溃疡109例,食管溃疡8例。消化性溃疡患者中,男1892例,女737例。结论①病变好发部位以十二指肠溃疡最多见,胃溃疡次之,食管溃疡最少见。②溃疡发病率男性明显高于女性,与不良生活习惯有关。③十二指肠溃疡以球前壁最多,胃溃疡好发部位以胃窦部最多。     

三联疗法治疗NSAID（非甾体抗炎药）消化性溃疡临床分析

目的探讨奥美拉唑、克拉霉素、阿莫西林三联疗法治疗非甾体类抗炎药（NSAIDs）相关性胃溃疡的临床疗效。方法以该院2010年4月—2011年10月长期应用非甾体抗炎药的80例风湿性疾病患者作为研究对象,所有患者均有不同程度的胃溃疡、十二指肠溃疡、复合性溃疡,将其随机分为实验组和对照组,各40例,实验组采用三联疗法,对照组单一应用奥美拉唑,观察两组疗效。结果实验组有效率为95.0%,对照组有效率为75.0%,实验组有效率明显优于对照组（P〈0.05）,实验组Hp根除率为92.5%,对照组为52.5%,实验组Hp根除率明显优于对照组（P〈0.05）。结论奥美拉唑、克拉霉素、阿莫西林三联疗法治疗NSAIDs相关性消化性溃疡的疗效确切,安全有效,值得在临床工作中推广应用。     

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.     

不同手术方法治疗胃十二指肠溃疡穿孔的疗效比较研究

目的比较分析不同手术方法治疗胃十二指肠溃疡穿孔的疗效,为消化性溃疡穿孑L的治疗方法的选择提供指导依据。方法选择2009年1月一2013年1月来我院进行手术治疗的胃十二指肠溃疡穿孔患者60例作为观察对象,其中30例行单纯缝合修补术,设立为A组,其余行胃大部切除术或高选择性迷走神经切除术＋修补术共30例设立为B组,比较两组患者的手术时间、术中出血量、术后住院时间及并发症发生率、术后随访不同时间其复发率情况。结果A组的手术时间、术中出血量、住院时间均明显短于B组．组间进行t检验显示．差异有统计学意义（P〈0．05）。A组并发症发生率明显少于B组,差异具有统计学意义（P〈0．05）。术后随访3年,其中A组复发率达40％,B组术后复发率达10％,两组复发率比较,差异具有统计学意义,B组复发率明显低于A组（P〈0．05）。结论单纯缝合修补术治疗胃十二指肠溃疡急性穿孔手术时间短、术后并发症少,胃大部切除术术后远期随访溃疡复发率低,两种手术方法各具优缺点,因此,对胃及十二指肠溃疡穿孔患者应根据其实际状况选择手术方式。     

十二指肠溃疡患者胃上皮化生与幽门螺杆菌关系的研究

目的 研究十二指肠溃疡患者胃上皮化生和幽门螺杆菌的关系。方法 收集门诊行上消化道胃镜检查确诊的十二指肠溃疡患者70例，另选胃和十二指肠黏膜正常患者55例为对照组。用快速尿素酶法和幽门活组织检查半定量法检测幽门螺杆菌(Hp)，苏木素一伊红染色和Schiff过碘酸染色半定量法检测十二指肠球部胃上皮化生。结果 十二指肠溃疡患者与对照组相比，十二指肠球部胃上皮化生检出率高；十二指肠球部胃上皮化生检出率和评分与胃幽门部Hp的检出率和评分无相关关系。结论 Hp不是十二指肠黏膜胃上皮化生的决定因素，也不是十二指肠黏膜胃上皮化生范围得以扩展的因素。十二指肠溃疡病本身的一些特点是十二指肠黏膜胃上皮化生的主要因素。     

高选择性胃迷切加胃窦粘膜切除术后胃酸,胃泌素的临床观察

选择性迷切加胃窦切除术(SV-A)治疗十二指肠溃疡是目前防止溃疡复发最有效的手术方法,但术后并发症较多。本文临床对比研究高选迷切加胃窦粘膜切除术(HSV-MA)与SV-A对胃酸和血清胃泌素的影响。结果HSV-MA后的胃酸下降值和血清胃泌素的变化与SV-A后相比无显著差异(P>0.05)。本研究结果表明HSV-MA可以降低HSV后溃疡复发率,而且又保留了胃窦和幽门的功能,可避免SV-A后并发症,是治疗十二指肠溃疡较理想的术式。