外科手术治疗胃十二指肠溃疡大出血的疗效分析

目的探讨外科手术治疗胃十二指肠溃疡大出血的临床疗效。方法选取2009年3月～2012年3月笔者所在医院收治的30例胃十二指肠溃疡大出血患者,随机分为两组,对照组进行常规治疗,研究组在对照组治疗方法的基础上实施早期急诊手术或择期进行手术治疗。结果治疗结束后,研究组和对照组的总有效率分别为93.33%、73.33%,两组总有效率比较,差异有统计学意义(P<0.05)。研究组的并发症发生率及出血复发率均明显低于对照组,差异有统计学意义(P<0.05)。结论外科手术治疗胃十二指肠溃疡大出血具有良好的临床效果,且并发生症发生率低,复发率低,值得推广。     

Acid suppression in peptic ulcer haemorrhage: a 'meta-analysis'

BACKGROUND: The use of acid-decreasing agents in the management of peptic ulcer haemorrhage continues to be controversial. Most clinical trials examining the efficacy of these drugs contain small numbers of patients, making it difficult to draw conclusions about their efficacy. METHODS: We report a meta-analysis that examined the effect of these drugs in the management of peptic ulcer haemorrhage. Included studies were located using a search of the Medline database between 1980 and 1999. Studies were published in English, randomized and controlled by a placebo group. Mantel-Haenszel and blinded random models were used in conducting the statistical processing of this meta-analysis. RESULTS: Twenty-one randomized placebo-controlled trials were included. The total number of patients was 3566 and the mean study size was 170 (range 20-1005). Seventeen of the papers assessed the efficacy of H2-antagonists, three assessed proton pump inhibitors and one was concerned with antacid therapy. The meta-analysis showed a significant reduction in re-bleeding rates (odds ratio, OR 0.727, 0.618-0.855, P < 0.001) and surgery rates (OR 0.707, 0.582-0.859, P < 0.001) when acid decreasing agents are used for acute peptic ulcer haemorrhage. Mortality rates appear to be unaffected (OR 1.140, 0.818-1.588, P=0. 49). CONCLUSIONS: This meta-analysis demonstrates a significant beneficial effect of acid-decreasing agents in lowering re-bleeding and surgery rates, but demonstrated no effect upon mortality.     

腹腔镜胃十二指肠溃疡穿孔修补术的临床效果观察

目的 探讨腹腔镜胃十二指肠溃疡穿孔修补术的临床疗效.方法 将本院收治的92例胃十二指肠溃疡穿孔患者随机分为观察组和对照组各46例,其中观察组行腹腔镜胃十二指肠溃疡穿孔修补术治疗,对照组行传统开腹术治疗,比较两组手术时间、术中出血量、术后肠蠕动恢复时间、住院时间及术后并发症.结果 观察组手术时间为(46.2±9.7)min,术中出血量(31.8±5.6)mL,肠蠕动恢复时间(19.8±4.3)h,住院时间(6.2±1.7)d,患者均痊愈,并发症发生率为6.52％,各项指标均显著低于对照组(P＜0.01).结论 腹腔镜胃十二指肠溃疡穿孔修补术疗效显著,手术创伤小、并发症少、恢复快,值得临床推广应用.     

Risk of gastroduodenal ulcer in gastritis

The present evidence suggests that chronic gastritis is strongly associated with peptic ulcer disease. Gastritis, particularly in antrum, is nearly invariably present in patients with peptic ulcer. Gastritis is a progressive disease which begins as a superficial inflammation and progresses to atrophic gastritis. Gastritis can be considered to lower resistance of the gastric mucous membrane but it may also affect secretion of acid and pepsins from oxyntic mucosa. The presence or absence of gastritis, and its involvement in antral and/or body mucosa, can be considered to reflect the risk and probability of a person to contract peptic ulcer. Estimations of the risks of coexistent peptic ulcer in different types and grades of gastritis suggest that the relative risk (RR) of coexistent peptic ulcer disease is markedly increased in the presence of gastritis in general (RR = 7-10), as compared to patients who have a normal, non-gastritic stomach (RR = 1). This risk is particularly high in patients with gastritis of B type (atrophic gastritis is in antrum but body mucosa is non-atrophic) in whom the coexistent peptic ulcer is 20-30 times more common (RR = 20-30) than in patients who have normal stomach. On the other hand, the risk of peptic ulcer disease is low in patients who show marked atrophic alterations in the gastric body mucosa (A or AB types of gastritis), the risk being in these patients even lower (RR below 1) than that in patients with normal, non-gastritic stomach.     

海洋假单胞菌碱性蛋白酶的纤溶和溶栓作用研究

目的：为进一步确认海洋假单胞菌碱性蛋白酶(MPAP)的纤溶性质，并观察其抗栓作用。方法：通过体外试凝块实验，观察MPAP对纤维蛋白和纤维蛋白原的降解作用；建立家兔肺动脉血栓模型，观察MPAP的溶栓作用以及对组织型纤溶酶原激活剂(t—PA)和组织型纤溶酶原激活荆抑制剂(PAI)纤溶功能的影响。结果：MPAP有直接降解纤维蛋白和纤维蛋白原的作用，而无纤溶激酶活性；MPAP能明显溶解肺动脉血栓，MPAP用药后t—PA／PAl明显升高。结论：MPAP具有明显的溶栓和提高纤溶系统活性的作用。     

Lack of effect of 5-aminosalicylic acid on platelet aggregation and fibrinolytic activity in vivo and in vitro

Summary We have studied platelet aggregation and fibrinolytic activity in six patients with chronic inflammatory bowel disease treated with 5-aminosalicylic acid (mesalazine).There were no changes in these measurements during normal treatment, i.e. 1.5 g per day with a slow-release formulation, nor after an intravenous dose of 250 mg. Also in vitro tests were negative, in contrast to the inhibition seen with aspirin (acetylsalicylic acid).We conclude that treatment with mesalazine does not constitute a hazard to these patients in regard to prolonged bleeding time caused by an influence on platelet aggregation or fibrinolytic activity.     

抗坏血酸注射液对纤维蛋白溶解系统活性的影响

为观察大剂量抗坏血酸对纤溶系统活性的影响，测定了健康家兔和风湿性心脏病病人的ELT。实验证明，抗坏血酸具有促纤溶作用，而抗坏血酸注射液抑制纤溶系统活性，这与其所含稳定剂亚硫酸氢钠明显抑制纤溶系统活性有关。     

胃十二指肠溃疡急性穿孔的诊断和治疗

目的探讨胃十二指肠溃疡急性穿孔的诊断和手术治疗的疗效。方法前瞻性的将2008年4月～2011年12月收治于笔者所在医院的63例胃十二指肠溃疡急性穿孔患者根据临床症状、腹部穿刺及X线检查进行诊断,确诊后随机分为两组,分别为腹腔镜组(实验组),30例,开腹组(对照组)33例,回顾性的对比分析两组手术时间、术后排气时间、住院时间、术中出血量和切口感染以及术后使用镇痛剂例数等。结果腹腔镜组在术后排气时间、住院时间、术中出血量和切口感染以及术后使用镇痛剂比例数中均明显低于开腹组(P<0.01),差异有统计学意义,但手术时间腹腔镜组明显高于开腹组(P<0.05),差异有统计学意义。结论急性胃十二指肠溃疡穿孔的修补采取腹腔镜修补进行治疗较开腹手术治疗而言具有创伤小、恢复快、住院时间短等特点,是一种治疗胃十二指肠溃疡急性穿孔的理想方案。     

胃十二指肠溃疡大出血的外科治疗

目的 探讨胃十二指肠溃疡大出血的外科治疗。方法 收集我院11年来胃十二指肠溃疡大出血病人的临床资料，分析总结其临床表现、诊断、外科治疗原则、术式。结果 本组病人经积极救治，手术疗效满意。结论 胃十二指肠溃疡大出血是外科急危重症，应及时用有效手段进行诊断，把握手术原则，用安全有效的方法，挽救病人的生命。     

Gastrointestinal mucosal gamma-glutamyl transpeptidase activity changes in different ulcer models of rat

The experiments presented gave evidence that changes in gamma-glutamyl transpeptidase activity-under experimental circumstances-seem to be in close connection with gastro-intestinal ulceration. In the pre-ulcerative period in both gastric and duodenal ulcer models, the mucosal gamma-glutamyl transpeptidase activity is higher than normal, while in the definitive ulcerative stage the gastric gamma-glutamyl transpeptidase activity is significantly decreased but in the duodenum it remained on normal level. This phenomenon may reflect to a difference in the pathomechanism of the gastric and duodenal ulceration.     

无选择性非手术治疗胃十二指肠溃疡穿孔临床分析

目的探讨胃十二指肠溃疡穿孔（PGDU）无选择性非手术治疗的可行性和效果。方法90例PGDU患者于住院首日全部无选择地采用胃肠减压、防治感染、抑酸、支持治疗、促进胃肠功能恢复等非手术综合治疗。结果非手术治愈86例（95．6％），其中5例腹腔积液或脓肿行腹腔穿刺置管引流后痊愈，均未遗留相关并发症。中转手术急诊治疗3例（3．3％），另1例（1．1％）十二指肠溃疡合并肠外瘘非手术后择期手术治愈。结论非手术的现代综合治疗措施对绝大多数无严重并发症的PGDU行之有效，PGDU传统的手术治疗适应证应重新评估。     

Buccal mucosal ulcer healing effect of rhEGF/Eudispert hv hydrogel

We have studied the effect of rhEGF on the buccal mucosal ulcer healing. rhEGF was rapidly degraded upon incubation with the hamster buccal mucosal homogenates; The degradation of rhEGF was significantly inhibited by sodium lauryl sulfate (SLS). Eudispert hv hydrogel and Polycarbophil 974P hydrogel were prepared for rhEGF delivery and their mucoadhesiveness was measured by the Instron method. The mucoadhesive force of Eudispert hv was significantly greater than that of Polycarbophil 974P. Moreover, rhEGF in Eudispert hv hydrogel remained stable for about 2 months. To evaluate the ulcer healing effect of rhEGF, the buccal mucosal ulcer was induced in golden hamsters using acetic acid. At 24 h after administration of rhEGF/Eudispert hv hydrogel, the ulcerous area was decreased compared with rhEGF solution and, as a result, the curative ratio was 36.8 +/- 5.68%. By the addition of SLS (0.5%) to Eudispert hv hydrogel, the curative ratio increased 1.5 times. The mechanism of the action was probably due to a combination of protection of the drug against proteases present in mucosa and prolongation of the release of rhEGF from the formulation at the site of action.     

慢性牙周炎与胃十二指肠溃疡关系的研究

目的：观察慢性牙周炎与胃十二指肠溃疡的关系。方法从本院口腔科2013年3月~2014年10月收治的213例慢性牙周炎患者中,选择50例慢性牙周炎伴胃十二指肠溃疡的患者(观察组),50例不伴有胃十二指溃疡的慢性牙周炎患者(阳性对照组)。另外在健康体检者中选择30例作为阴性对照组。检测3组受试者的血清胰岛素样生长因子-Ⅱ(IGF-Ⅱ)、白介素6(IL-6)、白介素8(IL-8)、生长抑素(SS)、胃泌素(Gas)以及幽门螺杆菌。比较观察组与阳性对照组的上述指标水平。结果观察组与阳性对照组的血清IGF-Ⅱ、IL-6、IL-8、SS、Gas比较,差异无统计学意义(P>0.05)。观察组与阳性对照组的幽门螺杆菌阳性率比较,差异无统计学意义(P>0.05)。结论慢性牙周炎伴胃十二指肠溃疡患者的IGF-Ⅱ、IL-6、IL-8、Gas、SS、幽门螺杆菌等异常指标,在单纯慢性牙周炎患者中也是异常的,说明慢性牙周炎与胃十二指肠溃疡有一定的相关性。     

腹腔镜在胃十二指肠溃疡穿孔修补手术中的应用

目的 探讨腹腔镜修补术治疗胃十二指肠溃疡穿孔的可行性和安全性.方法 回顾性分析67例腹腔镜胃十二指肠穿孔修补术患者的临床资料.结果 手术全部成功,无中转开腹,平均手术时间为55 min,平均术后排气时间为23.8 h,无使用镇痛药物,无戳口感染及腹腔脓肿发生,平均住院时间为6.3 d.结论 腹腔镜手术治疗胃十二指肠溃疡穿孔是可行的,并具有创伤小、康复快、并发症少等优点,值得临床推广应用.     

护理干预对胃十二指肠溃疡出血患者的影响

目的：探讨胃十二指肠溃疡出血的护理干预效果。方法：将本科70例胃十二指肠溃疡出血患者随机分为观察组与对照组各35例,观察组行护理干预,对照组行常规护理,观察两组患者的住院时间、溃疡愈合情况。结果：观察组患者住院时间为（5.0±1.5）d,与对照组相比明显缩短,1年内溃疡愈合情况,观察组27例,对照组10例,两组各指标比较差异具有统计学意义（P〈0.05）。结论：护理干预有助于改善胃十二指肠溃疡出血患者的预后。     

Therapeutic effect of rebamipide in a modified acetic acid-induced buccal mucosal ulcer model

Previous studies have suggested that rebamipide, a gastroprotective drug, might be effective for the treatment of aphthous oral ulcers in Behçet's disease patients. The aim of this study was to confirm the effect of rebamipide on experimentally induced stomatitis in a rat acetic acidinduced oral ulcer model. Buccal mucosal lesions were induced by local injection of 50 l of 99.7% acetic acid into the buccal mucosa, which produced a single large ulcer in each of the treated rats. The ulcer remained up to 14 days. Repeated dose of rebamipide (3-100 mg/kg) dose-dependently decreased the ulcer area. Histopathologically, increased fibrosis and regenerated epithelium were observed in the rebamipide-treated group. In contrast, indomethacin, a cyclooxygenase inhibitor, impaired the healing of ulcers. We have successfully established an improved method for the administration of acetic acid to induce oral ulcers, and rebamipide accelerated the ulcer healing.