服毒患者胃粘膜损伤的初步观察

目的　探讨部分毒物内服时对人胃粘膜的损伤及其规律性。方法　对１６４ 例内服毒物自杀的患者在洗胃后即时由专人操作内窥镜查，观察胃底、胃体、胃窦部，分别在以上各处钳取粘膜组织２～６ 块，ＨＥ染色镜检，对内镜观察结果分级分度，对８ 例患者进行了１０ｄ ～６ｍｏ 的随访。结果　１６４ 例１００ ％ 异常，对照组中１８ 例异常（１８ ．０％ ），两组比较有显著性差异（ Ｐ＜ ０．０１），胃粘膜病变为具有特征性的急性出血性糜烂性胃炎，随着中毒症状的恶化、内服毒物量的增加及毒性的上升，胃粘膜损伤加重，随着病情的改善而改善。结论　粘膜损伤是毒物内服时全身病变的一部分。     

急性上消化道出血并脑梗塞12例治疗分析

１临床资料１１一般资料本组病例男８例,女４例。年龄５８～７６岁,平均６２岁。胃溃疡并出血４例,十二指肠球部溃疡并出血１例,胃癌并出血３例,急性胃粘膜病变并出血２例,食道－贲门粘膜撕裂综合征１例,食道－胃底静脉曲张破裂出血１例。以上病例均经急诊胃镜检...     

晚期血吸虫病并上消化道大出血48例诊治体会

总结晚期血吸虫病性肝硬变、门静脉高压症并上消化道大出血４８例，其中肝功能ＣｈｉｌｄＡ级１２例、Ｂ级２８例、Ｃ级８例；急诊纤维胃镜检查２８例，发现９例为胃粘膜病变致出血。４４例行非手术治疗，止血率９３．２％，急诊手术止血４例，肝功能均为Ａ级，全部停止出血，全组即期止血率９３．８％。因此，只要病情允许，均应行急诊纤维胃镜检查；胃粘膜病变出血占门脉高压症出血的２０％－４０％，这些出血手术危险性大，应尽量行非手术治疗；三腔二囊管填塞止血，多种药物等综合治疗，仍然是治疗门脉高压症上消化道出血非手术治疗的主要措施。     

门奇断流术治疗食管胃底曲张静脉大出血32例

采用门奇断流术治疗胃底食管下段曲张静脉破裂大出血３２例，其中急诊手术１０例，治愈８例，死亡２例；择期手术２２例均治愈。结果表明门奇断流术是治疗食管下段胃底曲张静脉破裂大出血的首选术式。手术时机的选择与病情严重有关。     

胃粘膜下恒径动脉破裂出血1例

1　病例报告患者 ,男 ,4 3岁。因黑便、餐后呕血半天入院。入院诊断为急性上消化道出血。急诊胃镜检查 ,胃底可见一长条形血痂 ,无溃疡和静脉曲张。保守治疗期间发生大量呕血 ,呕出鲜红色血液和血凝块 ,总量 4 50 0 ml以上。急诊剖腹、剖胃探查。术中发现 :胃底粘膜局限性糜烂 ,可见一 0 .2 cm直径动脉喷射状出血。诊断为胃粘膜下恒径动脉破裂出血 ,手术治愈。2　讨　论胃粘膜恒径动脉破裂出血 ,其病理诊断为粘膜下血管管径持续性扩大症 〔1〕。该病主要表现为无痛性上消化道大出血 ,占同期上消化道大出血的 0 .2 8%～ 1.7%。由于先天性胃粘…     

Dieulafoy病

胃粘膜下恒径小动脉溃破，致急性突发性致死性上消化道大出血，称为Ｄｉｅｕｌａｆｏｙ病。其出血病变隐匿，诊断有一定困难；易反复出血且量大，病死率高。是上消化道大出血最为严重和罕见原因之一而颇受关注。现就其有关问题综述如下。１　命名１８８４年Ｇａｒｌａｎｄ首先报道因呕血致死的“胃粘膜下粟粒样动脉瘤”２例。法国外科医师Ｄｉｅｕｌａｆｏｙ先后于１８９６、１８９７和１８９８年报道１０例临床表现极为相似的突发性致死性大出血的“单纯性胃浅表小溃疡”患者，并经尸解发现本病系胃体上部粘膜缺损处有异常口径动脉破裂出血所致。后来学者遂称之为Ｇａｒｌａｎｄ－Ｄｉｅｕｌａｆｏｙ溃疡或Ｄｉｅｕｌａｆｏｙ病。尽管本病命名尚有许多，诸如曲张动脉瘤、粘膜下动脉畸形、胃动－静脉畸形、胃动脉硬化、胃粘膜下动脉硬化、胃粘膜下微小动脉瘤、胃左动脉区溃疡及胃粘膜下恒径小动脉溃疡等［１～６］，多数不够确切，未能被普遍使用。其中多数称谓已被否定和摒弃。近年来，还有把胃外的十二指肠、空肠，甚至结肠异常增粗之恒径血管破裂大出血者也称为Ｄｉｅｕｌａｆｏｙ溃疡［５～９］。２　发病情况２．１　发病率　Ｇｏｌｄｅｎｂｅｒｇ（１９９０）认为本病的所谓少见是因为对其缺乏认识...     

门脉高压断流术后再出血的病因和治疗(附16例分析)

对1985－1999年行门脉高压断流术后再出血的16例病人行急诊胃镜检查，分析出血原因，发现门脉高压性胃粘膜糜烂出血10例（62.5%），胃及十二指肠球部溃疡出血2例（12.5%），食道胃底静脉曲张破裂出血4例（25％），认为断流术不但没有解决肝硬化后胃粘膜缺血问题，反而加重了胃体、胃底的缺血，导致门脉高压性胃粘膜病变出血是断流术后再出血的主要原因，从而提出联合断流术是防治断流术后胃粘膜病变出血的切实可行的方法。     

急性胃粘膜病变16例分析

本文16例经胃镜检查证实为急性胃粘膜病变。其中男11例，女5例，年龄21岁。病因明确者15例，未明者1例。全部病例均为急性起病，主要症状为突然呕血、黑便，并伴有低血容量表现，75％病人出血前多无症状，仅25％病人曾有上腹部隐痛，胀满不适，食欲减退等消化不良的表现。16例病人均在人院后24h内急诊胃镜检查，见胃粘膜不同程度的糜烂、出血、溃疡而确诊为急性胃粘膜损害，胃窦部胃粘膜病损12例，胃体、胃底4例。     

胃癌患者血清和组织中癌胚抗原,胃泌素检测的临床意义

应用放射免疫分析法测定３０例胃癌和２０例对照组血清、组织中ＣＥＡ、Ｇａｓｔｒｉｎ水平。结果显示胃癌组血清ＣＥＡ明显高于对照组（Ｐ＜０．０１）；组织ＣＥＡ水平为胃癌组织＞癌旁３ｃｍ粘膜＞癌旁８ｃｍ粘膜＞正常胃粘膜；胃癌组血清Ｇａｓｔｒｉｎ明显高于对照组（Ｐ＜０．０１），胃底癌、胃体癌增高尤为明显；组织Ｇａｓｔｒｉｎ为胃窦癌组织＜癌旁３ｃｍ粘膜＜正常胃窦粘膜，胃底、胃体癌组织胃泌素与正常胃底胃体粘膜差异不大。结论：胃癌患者血清和组织ＣＥＡ、Ｇａｓｔｒｉｎ水平变化的研究对其诊断、治疗及预后判断具有十分重要的临床意义。     

静脉注射奥美拉唑治疗上消化道出血48例分析

上消化道大出血是内科常见急症之一,自Ｈ２受体拮抗剂应用于临床以来,内科保守治疗已明显降低了急诊手术率,改善了患者的预后,但仍有２０％～３０％的患者因大出血而需急诊手术。我院从１９９４年５月～１９９８年６月应用质子泵抑制剂奥美拉唑治疗上消化道大出血４８例,收到良好效果,报告如下。１　临床资料１．１　４８例中男４３例,女５例,年龄２１～７９岁,平均４７岁。其中急性胃粘膜病变１２例,消化性溃疡２３例,糜烂型胃炎５例,应激性溃疡６例,肝硬变食管及胃底静脉破裂出血２例。１．２　治疗方法　奥美拉唑４０ｍｇ＋…     

31例胃粘膜黄色瘤临床,内镜及病理分析

本文报告３１例胃黄色瘤，占我院同期胃镜受检查者１．０８％。男性１８例，女 １３例。年龄２８－７６岁，５０岁以上２１例。胃部并发病主要是慢性萎缩性胃炎（５１．６％）及慢性浅表性胃炎（２２．６％）。黄色瘤好发部位为胃窦（２１例），其次体（８例）。病理检查见胃粘膜浅表固有层内聚集较多泡沫细胞，有不同程度的淋巴细胞浸润，伴肠上皮生者２１例（６７．７％）。结果提示，胃黄色瘤为一良性病变，临床症状无特异性，发     

Na~+-K~+-2Cl~-共转运体不同亚型在大鼠胃黏膜的差异性分布及表达

目的研究Na+-K+-2Cl-共转运体(Na+-K+-2Cl-co-transporter,NKCC)的两种亚型在胃不同部位黏膜层的差异性分布及表达的意义。方法用免疫荧光组织化学法和实时定量PCR技术检测NKCC不同亚型NKCC1与NKCC2在正常大鼠胃不同部位(胃底、胃体和胃窦)黏膜组织的分布和表达。结果①免疫荧光组织化学显示:NKCC1多分布于胃底、胃窦黏膜底部及胃体黏膜中下部,细胞膜表达最多;而NKCC2则多分布于胃体、胃窦黏膜全层及胃底黏膜上1/3部,细胞质、细胞膜均有表达。②实时定量PCR显示:NKCC1的mRNA在正常大鼠胃体表达最高,NKCC2的mRNA则在胃窦表达最高。结论正常大鼠NKCC1与NKCC2在不同部位胃黏膜上皮细胞的分布及表达含量不同,NKCC1多分布在黏膜底部或中下部,NKCC2多分布于黏膜顶部或全层。     

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study

Background Helicobacter pylori （Hp） is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years. Methods From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group （T; n=276） or a placebo group （P; n=276）. In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination. Results Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia （IM） had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer （2 in the T group; 7 in the P group; P=0.176）. When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group （n=6） was much higher than that in the T group （n=0, P=0.013）. Conclusions Hp eradication may significantly diminish and delay the development of IM and atrophy gastritis. Hp especially in the early stage of Hp infection. and help halt progression of gastric mucosal inflammation eradication is helpful for reducing the risk for gastric cancer,     

Role of Biopsy from Gastric Corpus in Diagnosis of Helicobacter pylori Infection in Patients on Acid Suppression Therapy

There are reports of migration of Helicobacter pylori from the gastric antrum to the proximal stomach following acid suppression therapy. The diagnosis of H pylori infection is usually based on rapid urease test and histology of gastric antral biopsies. 50 consecutive patients of peptic ulcer, 22 on proton pump inhibitors and 28 on histamine-2 receptor antagonists for at least 4 weeks were subjected to biopsies from the gastric corpus in addition to the antrum at the time of upper gastrointestinal endoscopy. H pylori infection was detected in 42 (84%) patients. The diagnosis was established from both antral and corpus biopsies in 34 (68%) and only antrum in 4 (8%). In 4 patients, 3 on proton pump inhibitors and one on H-2 receptor antagonists, H pylori was isolated only from the corpus. The rapid urease test was positive at a mean time of 67.6 minutes from the antrum as compared to 234.6 minutes from the corpus. Testing for H pylori from the antrum alone and not the corpus would have resulted in a false negative result in 8% patients. Biopsy from the gastric antrum should always be combined with biopsy from gastric corpus for the diagnosis of H pylori infection in patients with dyspepsia on acid suppression therapy.Key Words: Helicobacter pylori, Rapid urease test     

血清胃蛋白酶原、促胃液素-17和幽门螺杆菌抗体对胃癌前状态筛查能力的评价

目的 探讨血清胃蛋白酶原(PG)、促胃液素-17(G-17)和幽门螺杆菌抗体对胃癌前状态的诊断效能.方法 收集331例慢性胃炎患者,观察胃黏膜萎缩、肠化、上皮内瘤变以及不同OLGA/OLGIM分期患者的血清PG和G-17水平的变化以及ABC法各组中胃癌前状态的发病情况.结果 ①胃窦萎缩患者的血清G-17水平低于无萎缩(P =0.030),胃体萎缩患者的血清PG Ⅰ/PGⅡ比值(PGR)水平低于无萎缩(P =0.046),全胃萎缩患者的血清PG Ⅰ(P=0.036)及PGR(P=0.030)水平低于无萎缩;②胃窦肠化患者的血清G-17水平低于无肠化(P =0.021),全胃肠化患者的血清PG Ⅰ水平低于无肠化(P =0.015);③全胃低级别上皮内瘤变患者的血清PG Ⅰ水平低于无低级别上皮内瘤变(P=0.036);④OLGA分期中血清PG Ⅰ水平随分期严重程度加重逐渐降低,以Ⅳ期降低明显(P=0.035);⑤OLGIM分期中血清PGⅠ水平随分期严重程度的加重逐渐降低,以Ⅳ期降低明显(P=0.018);⑥“ABC法”分组中,尽管高危组中发生胃癌前状态的患者占组内人数的比例较低危组高,但低危组中仍有50.16％的患者为慢性萎缩性胃炎以及15.96％的患者为低级别上皮内瘤变.结论 血清PG和G-17可以作为胃癌前状态发生风险的临床筛查指标,ABC法对早期胃癌具有筛查作用,但低危组人群仍存在发生胃癌前状态的风险.     

Changes of mucosal blood flow in the healing process of peptic ulcer

Changes of gastroduodenal mucosal blood flow (GDMBF) in the healing process of 79 cases of gastric ulcer and 118 cases of duodenal ulcer were investigated by Laser Doppler Flowmetry during endoscopy. 108 cases with no gastroduodenal lesions were used as controls. In the controls, the mucosal blood flow was greater at the corpus than at the antrum and the angle, and it was smaller at the lesser curvature than at the greater curvature. The mucosal blood flow at the antrum and the angle of the lesser curvature was the smallest. The mucosal blood flow at the anterior wall of the duodenal bulbus was lower than at the lesser curvature and the posterior wall. In patients with active gastric ulcer, GMBF were decreased significantly. The mucosal blood flow at the ulcer center and ulcer margin was lower in the active stage and it was increased markedly in the healing stage, while no marked change was observed in peripheral mucosal blood flow during the different stages.     

Laparoscopic and endoscopic cooperative partial gastrectomy in the treatment of submucosal gastric neoplasms

Objective To evaluate the feasibility of laparoscopic and endoscopic cooperative partial gastrectomy,a minimally invasive surgery, in treating gastric submucosa lesion. Methods We retrospectively analyzed 63 patients [34 women and 29 men, aged (52.8±18.1) years (range:14 to 78 years)] who had undergone laparoscopic and endoscopic cooperative partial gastrectomy with preserving cardia and pylorus for gastric submucosal tumor in the past 6 years. All of the patients were followed up for 2-69 months (average 35 months). The clinicopathological data, surgical approaches, and follow-up results were analyzed. Results The surgery was successfully performed in all these 63 patients, among whom 61 were assisted by endoscopy. The most common symptom was dyspepsia. The mean distance from the lesions locating at fundus or antrum to cardia or pylorus was(2.9±1.1)cm. The minimum distance from tumor edge to cardia was 1cm. The diseases included gastrointestinal stromal tumor (n=54), carcinoid tumors (n=3), ectopic pancreas (n=2), lipoma (n=2), and leiomyoma (n=2). The tumor size ranged from 0.8 to 8.2cm, with 44 lesions (69.8%) less than 2cm. Forty-five lesions(71.4%) were located at fundus, 12 (19.0%) at body, and 6 (9.6%) at antrum. No recurrence or death was noted during follow-up. Conclusions Laparoscopic and endoscopic cooperative partial gastrectomy is feasible for treating gastric submucosal tumor. Endoscopy is useful for intraoperative localization and supporting, and therefore is especially helpful for preserving cardia and pylorus.     

慢性乙型肝炎患者血清和胃黏膜乙型肝炎病毒与肝胃不和证的关系

目的:探讨慢性乙型肝炎患者胃黏膜乙型肝炎病毒(hepatitis B virus,HBV)与中医肝胃不和证的关系.方法:选择符合条件的慢性乙型肝炎肝胃不和证患者30例,并以慢性胃炎肝胃不和证患者30例为对照,采集空腹血液标本,进行电子胃镜检查,取胃窦、胃体、胃底黏膜;用核酸扩增荧光定量法检测血清、胃黏膜HBV-DNA,综合分析各检测值对肝胃不和证积分的意义.结果:(1)慢性乙型肝炎肝胃不和证组的脘胁胀闷疼痛、嗳气呃逆以及肝胃不和证总积分明显低于慢性胃炎肝胃不和证组(P＜0.01).(2)慢性乙型肝炎组患者血清和胃窦、胃体、胃底黏膜HBV-DNA检出率分别为56.7%、76.7%、76.7%、70.0%,血清、各处胃黏膜HBV-DNA滴度呈正相关(r=0.66～0.94,P＜0.01),且与肝胃不和总分呈正相关(r=0.36～0.52,P＜0.05),以胃体HBV-DNA与肝胃不和总分相关性最密切(r=0.52,P＜0.01).结论:慢性乙型肝炎患者肝胃不和证与胃黏膜HBV感染有关.     

微探头超声内镜在胃平滑肌瘤诊断中的应用价值

目的探讨微探头超声内镜（miniprobe endoscopic ultrasonography MEUS）在胃平滑肌瘤诊断中的应用价值。方法对125例胃黏膜下隆起性病变行微探头超声内镜检查,在MEUS检查前均经胃镜检查并发现胃内有隆起性病变,但诊断未能确定。对76例MEUS诊断为胃平滑肌瘤的病例均行内镜下治疗,术后标本送病理检查。将胃镜、MEUS及病理结果进行比较。结果超声内镜诊断胃平滑肌瘤76例,其中病变起源于黏膜肌层62例,给予内镜下黏膜下切除术治疗;起源于固有肌层14例,给予内镜下黏膜下剥离术治疗。病变位于胃底部14例,胃体部28例,胃窦部34例;直径〈2cm 64例,〉2cm 12例。76例患者均成功切除病变,7.5MHZ适合于显示病灶内部回声,12MHZ显示病灶起源较清楚。病理均提示为胃平滑肌瘤,其起源层次与超声内镜诊断结果一致,超声内镜检查准确率为100%。结论微探头超声内镜可清晰显示胃平滑肌瘤的病变层次结构,根据其诊断结果对胃平滑肌瘤行内镜下治疗是一种安全、有效、创伤小的治疗方法。