肝源性溃疡临床特点与治疗探讨

目的 研究乙肝后肝硬化患者消化性溃疡的临床特点,探讨小剂量心得安对肝源性溃疡愈合的影响。方法 肝源性溃疡４５例,观察其发病年龄、临床表现、溃疡部位、ＨＰ感染率和并出血及溃疡愈合率等特点。随机分为治疗组用心得安＋泰胃美治疗;对照组,用维生素Ｂ６＋泰胃美治疗,另外选单纯性消化２２例,作为对照２例,治疗方法与对照组相同,结果 肝源性溃疡发病年龄较单纯性消化性溃疡晚１０年,溃疡部位以胃溃疡居多和并出血率高     

心得安辅助治疗肝源性溃疡疗效观察

研究乙肝后肝硬化患者消化性溃疡的临床特点,探讨小剂量心得安对肝源性溃疡愈合的影响。肝源性溃疡124例,观察其发病年龄、溃疡部位、腹痛情况、临床表现、合并出血率、溃疡愈合率等特点。随机分为治疗组,用心得安+奥美拉唑治疗;对照组,用维生素B6+奥美拉唑治疗。另设单纯性消化性溃疡为对照2组,治疗方法与对照组相同。肝源性溃疡发病年龄较单纯性消化性溃疡晚10年,溃疡部位以胃溃疡居多、合并出血率高,心得安可明显提高肝源性溃疡愈合率与对照组具统计学意义(P相似文献   

不同方法对肝源性溃疡的疗效比较

[目的]比较不同方法对肝源性溃疡的疗效。[方法]将40例肝源性溃疡患者根据不同治疗方法分为A组、B组、C组,分别予以心得安+洛赛克、消心痛+洛赛克、单用洛赛克治疗,疗程均为28d。观察各组溃疡部位,治疗前后幽门螺杆菌(Hp)感染率,溃疡愈合情况及治疗后1年以内、3年以内上消化道大出血发生率。[结果]各组胃溃疡的发病者均明显多于球部溃疡者。各组治疗前后Hp感染率比较无差异(P0.05)。治疗后溃疡愈合率A组高于C组(P0.05);B组也高于C组,但2组比较差异无统计学意义(P0.05)。A组、B组在1年、3年以内上消化道出血率均明显低于C组(P0.01)。[结论]心得安或消心痛联合洛赛克治疗有助于肝源性溃疡的愈合,同时可减少肝硬化并发上消化道出血发病率。     

埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡临床观察

[目的]观察埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡的临床疗效。[方法]将Hp阳性的胃及十二指肠溃疡患者257例随机分为2组,观察组129例、对照组128例。对照组使用埃索美拉唑镁肠溶片+克拉霉素+阿莫西林,观察组在对照组基础上加服胃复春;治疗4周后统计分析2组患者的溃疡愈合率、Hp根除率、不良反应和治疗满意度。[结果]观察组患者溃疡愈合率、Hp根除率及治疗满意度均优于对照组,不良反应发生率低于对照组,2组之间以上指标比较,差异均有统计学意义(P0.05)。[结论]埃索美拉唑镁肠溶片联合胃复春治疗Hp阳性消化性溃疡方案能有效根除幽门螺杆菌,促进溃疡愈合,对Hp阳性消化性溃疡起到了较好的治疗效果。     

溃疡散治疗消化性溃疡的临床观察

目的：观察自拟溃疡散治疗消化性溃疡的临床疗效。方法：应用溃疡散治疗消化性溃疡107例,与西药泰胃美片治疗的54例作比较。服药30d后判定近期疗效。停药半年后观察溃疡的复发情况。结果：治疗组总有效率为94．39％,治愈率为86．91％,对照组分别为92．59％和83．33％。经X^2检验两组近期疗效比较差异无显著性意义（P＞0．05）。停药半年后治疗组溃疡复发率为6．45％,对照组为26．67％,两者比较差异有显著性意义（P＜0．05）。结论：溃疡散治疗消化性溃疡的近期疗效与泰胃美片相似,而遏制溃疡复发则优于泰胃美片。     

洛赛克与泰胃美治疗消化性溃疡对比观察

材料与方法:将内镜确诊的活动性消化性溃疡(PU)随机分为洛赛克(L)组46例,泰胃美(T)组40例,两组患者的性别,年龄、病程、溃疡平均面积及吸烟史等均具有可比性。L组给予洛赛克20mg,每日1次,睡前服,疗程2～4周;T组给予泰胃美800mg,每晚1次、疗程同上。治疗过程中不加用其他抗溃疡药物。治疗2周、4周后各复查胃镜1次,了解溃疡的愈合情况。 结果:L组28例DU服药2周愈合23例,4周愈合27例;18例GU2周愈合11例,4周愈合15例。     

消化性溃疡的治疗及远期疗效观察

本文报告ＣＢＳ甲氰咪胍雷尼替丁对１６２例消化性溃疡伴幽门螺杆菌阳性的治疗及远期疗效观察，结果：ＣＢＳ对ＨＰ的转阴率（９５％）显著高于甲氰咪胍（２３％）和雷尼替丁（２２％）。一年后ＨＰ阳转率ＣＢＳ组显著低于其它两组，三组分别为５％，１００％和９０％（Ｐ＜０．００１）。消化性溃疡治愈率三组之间无显著差异，分别为８０％、８４．６％和７８％（Ｐ＞０．０５）。但一年以后溃疡复发率ＣＢＳ组（１２．５％）显著低于甲氰咪胍（７１．５％）和雷尼替丁（５０％）（Ｐ＜０．００１）。伴随慢性胃炎好转率及活动性胃炎消失率ＣＢＳ组也优于其它两组。结论：ＨＰ感染与溃疡发生，延迟愈合及复发有密切关系；清除ＨＰ有助于溃疡愈合，改善胃窦炎症，降低溃疡复发率。     

三联疗法治疗HP相关性出血性十二指肠溃疡的远期疗效观察

目的：观察三联疗法根除幽门螺杆菌（ＨＰ）,预防溃疡复发与再出血的远期疗效。方法：选择有ＨＰ感染的出血性十二指肠溃疡患者５８ 例,随机分为两组。治疗组３６ 例,用丽珠得乐冲剂、呋喃唑酮片剂、泰胃美片治疗２周;对照组２２例,单用泰胃美片治疗２周。疗程结束后,两组患者均再用泰胃美治疗２ 周,总疗程结束后４ 周及每半年复查胃镜和ＨＰ,定期随访２ 年。结果：治疗组和对照组溃疡愈合率分别为１００％ 和８１．８％ ,ＨＰ根除率分别为８０．５％ 和９．１％ 。随访２ 年后,治疗组溃疡复发率为１３．９％ ,再出血率为５．５％ ,对照组溃疡复发率为９０．９％ ,再出血率为４５．４％ ,两组溃疡复发率与再出血率比较有显著性差异（ Ｐ＜ ０．０５）。结论：三联疗法具有较好的根除ＨＰ、明显减少溃疡复发和再出血发生的作用,具有较好的远期疗效     

耐信三联疗法对肝源性溃疡的疗效分析

目的观察耐信三联疗法对肝源性溃疡的治疗效果。方法2005年1月～2006年12月消化内科门诊病例中活动性胃溃疡患者168例,随机分为两组:肝源性溃疡组80例,非肝源性溃疡组88例,两组患者均处方埃索美拉唑片20mg,bid(4周) 克拉霉素500mg,bid(1周) 阿莫西林1000mg,bid(1周)。4周后随访患者,确定症状缓解率;同时复查胃镜,确定患者溃疡愈合情况。结果治疗4周后症状缓解率两组间无显著性差异(P>0.05),复查胃镜溃疡愈合例数两组间存在显著性差异(P<0.05)。结论肝源性溃疡药物治疗效果较差。可能需要延长疗程或辅之以其他方法。     

洛赛克治疗十二指肠溃疡的近期疗效观察

60例十二指肠球部溃疡患者随机分为洛赛克治疗组及泰胃美对照组。结果洛赛克组2周愈合率90%,泰胃美组2周愈合率60%(P<0.01);4周愈合率洛赛克组96.7%,泰胃美组为86.7%(P>0.05)。症状消失洛赛克组服药3天93.3%(28/30),对照组10%(3/30),P<0.01;洛赛克组5天疼痛消失率100%,对照组多在10天内消失。初步结果显示洛赛克治疗十二指肠溃疡疗效极好,症状缓解尤为理想。     

Treatment of Helicobacter pylori Reduces the Rate of Rebleeding in Peptic Ulcer Disease

Background: We evaluated whether therapy designed to eradicate Helicobacter pylori infection resulted in a reduction in rebleeding in patients with peptic ulcer disease. Patients presenting because of major upper gastrointestinal hemorrhage from peptic ulcer and whose ulcers healed in a study in which they were randomized to receive ranitidine alone or triple therapy plus ranitidine were followed up regularly with endoscopy. No maintenance anti-ulcer therapy was given after ulcer healing. Methods: Patients Received ranitidine, 30(1 mg, or ranitidine plus triple therapy. Triple therapy consisted of tetracycline, 2g; metronidazole, 750 mg; and bismuth subsalicylate, 5 or 8 tablets (151 mg bismuth per tablet), and was administered for the first 2 weeks of treatment; ranitidine therapy was continued until the ulcer had healed or 16 weeks had elapsed. After ulcer healing, no maintenance antiulcer therapy was given. Development of ulcer recurrence with or without recurrent upper gastrointestinal bleeding was evaluated. Results: Thirty-one patients with major upper gastrointestinal bleeding from peptic ulcer were studied; 17 Received triple therapy and 14 ranitidine alone. Major rebleeding occurred significantly (p = 0.031) more often in those in the ranitidine group (28.6%), compared with none (0%) in the triple therapy group. Conclusion: Eradication of H. pylori infection reduces the rate of ulcer recurrence and rebleeding in complicated ulcer disease.     

泮托拉唑治疗重症脑出血并发应激性消化道溃疡的疗效研究

目的探讨泮托拉唑治疗重症脑出血并发应激性消化道溃疡的临床疗效。方法将我院收治的60例重症脑出血并发应激性消化道溃疡的患者随机分为观察组和对照组,各30例。观察组给予泮托拉唑治疗,对照组给予雷尼替丁治疗,比较两组患者的治疗效果及不良反应。结果观察组患者的总有效率为100.00%,对照组患者的总有效率为73.33%,两组比较差异有统计学意义(P<0.05)。观察组不良反应8例,对照组不良反应12例,两组不良反应率比较,差异有统计学意义(P<0.05)。结论泮托拉唑治疗重症脑出血并发应激性消化道溃疡的临床疗效显著,不良反应少,值得临床推广应用。     

Argon plasma coagulation versus injection sclerotherapy in peptic ulcer hemorrhage--a prospective, controlled study

BACKGROUND/AIMS: In Slovenia, the annual incidence of peptic ulcer hemorrhage is 118/100,000 inhabitants, with mortality up to 14%. Interventional endoscopy has largely reduced mortality in these patients. This study aims to evaluate the efficacy and safety of argon plasma coagulation and injection sclerotherapy in bleeding peptic ulcer. METHODOLOGY: A prospective, controlled study which includes 100 patients with peptic ulcer hemorrhage (male 63, female 37, av.age 57.1 years, SD+/-16, span 26-80; gastric ulcer 50 patients, duodenal ulcer 50 patients) in the period between 1.01.1999 and 15.05.2000 treated in our institution. The bleeding activity was determined according to the Forrest classification. Fifty patients were randomized to receive argon plasma coagulation (ARCO 2000 ES unit, group A) and in fifty patients injection sclerotherapy (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%, group B) was performed. The groups did not differ with respect to age, sex, site, severity of bleeding, use of NSAID and additional diseases. RESULTS: Clinically and endoscopically diagnosed rebleeding occured in 7/50 patients (14%) in group A and in 9/50 patients (18%) in group B; p=0.78. The majority of rebleeding occured within 48 hours after endoscopic hemostasis, group A 4-/7 (57.1%), group B 7/9 (77.7%), p = 0.74. Repeated endoscopic hemostasis did not prove successful in 8 patients (group A 3/50, 6%, group B 5/50, 10%), p=0.71. Seven patients were treated operatively. The total mortality rate was 9% (9/100 patients, group A 4/50, 8%, group B 5/50, 10%), p>0.05. Only one patient died due to peptic ulcer hemorrhage, other 8 patients died due to concomitant diseases. CONCLUSIONS: Argon plasma coagulation seems to be an effective and safe alternative to other hemostatic modalities in peptic ulcer hemorrhage.     

Endoscopic findings and management of dengue patients with upper gastrointestinal bleeding

There are 100 million cases of dengue infection, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually due to dengue worldwide. Gastrointestinal bleeding is the most common type of severe hemorrhage in dengue fever. However, there are no reports about the clinical applications of endoscopic therapy for upper gastrointestinal bleeding (UGI) in dengue patients. From June 17, 2002 to January 30, 2003, 1,156 patients with confirmed dengue virus infection were treated at Kaohsiung Chang Gung Memorial Hospital in Taiwan. We analyzed those patients who had received endoscopic therapy for UGI. The characteristic endoscopic findings, therapeutic courses, and amount of blood component transfused were collected from their charts for statistical analysis. Among the 1,156 dengue patients, 97 (8.4%) had complications of UGI bleeding during hospitalization. The endoscopic findings included hemorrhagic (and/or erosive) gastritis in 67% of the patients, gastric ulcer in 57.7%, duodenal ulcer in 26.8%, and esophageal ulcer in 3.1%. Of the 73 patients with peptic ulcer, 42 (57.5%) met the endoscopic criteria (recent hemorrhage) for endoscopic hemostasis therapy. Peptic ulcer patients with recent hemorrhage required more transfusions with packed red blood cells (P = 0.002) and fresh frozen plasma (P = 0.05) than those without recent hemorrhage. Among these 42 patients with recent hemorrhage, endoscopic injection therapy was conducted in 15 patients (group A). The other 27 patients (group B) did not receive endoscopic therapy. After endoscopy, patients in group A required more transfusions with packed red blood cells (P = 0.03) and fresh frozen plasma (P = 0.014) than did patients in group B. There were no significant differences between groups A and B in duration of hospital stay and amounts of transfused platelet concentrate after endoscopy. Medical treatment with blood transfusion is the mainstay of management of UGI bleeding in dengue patients. Patients having peptic ulcer with recent hemorrhage require more transfusions with packed red blood cells and fresh frozen plasma for management of UGI bleeding than those without recent hemorrhage. However, when peptic ulcer with recent hemorrhage is encountered during the endoscopic procedure, endoscopic injection therapy is not an effective adjuvant treatment of hemostasis in dengue patients with UGI bleeding.     

硝苯啶治疗消化性溃疡的疗效及其机理探讨

用硝苯碇预防无水乙醇和幽门结扎所致大鼠胃溃疡，结果显示用药组胃溃疡指明显低于对照组，对溃疡的抑制率与ＮＦＤ剂量呈正相关。临床观察４２例十二指肠球部溃疡患者，服用ＮＦＤ １０ｍｇ，每日４次，６周后溃疡愈合２７例，总有效３９例，与对照比较有显著差异。     

雷尼替丁维持治疗对幽门螺杆菌相关性溃疡四联法治疗后意义的探讨

目的：观察以洛赛克为核心的两种四联疗法的幽门螺杆菌（HP）根除率和溃疡治愈率以及HP相关性胃十二指肠溃疡治愈后是否仍需应用抑酸剂维持治疗。方法：（1）196例病人（HP相关性胃炎40例,HP相关性溃疡156例）随机分两,分别给予洛赛克＋灭滴灵＋瑞贝克（庆大霉素混悬剂）＋四环素（A组）和洛赛克＋灭滴灵＋丽珠得乐＋四环素（B组）口服2周。十二指肠溃疡者继续应用洛赛克6周。胃溃疡和复合性溃疡者则继续用10周后查复查胃镜。（2）对溃疡愈合者将A与B两组各分为雷尼替丁维持组和对照组（AR^ 、AR^－、BR^ 、BR^－组）,对溃疡已愈合但HP未能根除者加用2周四联疗法后再用上述方法处理,1年后复查胃镜记录其溃疡愈合情况。结果：A组与B组的HP根除率分别为92．60％和92％和92．16（P≥0．05）,12周溃疡愈合率分别为90．54％和92．68％（P≥0．05）;AR^ 组与AR^－组组1年后溃疡持久事率分别为91．67％和58．06％（P≤0．01）,BR^ 组和BR^－组的溃疡持久愈合率分别为90．91％和53．13％（P≤0．001）,结论：（1）以洛赛克为核心的两种四联疗法均具有极高的HP根除率和极好的治疗溃疡作用。（2）HP相关性溃疡在HP根除和溃疡短期治愈后仍需用抑酸剂维持治疗。     

内镜下致康胶囊溶液治疗消化性溃疡出血的研究

目的 探讨致康胶囊溶液内镜下治疗消化性溃疡出血的效果。方法 对我院消化性溃疡出血患者94例观察治疗。本研究治疗组在内镜确诊的同时,应用致康胶囊溶液于病灶处局部加压喷注治疗。治疗组用生理盐水、致康胶囊溶液。对照组应用生理盐水、去甲肾上腺索内镜下治疗。结果 治疗组：47例,即刻止血39例,无效8例,总有效率82．98％,止血后复发17．95％;对照组：47例,即刻止血24例,无效23例,总有效率51．06％,止血后复发41．67％。结论 本研究在内镜确诊的同时,应用致康胶囊溶液于病灶处局部喷注治疗,治疗组疗效明显优于对照组。治疗后在再出血复发方面,治疗组发生率低于对照组。     

Endoscopic hemostasis by using the TriClip for peptic ulcer hemorrhage: a pilot study

BACKGROUND: The feasibility, efficacy, and safety of the TriClip in the management of peptic ulcer hemorrhage in human beings are scarcely reported in the literature. OBJECTIVE: A pilot study was conducted to assess the feasibility, efficacy, and safety of the TriClip endoscopic clipping device in the control of peptic ulcer hemorrhage. DESIGN: Prospective evaluation. SETTING: Regional government hospital. PATIENTS: From July 2004 to January 2005, patients older than 16 years and with Forrest type I and IIa peptic ulcer hemorrhages were included in the study. INTERVENTIONS: TriClips were used for initial hemostasis. Salvage procedures, including adrenalin injection, heat probe application, argon plasma coagulation, or surgery will be carried out appropriately if TriClip failed to control bleeding alone. An endoscopy was repeated 24 hours later for the security of the TriClip and for any endoscopic evidence of recurrent bleeding. A follow-up endoscopy was performed 8 weeks later to assess ulcer healing. MAIN OUTCOME MEASUREMENTS: Procedure time, successful hemostatic rate, number of clips used, ulcer recurrent bleeding rate, complications, and ulcer healing rate were measured. LIMITATIONS: No comparative arm; pilot study only. RESULT: A total of 27 cases (11 women, 16 men) were included in the study, with a median age of 70 years (range 18-88 years). There were 19 cases of duodenal ulcer and 8 cases of gastric ulcer, with median size of 8 mm (range 2-20 mm). The rate of successful hemostasis in the first endoscopy by TriClips alone was 81.5% (22/27), with a median procedure time of 10 minutes (range 3-30 minutes). In the second endoscopy, the endoscopic recurrent bleeding rate was 14.8% (4/27) and the TriClips were found dislodged in 11 patients (40.7%). The permanent hemostasis rate was 67% (18/27). The overall failure rate was 33% (9/27). Three patients required blood transfusion before the first endoscopy. There was no morbidity or mortality observed in all cases. All ulcers healed after 8 weeks. CONCLUSIONS: The use of the TriClip is feasible in the initial control of peptic ulcer hemorrhage. However, we could not detect any obvious advantages in arresting bleeding vessels by using this new clipping device.