Clinical Outcomes Associated with Treatment Modalities for Gastrointestinal Bezoars

Background/Aims

With technical and instrumental advances, the endoscopic removal of bezoars is now more common than conventional surgical removal. We investigated the clinical outcomes in a patient cohort with gastrointestinal bezoars removed using different treatment modalities.

Methods

Between June 1989 and March 2012, 93 patients with gastrointestinal bezoars underwent endoscopic or surgical procedures at the Asan Medical Center. These patients were divided into endoscopic (n=39) and surgical (n=54) treatment groups in accordance with the initial treatment modality. The clinical feature and outcomes of these two groups were analyzed retrospectively.

Results

The median follow-up period was 13 months (interquartile range [IQR], 0 to 77 months) in 93 patients with a median age of 60 years (IQR, 50 to 73 years). Among the initial symptoms, abdominal pain was the most common chief complaint (72.1%). The bezoars were commonly located in the stomach (82.1%) in the endoscopic treatment group and in the small bowel (66.7%) in the surgical treatment group. The success rates of endoscopic and surgical treatment were 89.7% and 98.1%, and the complication rates were 12.8% and 33.3%, respectively.

Conclusions

Endoscopic removal of a gastrointestinal bezoar is an effective treatment modality; however, surgical removal is needed in some cases.     

风险护理对食管平滑肌瘤患者内镜下剥离电切术治疗效果与手术时间、术中出血量的影响

目的探讨风险护理对食管平滑肌瘤患者内镜下剥离电切术治疗效果与手术时间、术中出血量的影响。方法 选取2018 年5 月～2019 年5 月我院收治的食管平滑肌瘤患者98 例,随机分为研究组（n=49）与对照组（n=49）。对照组应用常规护理,研究组应用风险护理。比较两组患者的手术时间、术中出血量、满意度及不良事件发生率。结果 研究组患者的手术时间与术中出血量均少于对照组（P＜0.05）;研究组患者的满意度高于对照组（P＜0.05）;研究组食管穿孔、局部肿胀等不良事件发生率低于对照组（P＜0.05）。结论 在食管平滑肌瘤患者内镜下剥离电切术的护理过程中,应用风险护理,可以提高患者的临床治疗效果,且患者的满意度较高,不良事件发生率降低,可在临床推广应用。     

134例贲门息肉患者内镜及病理特征研究

目的研究胃贲门息肉的内镜下表现、病理特征,提高对其认识。方法回顾分析解放军总医院内镜中心2012年-2013年134例贲门息肉患者内镜及病理资料。结果贲门息肉的检出率为0.495%。134例贲门息肉中,增生性息肉123例,贲门腺癌2例,胃底腺息肉9例。增生性息肉的组织来源主要为胃柱状上皮。贲门增生性息肉常合并反流性食管炎和慢性胃炎。结论贲门息肉是一组异质性疾病,最多见的是增生性息肉,极少数为贲门腺癌。     

炎症性肠病发生消化道狭窄的临床特点分析

目的探讨住院炎症性肠病(inflammatory bowel disease,IBD)患者发生消化道狭窄的临床特点。方法纳入2010年1月至2018年12月在中国人民解放军总医院第七医学中心住院诊治的IBD患者,对发生消化道狭窄患者的诊治过程和随访情况进行回顾性分析。结果发生消化道狭窄患者118例(23.14%),其中克罗恩病(Crohn’s disease,CD)、溃疡性结肠炎(ulcerative colitis,UC)和IBD类型待定(IBD unclassified,IBDU)的消化道狭窄发生率分别为59.02%、6.67%和34.25%,三者比较,差异有统计学意义(P<0.001)。病程0~10年的消化道狭窄发生率为25.06%,而病程>10年的发生率为14.29%,二者比较,差异有统计学意义(χ2=4.880,P=0.027)。发生消化道狭窄患者中,33.90%(40例)的患者经单纯药物治疗有效;55.93%(66例)的患者予以外科手术治疗,术后并发症发生率为18.46%(12例),10.61%(7例)的患者予以再次手术治疗。27.12%(32例)的患者予以内镜下治疗,内镜治疗有效率为81.25%(26例),18.75%(6例)的患者经内镜治疗无效后行外科手术治疗,内镜治疗术后并发症发生率为3.13%(1例)。结论消化道狭窄是IBD的严重并发症之一,CD的消化道狭窄发生率显著高于UC。有效的内科药物及营养治疗可降低消化道狭窄发生率、手术率。内镜治疗消化道狭窄具有较高的有效性、安全性,可有效避免外科手术的发生。     

我国消化内镜传统诊治项目开展现状与分析:169家医院调查报告

目的 调查分析我国消化内镜传统诊治项目(常规胃肠镜检查、息肉切除等)开展状况.方法 以国内不同省份的各级医院消化内镜单元(室)为调查对象,采用电子邮件或电话问卷方式对我国消化内镜传统诊治项目开展状况进行调查分析.率的比较采用X2检验.结果 自2010年5月至11月,共有169家医院纳入本次调查,分布于28个省,占国内大陆省份的90.3％ (28/31),其中147家医院可开展消化内镜操作,占87.0％.在这147家医院中,所有医院(100％)均可开展常规胃镜检查,93.9％(138/147)的医院可开展肠镜检查,二、三级医院肠镜开展率(97.8％、100％)高于一级医院(25.0％,x2=60.9,P＜0.01);所有三级医院(100％)和79.8％(71/89)的二级医院能开展内镜下息肉切除术,明显高于一级医院(16.7％,x2=20.0,P＜0.01);在147家医院中,共有74家开展经内镜逆行胰胆管造影(ERCP),占50.3％,其中76.1％(35/46)的三级医院、43.8％(39/89)的二级医院可开展ERCP,三级医院高于二级医院(x2=12.7,P＜0.01);12家已开展消化内镜操作的一级医院中,均未开展ERCP、超声内镜检查(EUS)及食管静脉套扎+硬化(EVL+ EVS)治疗.结论 常规胃肠镜检查在我国二、三级医院已普及,一级医院还有较大提升空间;ERCP术及EVL+ EVS等传统消化内镜介入操作在三级医院较普及,二级医院有待提高.     

Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies

Background

The aim of the present study was to comparatively evaluate the outcomes of laparoscopic transabdominal preperitoneal inguinal hernia repair and totally extraperitoneal repair.

Methods

The electronic databases of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a meta-analysis of randomized clinical trials was undertaken.

Results

Seven studies comprising 516 patients with 538 inguinal hernia defects were identified. A shorter recovery time (P = .02) was found for totally extraperitoneal repair in comparison with transabdominal preperitoneal inguinal hernia repair (weighted mean difference = −.29; 95% confidence interval [CI], −.71 to .07) although the length of hospitalization (P = .89) was similar in the 2 treatment arms (weighted mean difference = .01; 95% CI, −.13 to .15). Operative morbidity (P = .004) was higher for the preperitoneal approach (odds ratio = 2.15; 95% CI, 1.29 to 3.61). No differences were found with regard to the incidence of recurrence, long-term neuralgia, and operative time.

Conclusions

Current evidence suggests similar operative results for endoscopic and laparoscopic inguinal hernia repair, with a trend toward higher morbidity for the preperitoneal approach. Randomized trials with a longer-term follow-up are needed in order to assess the effect of each approach on the prevention of recurrence.     

念珠菌性食管炎98例诊治分析

目的了解念珠菌性食管炎的危险因素和治疗方案的选择。方法念珠菌性食管炎患者98例,对照组196例,分析其高危因素。念珠菌性食管炎组剔除10例长期服用PPI的患者后,剩余88例按抽签单双号方式随机分为氟康唑治疗组和制霉素治疗组各44例,分别给予2周的抗真菌治疗,疗程结束后复查胃镜,分析治疗效果,并对所有患者进行药物敏感测试。结果念珠菌性食管炎的高危因素包括应用广谱抗生素(OR=5.66,χ2=20.14,P<0.05)、糖尿病(OR=4.00,χ2=7.96,P<0.05)、质子泵抑制剂(OR=3.59,χ2=6.46,P<0.05)、恶性肿瘤(OR=3.41,χ2=10.40,P<0.05)等。治疗效果方面,制霉素治疗组37例(84.1%)患者完全治愈,5例(11.4%)患者治疗有效,2例(4.5%)患者治疗无效;氟康唑治疗组35例(79.5%)患者完全治愈,8例(18.2%)患者治疗有效,1例(2.3%)患者治疗无效;两组在治愈率方面无统计学差异(P>0.05)。氟康唑耐药率为8.6%,制霉素为7.1%,无统计学差异(P>0.05)。制霉菌素组治疗费用明显低于氟康唑组(P<0.05),二者在药物副反应方面无明显差异(P>0.05)。结论使用广谱抗生素、质子泵抑制剂、合并恶性肿瘤、糖尿病是念珠菌性食管炎的危险因素,制霉素可以作为治疗念珠菌性食管炎一种安全、有效、经济的选择。     

嗜酸性粒细胞性胃肠炎32例临床诊治分析

目的 分析嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、内镜下表现、病理特点及诊治要点,以提高对该病的认识.方法 回顾性分析湖北医药学院附属太和医院消化内科2001年1月～2011年5月收治的32例EG患者临床资料,对病史、临床表现、实验室结果、内镜结果及治疗情况汇总分析.结果 32例患者黏膜型25例,浆膜型6例,黏膜-肌层混合型1例;患者多以腹痛为首发症状(84.38％);外周血和骨髓嗜酸粒细胞(ensinophils,EOS)计数明显增高(14.2％ ～49.5％ vs 12.5％ ～42.5％);镜下表现为黏膜充血水肿、糜烂、红斑,病变多分布在胃窦部、十二指肠和结肠;活检和腹水检测有大量EOS浸润;糖皮质激素治疗后患者症状缓解,复发用药亦有效.结论 EG多以腹痛起病,胃窦部、十二指肠、结肠为常见病变部位,内镜活检和腹水中见EOS浸润有助于明确诊断,糖皮质激素疗效好.