胃溃疡穿孔修补术在基层医院的应用再探讨

目的探讨胃溃疡穿孔修补术在基层医院的应用。方法回顾性分析我院外科2006年1月—2011年12月47例胃溃疡穿孔行修补术患者的临床资料。结果 47例均进行了穿孔修补术,其中45例行电话和门诊检查随访,随访时间为6个月~36个月,无1例发生癌变。结论在基层医院单纯修补术仍是胃溃疡穿孔的主要手术方法,但是必须严格掌握手术指征,彻底性手术仍不能摒弃,临床医师要权衡利弊选择最佳治疗方案,并严格执行随访制度。     

Acid and Hyperosmolal Solutions in the Upper Intestine of Chronic Gastric Fistula Rats Inhibit Gastric Acid Secretion by Different Mechanisms

In chronic gastric fistula rats 0.20 M HC1 and 1200 mOsm × kg^-1 solution of polyethylene glycol (PEG) infused into a duodenal loop anastomosed to the jejunum (Roux-en-Y) produced maximal inhibition of pentagastrin-stimulated acid secretion, which amounted to 60% and 50%, respectively. In the present study in Roux-en-Y rats with gastric fistula, perfusion of the loop with hyperosmolal (1200 mOsm × kg^-1 of PEG solution) 0.20 M HC1 produced a greater reduction of the maximal response to pentagastrin (91% inhibition) than perfusion with 0.20 M HC1 (64%), suggesting that HC1 and hyperosmolal solution inhibit secretion by different mechanisms. The maximal acid response to histamine was more resistant to inhibition than that to pentagastrin; 0.20 M HC1 inhibited secretion by 43%, 1200 mOsm × kg^-1 of PEG solution by 42%, and hyperosmolal 0.20 M HC1 by 60%. The results suggest that HC1 and hyperosmolal solution also inhibit histamine-stimulated secretion by different mechanisms. The anatomical sites of the mechanisms remain to be established.     

Single Gastric Biopsy in Subjects with Low Acid Secretion after Maximal Histamine Stimulation

Examinations of 83 patients and 13 healthy subjects with the augmented histamine test and gastric biopsy show that a maximal acid secretion lower than 10 mEq HCl/hour signifies a diffuse gastritic lesion, the type of which can be verified by a single gastric biopsy. Detailed investigations of the nature and clinical course of gastritis, however, require repeated tests of gastric function and multiple gastric biopsies.     

Minimal-access surgery for gastric cancer in Japan

Recently in Japan, endoscopic surgery has become focused on minimally invasive treatment for early gastric cancer. Endoscopic mucosal resection (EMR) is used to treat small mucosal gastric cancers &#104 2 cm in size; however, total removal of the cancerous lesion in one session cannot be performed easily. Laparoscopic partial resection of the gastric wall is indicated for the same lesions as EMR, and we can achieve complete removal of cancer lesions more accurately. However, the extension of indication to depressed type cancer > 1 cm may carry the risk of lymph-node metastasis. Laparoscopic-assisted gastrectomy with lymph-node dissection is necessary for such lesions. It has many advantages over open gastrectomy in terms of postoperative pain, shorter febrile duration, reduced blood loss, earlier return to standing and earlier bowel movement. The wound is small and an almost-enclosed operation is possible. Furthermore, unlike other laparoscopic partial gastric resections, a major part of the regional lymph nodes can be extirpated, such as D1 + &#102. Laparoscopic gastrectomy will play a greater role in the future, especially in replacing open surgery in cases of early gastric cancer.     

Position paper update: gastric lavage for gastrointestinal decontamination

Context. The first update of the 1997 gastric lavage position paper was published by the American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists in 2004. This second update summarizes the 2004 content and reviews new data. Methods. A systematic review of the literature from January 2003 to March 2011 yielded few studies directly addressing the utility of gastric lavage in the treatment of poisoned patients. Results. Sixty-nine new papers were reviewed. Recent publications continue to show that gastric lavage may be associated with serious complications. A few clinical studies have recently been published showing beneficial outcomes, however, all have significant methodological flaws. Conclusions. At present there is no evidence showing that gastric lavage should be used routinely in the management of poisonings. Further, the evidence supporting gastric lavage as a beneficial treatment in special situations is weak, as is the evidence to exclude benefit in all cases. Gastric lavage should not be performed routinely, if at all, for the treatment of poisoned patients. In the rare instances in which gastric lavage is indicated, it should only be performed by individuals with proper training and expertise.     

支架蛋白RACK1与蛋白激酶WEE1互作调控胃癌细胞株HGC27增殖的作用研究

目的研究活化的蛋白激酶C受体(Receptor for activated protein kinase C,RACK1)与蛋白激酶WEE1互作调控胃癌细胞株HGC27生长增殖及其作用机制。方法采用Lipofect AMINE 2000在HGC27细胞中过表达RACK1,Western blotting检测HGC27细胞中WEE1蛋白表达;免疫共沉淀验证RACK1和WEE1在HGC27细胞内存在相互作用;细胞内免疫荧光观测RACK1与WEE1在HGC27细胞中的表达定位情况。结果过表达RACK1后WEE1在胃癌细胞HGC27中的表达降低,RACK1与WEE1在HGC27细胞内存在相互作用且共定位在细胞质内。结论 RACK1与WEE1共同作用调控胃癌的发生发展过程,为RACK1成为临床上胃癌治疗的潜在靶点提供理论基础和实验依据。     

实时超声法测定空腹胃窦面积的临床意义

本文利用实时超声法测定了５８例健康人及５９例胃病及糖尿病病人空腹胃窦面积。结果显示，健康中国人胃窦面积为１．５２ｃｍ２±０．４３ｃｍ２，与性别、年龄、身高、体重无关，胃炎、糠尿病、活动期十二指肠溃疡病人空腹胃窦面积均有不同程度扩大，慢性胃炎伴呃逆，腹胀症状及糖尿病病人异常率为１００％。本文中有２２例病人同时做食管测压检测，结果显示溃疡病病人空腹胃窦面积与食道上、中、下段压力均无关，糖尿病、胃炎病人胃窦面积与ＬＥＳＰ呈负相关。此研究结果提示空腹胃窦面积可在某种程度上代表胃排空功能。