目的：比较胃溃疡与溃疡型胃癌的发病特点。方法：对69例胃溃疡与32例胃癌进行回顾性分析，比较二者好发年龄、胃镜下变病部位和大小的差异。结果：63.7%胃溃疡多发生于50岁以下患者，81.3%胃癌发生于50岁以上患者（Ｐ＜0.01）。贲门部的胃癌是胃溃疡的5倍（Ｐ＜0.01）；胃角部的胃溃疡是胃癌的9倍（Ｐ＜0.01）；溃疡型胃癌与胃溃疡都易发生在胃窦，且检出率相似。82.6%胃溃疡直径＜3 cm，78.1%胃癌直径≥3 cm（Ｐ＜0.01）。结论：胃溃疡与溃疡型胃癌的好发年龄、生长部位和大小几乎各不相同，这些发病特点对溃疡型胃癌的早期诊断有一定指导意义。
目的 探讨环氧化酶-2（COX-2）在幽门螺杆菌（Hp）感染与非感染性胃溃疡及胃癌的表达。 方法 选择绵阳市404医院消化内科2011年2月－2012年2月的门诊及住院患者，用免疫组织化学方法检测196例经胃镜和组织病理学检查明确为胃溃疡（病理分型：肠上皮化生、异型增生）、胃癌及正常胃黏膜者的胃黏膜COX-2蛋白的表达，比较各病理分类之间及Hp感染与非感染之间COX-2蛋白表达的差异。 结果 胃溃疡（肠上皮化生、异型增生）、胃癌组的炎症细胞、腺上皮细胞、癌细胞及极少量正常黏膜上皮细胞中有COX-2表达。从正常胃黏膜-胃溃疡（肠上皮化生、异型增生）-胃癌COX-2的阳性表达有逐渐增强的趋势（P＜0.05）。Hp阳性组COX-2的阳性表达高于Hp阴性组（P＜0.05），胃癌组COX-2的阳性表达高于胃溃疡组（P＜0．05）。 结论 COX-2在胃癌的表达高于胃溃疡。Hp感染可诱导COX-2过度表达。
目的 探讨康复新液联合奥美拉唑三联疗法治疗幽门螺杆菌（Hp）阳性的胃溃疡的临床疗效和内镜下溃疡愈合情况。 方法 将2010年1月－2012年1月对住院及门诊180例内镜诊断并检测证实Hp阳性的胃溃疡患者，按计算机产生的随机数字表随机分为两组，每组各90例。两组均给予口服奥美拉唑20 mg，2次/d，克拉霉素0.5 g，2次/d，甲硝唑0.4 g，2次/d，铝碳酸镁1.0 g，3次/d，治疗7 d。7 d后改为口服奥美拉唑20 mg，1次/d，铝碳酸镁1.0 g，3次/d，疗程4周，治疗组加服康复新液10 mL，3次/d；对照组不使用康复新液。治疗期间以上腹痛作为判断症状改善的主要指标，疗程结束后复查胃镜观察溃疡愈合情况，同时观察药物不良反应。 结果 治疗组在临床症状改善总有效率93.3%，对照组为总有效率82.2%；溃疡病灶愈合方面治疗组总有效率94.4%，对照组为总有效率83.3%，两组比较有统计学意义（P＜0.05），临床应用4周后无任何不良反应，Hp根除率两组间差异无统计学意义。 结论 康复新液联合奥美拉唑三联疗法可有效治疗胃溃疡，治疗期间患者未发生不良反应，为治疗胃溃疡的一种安全有效的药物。
【摘要】 目的 讨论胃充盈超声造影在胃溃疡患者术后的应用价值。 方法 2002年6月-2009年6月对因胃溃疡行手术的72例患者采用饮水法充盈胃进行术后超声检查随访，观察术后胃的容量变化、术后近期并发症及远期并发症。 结果 所有胃术后的患者，近期胃容量较前减少60%～70%，随着时间的延长，容量逐渐恢复，最大恢复至术前的50%。吻合处胃壁僵直，蠕动波消失。十二指肠残端漏2例，近期吻合口狭窄5例，胃瘫综合症3例，吻合口反流40例，有临床症状的患者10例，无临床症状的患者30例，复发性溃疡1例，未发现残胃癌及远期吻合口梗阻。 结论 胃充盈超声造影是胃溃疡术后简单易行的随访方法，具有重要的临床应用价值。【Abstract】 Objective To evaluate the use of contrast-enhanced ultrasonography of gastric filling in gastric ulcer patients after the operation. Methods A total of 72 patients who underwent the operation due to gastric ulcer between June 2002 and June 2009 were selected. We used water-drinking method for filling stomach to perform the ultrasonic examination and the patients were followed up. The post-operation changes in the capacity of the stomach, postoperation complication and long-term complication were observed. Results The reduction of recent stomach capacity was 60%-70% in of the patients after the operation. As time goes on, the capacity gradually recovered, and the largest recovery was 50%. Anastomosis gastric wall was stiff, and peristaltic wave disappeared. Drain off residual duodenum was found in 2 patients, anastomotic stricture near was in 5, delayed gastric emptying was in 3, anastomotic reflux was in 40, clinical symptoms was in 10, no clinical symptoms was in 30, and recurrent ulcer was in 1. No gastric remnant cancer or long-term anastomtic obstruction was observed. Conclusion Contrast-enhanced ultrasonography of gastric filling is a simple and practicable ultrasound follow-up method after gastric ulcer.
摘要:目的:探讨量子血液疗法在胃溃疡治疗中的作用。方法:114例胃溃疡患者随机分为治疗组和对照组。治疗组60例,对照组54例。疗程均为4周。结果:经临床症状缓解,HP阴转及胃镜和病理复查的比较,治疗组总有效率99%,对照组总有效率为78%。经统计学处理,治疗组效果明显优于对照组(Plt;001)。结论:量子血液疗法对胃溃疡有肯定的辅助治疗作用。
Objective To evaluate the effect of ultrasound guided percutaneous drainage on acute perforation of gastroduodenal ulcer in elderly patients. Methods The clinical features, treatments, and the curative effects of 86 elderly cases (≥65 years) of acute perforation of gastroduodenal ulcer in our hospital between January 2004 and October 2009 were retrospectively analyzed. Twenty-one cases were treated by ultrasound guided percutaneous drainage (drainage group), and 65 cases were treated by exploring operation (operation group). Results Drainage group was cured and had no complications. In 15 patients which accepted recheck one month after drainage, gastroscope showed the ulcer healed in 12 cases， and improved in 3 cases. In operation group, 63 cases were cured and 2 cases died. Compared with the drainage group, there was no significant difference in cure rate (Pgt;0.05). However, 11 patients had operative complications in operation group, which was significantly more than that in the drainage group （Plt;0.05）. In 45 patients which accepted recheck one month after operation, gastroscope showed the ulcer healed in 38 cases， and improved in 7 cases. Conclusion For elderly patients with acute perforation of gastroduodenal ulcer， if the patients do not fit for exploring operation， ultrasound guided percutaneous drainage is proved to be a simple, safe, and effective means.
目的 探讨预防胃大部切除术后碱性返流性胃炎的术式。方法 回顾性分析1998年6月至2008年12月期间我科收治的42例行胃大部切除术患者的临床资料，根据不同术式分为传统Billroth-Ⅱ（简称B-Ⅱ）式组（n=21）和改良B-Ⅱ式组（n=21），对2组患者术后胃肠引流液的量、剑突下持续烧灼痛、胆汁性呕吐、体重减轻以及肠胃液返流情况进行比较。结果 传统B-Ⅱ式组胃肠引流液量平均为（300±50） ml，而改良B-Ⅱ式组胃肠引流液量平均为（100±40） ml,2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组剑突下持续烧灼痛12例，胆汁性呕吐8例，体重减轻1例； 而改良B-Ⅱ式组仅出现1例剑突下持续烧灼痛和1例体重减轻，未见胆汁性呕吐病例，2组间比较差异有统计学意义（P＜0.05）。传统B-Ⅱ式组发生轻度返流9例，重度返流12例; 改良B-Ⅱ式组仅2例发生轻度返流，1例重度返流，其余均未见返流，2组间比较差异有统计学意义（P＜0.05）。结论 与传统B-Ⅱ式相比，改良B-Ⅱ式的碱性返流性胃炎发生率明显降低，术后效果满意。