目的 探讨和分析反流性食管炎与幽门螺杆菌感染之间的关系。 方法 回顾性分析2009年1月－2011年11月间胃镜确诊为反流性食管炎334例，所有患者均行快速尿素酶试验；其中反流性食管炎合并消化性渍疡57例，慢性非萎缩性胃炎102例。 结果 反流性食管炎的幽门螺杆菌感染率为21.6% ，在幽门螺杆菌感染阳性的患者中最多见并发消化性溃疡，而在幽门螺杆菌感染阴性的患者中最多见并发慢性非萎缩性胃炎，解剖结构和动力障碍性疾病绝大多数并发于幽门螺杆菌阴性患者。A和B级反流性食管炎的幽门螺杆菌感染阴性的患者多于幽门螺杆菌感染阳性的患者。在A级反流性食管炎中幽门螺杆菌感染率28.0%，B级为8.4%，C+D级为0.0%。 结论 反流性食管炎中幽门螺杆菌感染率低，幽门螺杆菌阳性的反流性食管炎多并发于消化性溃疡，提示幽门螺旋杆菌对反流性食管炎发病有一定保护作用。
目的:研究Child-Pugh分级对失代偿期肝硬化预后的预测价值。方法:对34例死于失代偿期肝硬化患者进行回顾性分析,应用Child-Pugh分级对初次入院资料进行评分及分级,并计算初次入院至死亡的时间。结果:Child-Pugh分级A级生存时间56.2±24.7月、B级33.1±10.5月、C级12.6±9.6月;以上消化道出血为主要表现的患者,生存时间相对非出血者低(Plt;0.05)。结论:Child-Pugh分级可做为预测失代偿期肝硬化患者的生存时间的重要的客观指标。而是否伴有上消化道出血对生存时间有较大的影响;上腹部增强CT对失代偿期肝硬化患者有无肝肾分流等侧支循环的评估有助于出血风险的判断。
ObjectiveTo explore and analyze the clinical diagnosis and treatment of gastroesophageal reflux disease (GERD) which is manifested mainly as stubborn pharyngitis. MethodsFrom February 2010 to December 2012, 79 cases were diagnosed as stubborn pharyngitis and otolaryngology standard treatment was invalid. GERD questionnaire ratings and conventional endoscopy were performed for patients with obvious manifestations of stubborn pharyngitis shown on the laryngoscopy. They were randomly divided into treatment group (n=40) and control group (n=39). Patients in the treatment group accepted esomeprazole 40 mg, qd, for 12 weeks; and patients in the control group had sucralfate suspension 15 mL bid for 12 weeks. At the three observation points which are 4, 8, and 12 weeks after treatment began, clinical symptom score and pharyngeal inflammatory changes were recorded, and at the end of the treatment, all patients underwent endoscopy, and esophageal mucosal healing was observed. ResultsThere was no significant difference between the two groups of patients in terms of general data. After the treatment, the symptom scores were significantly decreased in the treatment group at the three observation points (P<0.05). The same situation happened also in the control group, but the difference was not significant (P>0.05). The symptom scores between the two groups after treatment were significantly different (P<0.5). And the effective rate for local pharyngeal infection was 83.9% and 41.4% in the treatment group and the control group respectively (P<0.05). ConclusionSome atypical GERDs feature by the symptoms of stubborn pharyngitis. Clinically, patients with long-term stubborn pharyngitis should be screened to exclude the possibility of GERD. esomeprazole therapy can significantly improve the pharyngitis symptoms and relieve local inflammation.
Objective To evaluate the efficiency and security of physical exercise with low intensity against malnutrition and sarcopenia in patients with cirrhosis. Methods Between December 2014 and October 2015, 37 patients with cirrhosis were divided into two groups according to their willings, with 19 in the exercise group and 18 in the control group. Endurance of the exercise for 3 months were recorded. Mid-arm circumference, " up and go” time, width of portal vein and Child-Pugh score were compared before and after the research between the two groups. Results Three months later, the mid-arm circumference and the " up and go” time of the exercise group [(33.99±2.15) cm, (9.17±0.35) s] were better than those before the exercise [(32.09±2.58) cm, (9.77±0.46) s] and those in the control group [(31.93±2.04) cm, (9.76±0.30) s], and the differences above were all statistically significant (P<0.05). The change of the width of portal vein was positively correlated with pre-exercise body mass index in overweight patients (r=0.93, P=0.007). Conclusions Physical exercise with low intensity is safe and effective against malnutrition and sarcopenia in patients with cirrhosis. Overweitht patiens or malnutrition at the early stage may benefit more.
目的 比较CT门静脉血管成像（CTP）与内镜诊断肝硬化胃食管静脉曲张的效果，探讨CTP对肝硬化门静脉高压侧支循环血管的显示及其在随访中的价值。 方法 对2010年1月－2011年12月收治的43例肝硬化患者行多排螺旋CT增强扫描门静脉血管成像，观察胃食管静脉曲张程度，及有无其他侧支开放，并在4周内行内镜检查，了解胃食管静脉曲张的程度。 结果 43例患者中有33例经胃镜确诊食管静脉曲张，其中CTP诊断与胃镜相符29例；胃镜诊断胃底静脉曲张14例，其中有12例CTP诊断与之相符；CTP诊断胃食管静脉曲张与内镜有较好的相关性和一致性，但在判断食管静脉曲张部位上与胃镜一致性较差。 结论 对肝硬化患者可采用CTP进行随访，以评估胃食管静脉曲张出血风险，可减少不必要的内镜随访。
【摘要】 目的 探讨肝硬化食管静脉曲张程度与门脾静脉内径、肝功能Child-Pugh分级间的关系。 方法 对2007年1月-2010年1月间56例肝硬化患者行增强CT，测量门静脉主干及脾门部脾静脉直径，采用Child-Pugh分级标准进行肝功能分级，并行胃镜了解食管静脉曲张的程度。 结果 食管静脉曲张程度与门、脾静脉内径呈正相关，而Child-Pugh分级与门脾静脉内径、食管静脉曲张程度无相关性。 结论 根据门、脾静脉内径可预测肝硬化上消化道出血的可能性；在Child-Pugh分级基础上对患者上消化道出血的风险进行评估显得尤为重要。【Abstract】 Objective To discuss the relationship among the esophageal varices, the diameter of portal vein and spleen vein, and Child-Pugh score in patients with liver cirrhosis. Methods The study included 56 patients who had liver cirrhosis between January 2007 and January 2010. We measured their portal vein and spleen vein diameter with CT; used Child-Pugh score to grade their hepatic function; and detected the degree of the esophageal varices by endoscopy. Results There was a positive correlation between the degree of esophageal varices and diameter of portal vein and spleen vein, while no correlation showed between portal vein and spleen vein diameter, degree of esophageal varices, and Child-Pugh score. Conclusion The upper gastrointestinal bleeding in patients with liver cirrhosis can be predicted by the diameter of portal vein and spleen vein, assessment of upper gastrointestinal bleeding based on Child-Pugh score should also be taken into account.