OBJECTIVE To sum up the experience of diagnosis and treatment of intrinsic upper gastro-intestinal membrane, 13 cases in children were studied retrospectively. METHODS There were 10 boys and 3 girls, the major symptoms were vomiting and epigastric distension. Eleven cases were treated by membranectomy with intestinal plasty, and 2 cases were treated by retrocolic side to end duodenojejunostomy. RESULTS All cases had good results without severe complications. CONCLUSION The children who have typical symptom of upper digestive tract should be considered duodental and upper jejunal membrane, and should be proved by contrast radiology. The membranectomy with intestinal plasty is the better operative method.
目的:探討幽門螺桿菌(Hp)感染與各種常見上消化道疾病的關系。 方法:回顧性地分析了2008年于我院采用快速尿素酶試驗(RUT)檢測Hp的6636例門診及住院患者Hp感染情況,及與性別、年齡、病種的關系。結果:6636例患者中,Hp陽性3248例,檢出率為48.9%;其中男性4391例,檢出率為49.97%,女性2 245例,檢出率為46.9%,男性略高于女性,差異有統計學意義(Plt;0.05);20～29歲和30～39歲這兩個年齡段Hp檢出率最高,分別為58.4%和54.6%,lt;20歲Hp檢出率最低(38.8%),各組間差異有統計學意義(Plt;0.01);各種常見的上消化道疾病,復合性潰瘍和上消化道惡性腫瘤Hp檢出率最高,分別為86.2%和84.1%,其次是幽門管潰瘍和十二指腸潰瘍,檢出率分別為54.2%和51.9%,慢性胃炎、殘胃炎、胃潰瘍和食管靜脈曲張Hp檢出率分別為46.9%、40.0%、36.6%和34.2%,各組間的差異有顯著的統計學意義(Plt;0.005)。 結論:本組資料Hp總檢出率為48.9%,男性略高于女性,慢性胃炎、消化性潰瘍和上消化道惡性腫瘤與Hp感染密切相關,尤以復合性潰瘍和上消化道惡性腫瘤更為顯著。
目的:研究上消化道大出血的外科處理辦法。方法:選因上消化道大出血而進行手術者共34例,尋找術前病因及出血部位,對不同病因和部位出血病例進行了相應的手術治療。結果:所有病例無1例死亡。術后出現吻合口滲血2 例,經止血,對癥治療出血停止。無1例再出血就診。結論: 對上消化道大出血患者,針對不同的情況,可分別采用全胃切除術、接近全胃切除術、迷走神經切斷加胃大部分切除術、迷走神經切斷加幽門成形等外科手術方式處理。
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
ObjectiveTo investigate the relationship between chronic obstructive pulmonary disease (COPD) and respiratory failure in patients with upper gastrointestinal bleeding and recent prognosis. MethodsWe retrospectively analyzed the clinical data of 73 patients with COPD and respiratory failure treated from February 2009 to May 2011. The patients were assigned to the observing group (n=33) and control group (n=40). General characteristics, improvement rates, mortality rates, lengths of hospital stay, endotracheal tube rates and arrhythmia rates were compared between the two groups. ResultsAge, sex, and medical history of the patients were similar in both groups (P>0.05). Compared with the control group, the improvement rate was lower (P<0.001), the mortality rate (P<0.001), length of hospital stay (P<0.001), endotracheal tube rate (P<0.05) and arrhythmia rate (P<0.05) were all higher in the observing group after treatment. ConclusionUpper gastrointestinal bleeding is a high risk factor for short-term prognosis patients with COPD and respiratory failure.
Objective To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.
目的:探索上消化道出血患者焦慮發生情況和相關因素分析。方法:采用問卷調查法對70 例上消化道出血患者發生情況進行研究,分析焦慮發生與患者性別、年齡、文化程度、醫療費用支付方式、出血次數、臨床癥狀、疾病了解程度及合并疾病的相關性。結果:上消化道出血患者焦慮發生率為58.6 %。女性患者焦慮發生率明顯高于男性患者,出血量多的患者焦慮發生率明顯高于出血量少的患者,出血次數、有無合并癥與焦慮有明顯相關性。結論:正確認識焦慮是開展負性情緒干預的前提,針對上消化道出血患者焦慮發生相關因素,積極開展心理疏導,是保障手術順利進行的重要環節。