ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.
Considering the problems such as reposition limited, easily detached and singly fired of the existing clip products, we developed an endoscopic multiple-clip applier which can apply 4 clips fired successively at a time. The instrument also equipped with an independent grasper which can be used to clamp target tissues. In order to explore its feasibility and effectiveness of endoluminal closure of gastric perforation, 22 pig stomachs were making a 1 cm full-thickness incision from outside and closed by multiple-clip applier (n=12) in vitro. Outcome was measured by bursting pressure and compared with negative control (n=5) and hand suture (n=5). We set a threshold pressure value (10 mm Hg) for a secure closure. Except 2 cases of invalid data, the mean bursting pressures of negative control, multiple-clip applier, hand suture were (1.5±0.3) mm Hg, (46.0±7.1) mm Hg, and (72.5±7.7) mm Hg, respectively. The results showed that bursting pressure of multiple-clip applier was significantly higher than that of negative control (P＜0.05) and threshold value. Multiple-clip applier can be served as an effective and safe device to perform the endoluminal closure of gastric perforation.
目的探討胃癌穿孔的手術時機及術式選擇。方法對我院1985年1月至2000年12月間急診收治的64例胃癌穿孔患者的資料進行回顧性分析。結果保守治療后行擇期手術5例； 59例行急診手術，其中行根治性切除術22例，姑息性切除術10例，穿孔修補后3周內二期行根治性手術6例，行單純穿孔修補術14例，穿孔修補+短路手術7例。本組手術后30天內死亡6例，死亡率為9.4%，58例中獲隨訪52例，隨訪5年，失訪6例，其中根治性手術、姑息性切除、單純穿孔修補和穿孔修補+短路手術者平均生存期分別為31個月、18個月、5個月和7個月。結論合理的手術時機及術式選擇是延長患者生命和提高患者生存質量的關鍵所在。