Objective To analyze and summarize the clinical characteristics of foreign body incarceration in upper digestive tract, and to explore the risk factors of its complications. Methods The clinical data of patients with foreign bodies in the upper digestive tract treated in the Affiliated Hospital of Zunyi Medical University between January 1, 2012 and December 31, 2021 were retrospectively analyzed, including demographic data, foreign body type, incarceration site, incarceration time, causes, symptoms, treatment methods and complications of foreign body incarceration. Logistic regression analysis was used to explore the risk factors of complications. Results A total of 721 patients were finally included, ranging in age from 3 months to 90 years old, with an average age of 26.76 years. The proportion of foreign bodies in the upper digestive tract in patients ≤14 years old was the highest (51.18%), and the duration of foreign body incarceration<12 hours was the highest (55.34%). The most common sharp foreign bodies in the upper digestive tract were animal bones (228 cases), and the most common round shaped foreign bodies were coins (223 cases). The most common impaction site was the upper esophageal segment (85.02%). 105 patients (14.56%) had complications, and perforation was the most common (5.55%). Logistic regression analysis showed that age [odds ratio (OR)=0.523, 95% confidence interval (CI) (0.312, 0.875), P=0.014], foreign body type [OR=0.520, 95%CI (0.330, 0.820), P=0.005], incarceration site [OR=2.347, 95%CI (1.396, 3.947), P=0.001], incarceration time [OR=0.464, 95%CI (0.293, 0.736), P=0.001] were the influencing factors of complications. Conclusions The majority of foreign bodies in the upper digestive tract are animal bones. The incidence of complications increase in patients with age ≥ 60 years, sharp foreign body edges, incarceration in the upper segment of the esophagus, and long incarceration time. It is recommended to remove the sharp foreign bodies incarcerated in the upper segment of the esophagus from the elderly as soon as possible.
【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
ObjectiveTo investigate the value of the change trend of lactic acid level 24 h after operation in predicting the complications of upper gastrointestinal ulcer perforation. MethodsA total of 167 patients with upper digestive tract ulcer perforation who underwent surgical treatment in Shougang Hospital of Peking University from March 2021 to June 2023 were selected as the study objects, and were divided into mild to moderate group (n=117) and severe group (n=50) according to the severity of the disease. General data and lactic acid levels in 24 h after surgery were compared between the two groups. In addition, according to whether the patients had complications or not, they were divided into a group without complications (n=119) and a group with complications (n=48). The general data of the two groups were compared. A combined model was constructed, and Cox regression model was used to analyze the relationship between the change of lactic acid level at 24 h after operation and the complications of infection. Logistic regression model combined with restricted cubic spline model was used to analyze the dose-response relationship between lactic acid level and infection complications in patients with upper gastrointestinal ulcer perforation 24 h after operation. Log-binomial model was used to analyze the risk effect of complication types on lactic acid levels in patients with upper gastrointestinal ulcer perforation. ResultsAt 8, 16 and 24 h after operation, lactic acid levels in both groups (mild to moderate group and severe group) were significantly lower than before operation, and lactic acid level in mild to moderate group was significantly lower than that in severe group (P<0.05). Repeated measurement ANOVA showed that the time effect, intergroup effect and interaction effect of lactic acid levels were significantly different between the two groups (P<0.05). There were significant differences in exhaust time, postoperative hospital stay, C-reactive protein, lactic acid level and red blood cell distribution width between the complicated group and the uncomplicated group (P<0.05). The combined model showed that each longitudinal increase of 1 mmol/L in lactic acid level 24 h after operation, was associated with a 4% increased risk of infection complications. The limit cubic spline map showed that lactic acid level at 24 h after operation was 4.22 mmol/L as the critical point of the dose-response relationship in the infection complications of patients with upper gastrointestinal ulcer perforation. Log-binomial model analysis results showed that when lactic acid level ≥4.22 mmol/L, patients with upper gastrointestinal ulcer perforation in the complication group had the highest risk of abdominal infection. The risk ratios (95%CI) before and after adjustment were 2.09 (1.25, 2.64), 2.16 (1.28, 2.05) and 2.20 (1.32, 2.63) times of those in the uncomplicated group, and the risk ratios of different lactic acid levels were statistically significant before and after adjustment (P<0.05). ConclusionLactic acid level increased 24 h after operation in patients with upper gastrointestinal ulcer perforation is closely related to infection complications, and has a high predictive value for infection complications in patients with upper gastrointestinal ulcer perforation.
目的 探讨胃切除术后近期上消化道大出血的原因及再手术治疗。 方法 对我院1986~2002年间收治的14例胃切除术后近期（24～72 h内）上消化道大出血行再手术治疗的病例资料进行回顾性分析。 结果 本组14例，术后吻合口出血4例，残胃粘膜损伤出血2例，残胃肠套叠出血2例，十二指肠残端出血1例，遗漏十二指肠球后溃疡及贲门粘膜撕裂出血各1例，原因不明出血3例，均经再次手术治疗后痊愈。 结论 胃切除术后近期上消化道大出血原因多为操作不当及病灶遗漏所致，出血灶直视下缝扎为有效止血方法。
Objective To investigate the effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. Methods Seventy-six patients who received traditional treatment between October 2020 and March 2021 were included in the traditional treatment group, and 82 patients who entered the emergency fast track for dangerous upper gastrointestinal bleeding between April 2021 and September 2021 were included in the fast-track treatment group. The patients in the traditional treatment group were treated with the traditional single-subject diagnosis and treatment mode, and the patients in the fast-track treatment group were treated according to the multidisciplinary diagnosis and treatment procedures of emergency fast track for dangerous upper gastrointestinal bleeding. The length of emergency stay, 24-hour endoscopic completion rate, effective rate, and length of hospital stay were compared between the two groups. Results The length of emergency stay [(3.75±3.19) vs. (6.51±4.72) h], the effective rate (96.3% vs. 85.5%) and the length of hospital stay [(8.26±2.51) vs. (11.07±2.79) d] were significantly better in the fast-track group than those in the traditional treatment group (P<0.05). There was no significant difference in the 24-hour endoscopic completion rate between the two groups (96.3% vs. 96.1%, P>0.05). Conclusion Compared with the traditional treatment mode, the fast-track treatment mode can significantly improve the treatment efficiency, and reduce the lengths of emergency stay and hospital stay.
目的:观察用白眉蛇毒血凝酶(邦亭)治疗上消化道出血的疗效。方法 上消化道出血患者90例,随机分为治疗组和对照组,所有病例均给予扩容及调整水电解质紊乱,静滴奥美拉唑42.6mg,每日1次;静滴卡络磺钠60mg,每日1次,重度贫血者予输血。治疗组再应用邦亭4 KU加生理盐水20mL口服,每日2次,对照组用去甲肾上腺素8mg加生理盐水90mL,每日分3次口服。结果 治疗组总有效率93.75%,对照组总有效率8095%,两组临床疗效差异有统计学意义(Plt;0.05)结论:白眉蛇毒血凝酶是一种有效的、安全的治疗上消化道出血的药物,在临床止血治疗中值得推广应用。
ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.
Objective To systematically evaluate the effectiveness and safety of China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding. Methods Such databases as PubMed, MEDLINE, Springer, The Cochrane Library, CNKI, VIP, CBM and WanFang data were searched to collect the randomized controlled trials (RCTs) about China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding, and the references of included studies were also retrieved. The retrieval time was from inception to December 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.1 software. Results A total of 11 RCTs were included. Among all 1 075 patients, 544 were in the treatment group, while the other 531 were in the control group. The results of meta-analysis showed that, there were no significant differences in the total effective rate (OR=0.68, 95%CI 0.35 to 1.33, P=0.26) and safety (RR=1.33, 95%CI 0.45 to 3.91, P=0.96) between the China-made omeprazole and imported omeprazole. Conclusion China-made omeprazole is effective and safe in treating acute non-variceal upper gastrointestinal bleeding in comparison with the imported omeprazole.