目的:探讨幽门螺杆菌(Hp)感染与各种常见上消化道疾病的关系。 方法:回顾性地分析了2008年于我院采用快速尿素酶试验(RUT)检测Hp的6636例门诊及住院患者Hp感染情况,及与性别、年龄、病种的关系。结果:6636例患者中,Hp阳性3248例,检出率为48.9%;其中男性4391例,检出率为49.97%,女性2 245例,检出率为46.9%,男性略高于女性,差异有统计学意义(Plt;0.05);20～29岁和30～39岁这两个年龄段Hp检出率最高,分别为58.4%和54.6%,lt;20岁Hp检出率最低(38.8%),各组间差异有统计学意义(Plt;0.01);各种常见的上消化道疾病,复合性溃疡和上消化道恶性肿瘤Hp检出率最高,分别为86.2%和84.1%,其次是幽门管溃疡和十二指肠溃疡,检出率分别为54.2%和51.9%,慢性胃炎、残胃炎、胃溃疡和食管静脉曲张Hp检出率分别为46.9%、40.0%、36.6%和34.2%,各组间的差异有显著的统计学意义(Plt;0.005)。 结论:本组资料Hp总检出率为48.9%,男性略高于女性,慢性胃炎、消化性溃疡和上消化道恶性肿瘤与Hp感染密切相关,尤以复合性溃疡和上消化道恶性肿瘤更为显著。
目的 对上消化道异物的诊治手段及结果进行阶段总结，方便今后诊治手段的选择。方法 对1999~2006年甘肃省康泰医院收治的75例上消化道异物患者的诊断及治疗过程进行回顾性研究。结果 本组病例经保守治疗异物自行排出42例，内镜取出8例，外科手术取出25例，均取得了满意的疗效，住院期间未出现严重并发症。结论 上消化道异物的治疗措施，应依照异物具体情况选择，推荐内镜治疗为首选治疗方法。
Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.
目的 总结经颈静脉肝内门体静脉分流术（TIPS）治疗未合并肝癌的门静脉高压症患者行脾切除术后反复上消化道出血的疗效。方法 对未合并肝癌或胆管癌的门静脉高压症合并上消化道大出血患者行脾切除术后复发出血患者行TIPS术治疗，并随访1～5年（平均3.2年）的资料进行总结与分析。结果 36例脾切除术后再出血者行TIPS术， 手术均获成功，围手术期死亡率为2.78％（1/36），死亡原因是肝性脑病。随访期间患者术后再次复发出血率为5.71％（2/35）。结论 TIPS对脾切除治疗门静脉高压症后反复出血病例的效果良好。
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.
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.
Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.