摘要:目的:研究分析德阳地区消化性溃疡的流行病学特点,为其防治提供依据。方法:对我院2002年1月至2007年12月中经胃镜检查诊断为消化性溃疡的病例的年龄、性别、发病季节、溃疡部位、幽门螺杆菌感染和并发症进行回顾性统计分析。结果:共检出5820例消化性溃疡,其中十二指肠溃疡(DU)3696例,胃溃疡(GU)1558例,复合性溃疡(CU)566例。溃疡患者男女比例为256:1。胃溃疡患者平均年龄为4782岁,比十二指肠溃疡患者大58岁。检出率以冬季最高(3225%),夏季最低(2163%),具有统计学意义(Plt;001)。幽门螺杆菌感染阳性率为9082%。结论:消化性溃疡的发生与季节、年龄、性别和部位相互有关,合并幽门螺杆菌感染者占绝大多数,并发症发生率低。
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
ObjectiveTo discuss the etiological factors and risk factors for peptic ulcer hemorrhage with negative Helicobacter pylori (HP). MethodsA total of 182 patients with peptic ulcer treated in our hospital from January 2010 to December 2012 were chosen in our study. There were 85 cases of hemorrhage among them, with 50 HP positive and 35 HP negative ones. The other 97 patients were without hemorrhage. Etiological factors and correlated risk factors for peptic ulcer hemorrhage with HP negative were analyzed. ResultsHP negative rate of the hemorrhage group was 41.2%, while that rate of the non-hemorrhage group was 14.4%, and the difference was significant (P<0.05). The patients with peptic ulcer hemorrhage with negative HP had correlations with age, sex, wine drinking, taking non-steroidal anti-inflammatory medicine and so on. ConclusionPeptic hemorrhage is easily complicated with peptic ulcer with negative HP, and it is intimately correlated with patients' age, sex, wine drinking history, and taking non-steroidal anti-inflammatory medicine, etc.
The study of relation between hepatogenic peptic ulcer and portal hypertension,transmitter metabolic disturbance,hepatic insufficiency and infection;and the therapeutic principles of complications of peptic ulcer are described.Twenty four of 58 patients with hepatogenic peptic ulcer were examined by color Doppler ultrasound.Portal venous flow volume (24 cases) was 1060.9±96ml/min.Portal venous pressure(8 cases)was 3.77±2.51kPa tested during operation.Histamine concentration (8 cases) was 0.70±0.31μmol/L in peripheral blood.The gastrin contents of 9cases tested 3cm,5cm away from the ulcer were 2195.6±1043.89ng/L and 2140.3±978.5ng/L respectively. H pylori positive rate was 80% in 58 cases.The therapeutic results were satisfactory with no death.The results suggest that pathogenesis of hepatogenic peptic ulcer is closely related to these factors foresaid.The treatment is nonsurgical and massive hemorrhage or perforation once occurs,surgical treatment is necessary.
目的:比较腹腔镜与开腹手术治疗消化性溃疡急性穿孔的临床效果。方法:对腹腔镜手术组19例和开腹组23例患者的手术时间,术中出血量,肠鸣音恢复时间、住院时间、术后使用镇痛剂,术后切口感染等指标进行比较。结果:腹腔镜组中术中出血量,术后肠鸣音恢复时间和术后使用镇痛剂等指标均显著小于开腹组(Plt;0.05)。结论:腹腔镜手术修补消化性溃疡急性穿孔类有创伤小、康复快、住院时间短等优点,是治疗消化性溃疡穿孔的理想术式。
目的:研究分析德阳地区消化性溃疡的流行病学特点,为其防治提供依据。方法:对我院2002年1月至2007年12月中经胃镜检查诊断为消化性溃疡的病例的年龄、性别、发病季节、溃疡部位、幽门螺杆菌感染和并发症进行回顾性统计分析。结果:共检出5 820例消化性溃疡,其中十二指肠溃疡(DU)3 696例,胃溃疡(GU)1 558例,复合性溃疡(CU)566例。溃疡患者男女比例为2.56︰1。胃溃疡患者平均年龄为47.82岁,比十二指肠溃疡患者大5.8岁。检出率以冬季最高(32.25%),夏季最低(21.63%),具有统计学意义(Plt;0.01)。幽门螺杆菌感染阳性率为90.82%。结论:消化性溃疡的发生与季节、年龄、性别和部位相互有关,合并幽门螺杆菌感染者占绝大多数,并发症发生率低。
Objectives To analyze risk factors associated with conversion to open surgery of laparoscopic repair for perforated peptic ulcer. Methods From January 2009 to December 2014, 235 patients underwent laparoscopic repair for perforated peptic ulcer in the Chengdu 5th Hospital, were enrolled in this study. These patients were divided into laparoscopic repair group (n=207) and conversion to open surgery group (n=28). The characteristics, clinical outcomes, and prognosis factors were compared between these two groups. The receiver operating characteristic (ROC) curve was used to determine the critical cutoff value for diameter and duration of perforation for predicting conversion to open surgery. Results There were no significant differences of the age, gender, body mass index, comorbidity, history of ulcer, smoking history, history of nonsteroidal antiinflammatory drugs or steroids use, history of alcohol use, American Society of Anesthesiologists classification on admission, white blood cell count on admission, C reaction protein on admission, surgeons, suture method, and location of perforation between these two groups (P>0.05). The patients in the conversion to open surgery group had a higher procalcitonin (PCT) level on admission (P=0.040), longer duration of peroration (P<0.001), larger diameter of peroration (P<0.001), longer hospital stay (P=0.002), higher proportion of patients with Clavien-Dindo classification Ⅰ and Ⅱ (P<0.001), longer gastrointestinal function recovery time (P=0.003), longer analgesics use time (P<0.001), and longer off-bed time (P=0.001) as compared with the laparoscopic repair group. The results of logistic regression analysis showed that the peroration duration on admission〔OR: 2.104, 95%CI (1.124, 3.012),P=0.020〕and peroration diameter on admission〔OR: 2.475, 95%CI (1.341, 6.396),P=0.013〕were two predictors of conversion to open surgery. For the diameter of perforation, 8.0 mm was the critical cutoff value for predicting conversion to open surgery by ROC curve analysis, the sensitivity was 76%, the specificity was 93%, and the area under the curve (AUC) was 0.912. For the duration of perforation, 14 h was the critical cutoff value to predict conversion to open surgery, the sensitivity was 86%, the specificity was 71%, and theAUC was 0.909. Conclusions The preliminary results in this study show that diameter of perforation of 8 mm and duration of perforation of 14 h are two reliable risk factors associated with conversion to open surgery for perforated peptic ulcer. Also, PCT level would mightbe considered as a helpful risk factor for it.