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Epidemiological Feature of Peptic Ulcer in Deyang Area

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5820例消化性溃疡,其中十二指肠溃疡(DU)3696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(Plt;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。

Evidence-Based Prevention and Treatment for Gastric Diseases

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.

雷钡拉唑三联疗法治疗难治性溃疡54例临床疗效观察

摘要:目的:观察雷钡拉唑钠三联疗法治疗难治性消化性溃疡的临床疗效，探讨难治性溃疡的有效治疗方法。方法:对有上腹痛、嗳气、反酸等症状，经胃镜检查确诊的且治疗前曾用过雷尼替丁、法莫替丁等H2受体拮抗剂和奥美拉唑或泮托拉唑等质子泵抑制剂正规治疗的消化性溃疡患者，改用雷钡拉唑钠10 mg，每晨一次口服，克拉霉素0.5 Bid，替硝唑1.0 Bid，疗程4周，每例均于治疗前和疗程结束后进行临床症状评估及电子胃镜和血、尿常规、肝功能检查，观察临床症状改善和胃镜下溃疡的愈合情况以及Hp的阴转率。结果: 54例中痊愈16例，显效29例，有效6例，无效3例，总有效率94.44%；治疗前合并Hp感染者52例，治疗后Hp阳性者2例，Hp根除率为9615%(50/52)；所有的患者治疗后血、尿常规及肝肾功能未见异常变化。结论:雷钡拉唑钠三联疗法能有效的治疗难治性消化性溃疡，不失为治疗难治性溃疡的最佳选择方案，值得推广应用。

中药治疗消化性溃疡疗效观察

摘要:目的: 观察自拟中药胃病I号方治疗消化性溃疡的疗效。 方法 :采用随机数字将90例消化性溃疡患者分为两组,治疗组60例,采用自拟中药胃病I号方治疗;对照组30例,采用奥美拉唑、阿莫西林、克拉霉素治疗。观察两组治疗前后证候疗效、胃镜疗效、临床症状改善情况及幽门螺杆菌(Hp)的根除率。 结果 :治疗组证候总有效率与对照组比较差异有统计学意义(〖WTBX〗P lt;0.05),治疗组证候疗效优于对照组,治疗组胃镜总有效率、Hp根除率分别与对照组比较差异无统计学意义(〖WTBX〗P gt;0.05),治疗组疗效与对照组相当。治疗组在改善上腹疼痛方面与对照组疗效相当,但在改善食欲不振、返酸、嗳气方面,治疗组疗效优于对照组。 结论 :自拟中药胃病I号方治疗消化性溃疡疗效肯定,副反应少,值得推广。

Etiological Factor Analysis of Peptic Ulcer Hemorrhage with Negative Helicobacter pylori

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.

PATHOLGENIC STUDY OF HEPATOGENIC PEPTIC ULCER AND TREATMENT OF COMPLICATIONS

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.

Epidemilogical Feature of Peptic Ulcer in Deyang Area

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。

胃穿透性溃疡侵蚀胰腺及脾脏血管： 1例报道及文献复习

目的总结胃穿透性溃疡侵蚀胰腺及脾脏血管患者的诊治经验，为临床诊治提供一定的参考。方法回顾四川大学华西医院收治的1例胃穿透性溃疡侵蚀胰腺及脾脏血管患者的病程发展、诊治过程及临床结局，并结合在中英文数据库中检索到的相关病例进行讨论，对本病临床特征、治疗措施、临床结局等进行总结。结果本例患者行近端胃切除术、脾切除术及胰腺修补术，术后检查及随访结果提示患者痊愈。共检索到27篇相关病例的文献报道，包括本例患者在内共30例患者，其中男21例、女9例，发病年龄为（56.7±13.2）岁，临床症状以上腹部疼痛为主（66.7%），溃疡好发于胃小弯（26.7%）及胃后壁（23.3%），穿透性溃疡最大直径为（4.2±2.4）cm，易受侵犯部位包括胰腺（40.0%）、脾脏血管（33.3%）、肝脏（33.3%），治疗方案以胃部分切除术为主（27.2%），受溃疡侵蚀组织器官多采取局部修补手术治疗（68.2%）。结论胃穿透性溃疡为消化性溃疡少见并发症，患者应行消化内镜及腹部CT评估溃疡进展情况。若已经发生溃疡穿透，则应积极开展手术治疗并及时处理病灶，避免穿透进一步侵蚀周围器官及重要血管。

THE SURGICAL OPERATIVE METHODS IN TREATMENT OF PEPTIC ULCER

Comparative outcomes of transumbilical three-port versus single-port laparoscopic surgery for acute perforated peptic ulcer

ObjectiveTo compare clinical efficacy between transumbilical three-port laparoscopic surgery (TU-TPLS) and transumbilical single-incision laparoscopic surgery (TU-SILS) in repair of acute peptic ulcer perforation. MethodsThe patients with acute peptic ulcer perforation who underwent TU-TPLS or TU-SILS in Chengdu Second People’s Hospital Affiliated to Sichuan University from January 2022 to December 2024 were retrospectively collected, and then were divided into the TU-TPLS group and TU-SILS group. The operation time, postoperative 24 h incision pain score (visual analogue scale) , postoperative hospital stay, total hospitalization cost, incision scar score (Vancouver scar scale), comprehensive satisfaction, and postoperative complications were compared between the two groups. ResultsA total of 105 patients met the inclusion criteria were enrolled, comprising 50 patients in the TU-TPLS group and 55 patients in the TU-SILS. There were no statistically significant differences in baseline characteristics between the two groups, such as gender, age, body mass index, perforation site, perforation diameter, and Boey score (all P>0.05). Postoperatively, the TU-TPLS group demonstrated significantly lower visual analogue scale pain score at 24 h compared to the TU-SILS group [(2.34±0.63) score vs. (3.22±1.05) score, P<0.001] and significantly higher comprehensive satisfaction score [(7.60±0.86) score vs. (7.02±1.01) score, P=0.002]. However, no statistically significant differences were observed between the TU-TPLS group and TU-SILS group regarding operative time [(71.84±10.51) min vs. (69.78±7.98) min, P=0.257], postoperative hospital stay [(10.35±2.08) d vs. (9.96±1.75) d, P=0.310], or total hospitalization costs [(20 856.23±4 095.73) yuan vs. (19 988.83±2 933.43) yuan, P=0.212]. The incidence of umbilical wound infection was 1 case in the TU-TPLS group and 3 cases in the TU-SILS group (P=0.619). Postoperative residual intra-abdominal infection occurred in 2 cases in the TU-TPLS group and 1 case in the TU-SILS group (P=0.604). Incisional bleeding occurred in 0 cases in the TU-TPLS group and 1 case in the TU-SILS group (P>0.999). Furthermore, there was no statistically significant difference in the scar assessment score between the TU-TPLS group and TU-SILS group [(3.11±1.13) score vs. (2.92±0.70) score, P=0.301] at the 2-month postoperative follow-up. ConclusionsBoth TU-TPLS and TU-SILS have achieved good therapeutic effects in treatment of acute peptic ulcer perforation. However, TU-TPLS has more advantages over TU-SILS. TU-TPLS causes milder incision pain, leads to higher patient satisfaction, and does not require special equipment.