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Endoscopic Modified by the ThreeCavity Tube 2 Capsule Combined Sclerotherapy of Esophageal Varices Bleeding Clinical Efficacy (Clinical Analysis of 14 Cases)

目的:观察经鼻内镜检查引导下通过改良三腔二囊管加沙氏导丝引导支撑,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血的疗效。方法:14例肝硬化食道静脉曲张破裂出血患者经过经鼻内镜检查后通过改良的三腔二囊管加沙氏导丝支撑下,结合内镜下硬化剂治疗食管静脉曲张破裂出血,观察止血效果以及并发症。结果:14例患者均1次止血成功,1例患者治疗后8h再次出血,行急诊TIPSS手术治疗。主要反应为胸骨后疼痛,持续时间为2～7d,对症处理后消失,3、6个月后再次复查食道胃底曲张静脉明显改善,3例10d左右行内镜下再次硬化治疗(因第1次硬化剂量少或治疗不完全)。结论:经鼻内镜检查行改良三腔二囊管加沙氏导丝引导支撑下,结合内镜下硬化剂治疗肝硬化食管静脉曲张破裂出血是一种有效的治疗方法。

The Clinical Application of Nasal Endoscopy in patients with Esophageal Stenosis Stent Expansion

【摘要】 目的 探讨经鼻胃镜在食管狭窄扩张和支架置入术中的作用。 方法 2007年10月-2009年3月对28例癌性食管狭窄以及并发食管-气管瘘的患者行PENTAX（EG-1580K）超细经鼻电子胃镜检查，计算插入深度，并进行扩张和支架治疗，在胃镜直视下调节输送器内支架上端的位置，观察扩张效果、支架放置成功率、定位的准确性以及并发症情况。 结果 全部患者均行扩张治疗，效果良好，支架一次性放置全部成功，定位准确，自膨满意，最狭窄处的内径由（4.8±1.2）mm扩至（12.5±1.5）mm，食管气管瘘被覆盖治疗效果好，患者的吞咽困难评级由3.25±0.58降至0.94±0.59。 结论 在食管狭窄扩张和支架置入术中应用经鼻超细胃镜患者依从性好，方法简便，安全有效。【Abstract】 Objective To explore the role of nasal endoscopy in the esophagostenosis expansion and esophageal stent. Methods PENTAX (EG-1580K) ultrafine nasal endoscopy was used in 28 patients (October 2007-March 2009) with esophageal cancer complicated with esophagostenosis and fistula to check the e-calculated insertion depth, stent expansion and the average diameter expansion. The endoscopy was carried under the direct vision with the location of the top bracket in order to ensure the accurate stent placement, all without X-ray assist. The success rates of stent placement, positioning accuracy, as well as complications were evaluated. Results The expansion treatments were successful in all patients with one-off operation. The narrowest part increased from (4.9±1.6) mm to (12.7±1.5) mm, and the esophageal fistula was covered. The rating of dysphagia decreased from 3.15±0.68 to 0.91±0.49. Conclusion Nasal endoscopy is simple, safe and effective in the treatment of ultrafine expansion for esophagostenosis and stent implantation with good compliance.

胃镜和腹腔镜联合治疗黑色素斑-胃肠多发性息肉综合征的护理一例

Clinical Comparison on Laparoscopic-Endoscopic Cooperative Surgery and Open Resection for Gastric Stromal Tumor

ObjectiveTo compare the results of laparoscopic-endoscopic cooperative resection and open surgery for gasric stromal tumor. MethodsFrom January 2010 to March 2015, the clinical data of 56 cases undergoing laparoscopic resection for gasric stromal tumor and 53 cases of traditional operation selected during the same period were retrospectively compared. ResultsThere was no significant difference between two groups in patient's gender, age, body weight, size of tumor, tumor staging, method of operation, intraoperative conditions, postoperative overall complications, local recurrence, and distant metastasis. There were 1 case with the rupture of tumor and 1 case of open surgery transforming in laparoscopic group. In another group, there was the absence of the rupture of tumors. There was no mortality, stomach bleeding, stenosis or leakage occurred between two groups. In laparoscopic group, there were less operative blood loss and abdominal drainage, shorter time of postoperative anal exhaust time, fewer anodyne, a reduction of hospital stay than in convention operation group.However, laparoscopic resection required greater hospital costs and longer operative time. There were significant differences between two groups (P < 0.05). Conciusions With advantages of less blood loss and quicker recovery as compared to conventional operation. Laparoscopic-endoscopic cooperative resection for gasric stromal tumor has similar effect when it is performed by well selection of cases, skilled surgeon with experience on open resection for surgical treatment of gastric stromal tumor.

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。

综合干预法对减轻胃镜下手术中的反应

【摘要】　目的　观察运用音乐疗法配合穴位按压的综合干预方法对减轻胃镜下行高频电凝电切术患者术中反应的作用。　方法　2008年10月-2009年12月，将行胃镜下高频电凝电切术的96例患者随机分为两组，对照组给予胃镜下高频电凝电切术常规护理，观察组在常规护理的基础上给予音乐疗法配合手法按压合谷、内关穴。　结果　观察组在术中反应程度及紧张恐惧程度上明显优于对照组（Plt;0.01）；　结论　音乐疗法配合穴位按压的综合干预法能减轻胃镜下高频电凝电切术中患者反应程度及紧张恐惧程度。

Dieulafoy 病 21 例临床分析

目的 探讨 Dieulafoy 病的病因、临床表现、诊断及治疗。 方法 回顾性分析笔者所在医院于 1998–2014 年期间收治的 21 例 Dieulafoy 病患者的临床资料。 结果 21 例 Dieulafoy 病患者的发病诱因：饮酒 6 例，长期服用非甾体类抗炎药 6 例，食辛辣食物刺激 5 例，精神刺激 1 例，其余 3 例无诱因。临床表现：均突发起病，17 例表现为呕血及大量黑便，3 例表现为大量呕血，1 例仅表现为黑便。所有病例入院后行急诊胃镜检查，确诊 20 例，1 例漏诊。病变位于胃底部 4 例，位于胃体近贲门小弯侧 13 例，位于胃角 2 例，位于十二指肠球部2 例。20 例行内镜下止血治疗，15 例经内镜下止血成功，5 例失败。内镜止血成功的 15 例患者获访 8～20 个月，中位数为 14 个月，随访期间均未再出血。6 例行外科手术治疗，包括胃镜引导下腹腔镜胃楔形切除 3 例，胃镜引导下腹腔镜单纯血管缝扎 1 例，开腹胃大部切除术 1 例，腹腔镜胃大部切除术 1 例。术后 6 例患者获访 6～14 个月，中位数为 9 个月，随访期间 5 例未再出血；1 例于术后 6 个月再次出血，但出血量少，经抑酸、止血等保守治疗后出血停止。 结论 急诊胃镜是诊断 Dieulafoy 病的首选方法。Dieulafoy 病的治疗首选内镜下止血，内镜止血不成功者可考虑手术治疗，手术方式首选双镜联合局部楔形切除术。

Analyses of Clinicopathologic Characteristics for Remnant Gastric Cancer

Objective　To analyze the clinicopathologic characteristics of remnant gastric cancer （RGC）. Methods　The clinical data of 114 patients with RGC treated in The Second Affiliated Hospital of Northern Sichuan MedicalCollege and The General Hospital of Chinese People’s Liberation Army from March 2000 to May 2008 were reviewed and analyzed retrospectively. The clinicopathologic characteristics between the patients with primary benign diseases and those with malignant diseases were evaluated. Results　A total of 114 cases，the age was （62.6±11.3） years，and the males versus females was 4.7∶1.0. Most patients （76.2%，64/84） were diagnosed at advanced stages （consistent with pT），and the proportion of pT1 stage cases was only 23.8% （20/84），tumor invasion pT4 was 60.7% （51/84）. It was more common that tumor directly invaded adjacent organs or structures （27.4%，23/84），lymph nodes positive （42.9%，36/84），and distant metastasis （27.2%，31/114）. The location of distant metastasis was usually confined in the abdominal cavity （93.5%，29/31），and the peritoneum disseminated was the most commonly structures （67.7%，21/31）. Histologically，the incidence of poorly differentiated adenocarcinoma （76.7%，79/103） was the mostly histologic grade as well as the diffuse type （78.6%，81/103） was the mostly Laurén classification. Between the patients with primary benign diseases and those with initial malignant disease，the initial gastrectomy or the methods of reconstruction had significantly differences （both P=0.000）. The median time from initial resection to development of RGC was 30.0 years in the patients with original benign disease，contrary to 3.3 years in those with previous malignant disease （P=0.000）. Both primary diseases （benign or malignant） and the age at initial gastrectomy were the major influencing factors for the time of RGC developed （P＜0.05）. For pathohistology characters，except signet-ring cell carcinoma （P=0.045）， pT4b （P=0.049），pN stage （P=0.025），and Borrmann classification （P=0.005），there were no significant differences between the patients with previous benign diseases and those with original malignant disease，as well as the resectability rate，curative resection （R0） rate，and overall survival rate （P＞0.05）. Conclusions　It is almost unaffected by originalbenign diseases or malignant diseases for clinicopathologic characteristics including the treatment option and prognostic factors.It is necessary and feasibility to form a pattern of endoscopic follow-up for RGC.

Relationship between Clinicopathological Characteristics and Invasion Depth of Early Gastric Cancer

ObjectiveTo investigate the relationship between clinicopathological characteristics and invasion depth of early gastric cancer (EGC), in order to put forward suitable regimens for EGC with different clinicopathological characteristics. MethodsThe clinicopathological data of 18 patients with EGC diagnosed from January 2008 to January 2013 were retrospectively analyzed. Clinicopathologic variables such as age, gender, tumor size and location, Helicobacter pylori infection, melaena, macroscopic type, and histopathological type were investigated by using chi-square test for their possible relationship with the depth of invasion. ResultsLymph node metastasis was more common in patients with submucous cancer (3/9, 33.3%) than in those with mucous cancer (0/9, 0%). Submucosal invasion was found in 77.8% (7/9) of undifferentiated adenocarcinoma cases, whereas only 22.2% (2/9) of differentiated adenocarcinoma had submucosal invasion. TypeⅢ EGC had a significant association with submucosal invasion (P<0.05). ConclusionEndoscopic treatment is unsuitable for patients with Type Ⅲ EGC.

Associated Medication of FentanylPropofol and MidazolamPropofol and Gastroscopy

目的:讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法:芬太尼-异丙酚为Ⅰ组,咪唑安定-异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果:Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义(Plt;0.01)。结论:镇静无痛苦胃镜检查中芬太尼-异丙酚联合用药更舒适。