内镜下5%碳酸氢钠注射治疗胃结石临床观察

Instillaion of 5% sodium bicarbonate under gastrescopyin the treatment of gastric bezoars

目的总结胃结石的临床特点及幽门螺杆菌在胃结石患者中的感染情况，观察内镜下结石内注射治疗的效果。方法选择经内镜检查证实的食管、十二指肠结石患者各1 例，胃内结石患者33 例，调查所进的食物，分析结石和溃疡的部位、大小。对内镜下经套圈碎石、内镜下结石内注射5%碳酸氢钠治疗的平均住院日进行比较，对结石、溃疡的幽门螺杆菌感染的治疗情况进行前后对比。结果上消化道结石的症状各异，秋季多发，与进食柿子、山楂等有关；内镜下结石内注射平均住院日少；伴发幽门螺杆菌感染者在半数以上。结论食管结石、十二指肠结石以梗阻为首发症状；胃内结石有消化道出血，以腹痛、溃疡为主，幽门螺杆菌感染与胃炎有关；内镜下结石内注射治疗效果相对较好。

Objective To study the clinical characteristics of upper GI tract bezoars, mainly gastric bezoars; to compare outcomes using lithotripsy and intrabezoar instillation under endoscopy; to study the helicobacter infection rate in patients with bezoars. Methods Bezoar(s) were locate in esophagus in 1 case, duodenum 1 case and stomach 33 cases, all were verified by endoscopy. The diet of the patients was investigated, and the size of the bezoars and location of the ulcers were noted. The average lengths of hospitalization of the 3 therapeutic methods were compared. Test to detect helicobacter infection was done pre- and post-treatment. Results Clinical manifestations of upper GI tract bezoars were variable and often occurred in autumn. The genesis of bezoars was related to consumption of persimmons and hawthorn fruits. Treatment by intrabezoar instillation under endoscopy yield the shortest length of hospitalization. Helicobacter infection was associated with more than half of the patients with bezoar ulcers. Conclusions Obstruction is the first symptom of esophageal and duodenal bezoars. Gastric bezoars manifest primarily as gastric hemorrhage and pain. Intrabezoar instillation under endoscopy gives good results. Helicobacter infection is related to gastritis.