潘妥拉唑联合碳酸氢钠治疗胃结石的临床疗效观察

Efficacy of pantoprazole combined with sodium bicarbonate in patients with gastric bezoars

目的：探讨潘妥拉唑联合碳酸氢钠治疗胃结石的临床疗效和安全性。方法：经胃镜或钡餐造影确诊胃结石的21例患者，给予潘妥拉唑80mg·d^-1，分2次静脉点滴，及5％碳酸氢钠20mL口服，tid。治疗后1周复查胃镜。如结石未消失，继续治疗1周。分析临床疗效与胃结石原因、大小、病程等的关系。结果：21例胃结石患者中柿石10例，黑枣4例，山楂4例，原因不清3例；病程在半月以内者14例，半月到1个月之间的2例，1月到3个月之间的2例，3月以上的3例；2～6cm之间的结石15例，6cm以上结石患者6例。14例（66．7％）患者药物治疗后结石消失，13例病程在半月以内，1例病程在1～3月；均为2～6cm之间的结石；7例柿石，4例山楂石，1例黑枣石，2例原因不清。17例合并胃溃疡。药物治疗无效者经内镜或手术治疗。结论：药物治疗可作为胃结石首选治疗方法，特别是病程在半月以内者；对于病程长、较大的胃结石患者，药物治疗可缓解症状，减轻胃溃疡，便于进一步的内镜下治疗或手术治疗。

Objective ： The aim of the study was to evaluate the efficacy of pantoprazole combined with sodium bicarbonate in treating gastric bezoars. Methods：Twenty-one patients with gastric bezoars proven by endoscopy or barium contrast were treated by intravenous infusion of pantoprazole （40 mg, twice daily） and oral intake of 5% sodium bicarbonate （20 mL, 3 times daily）. Endoscopy was performed one week after treatment to evaluate the efficacy, and the treatment continued for one more week in patients with undissolved bezoars. The efficacy was analyzed according to the causes, size and duration. Results： Of the 21 patients, 10 were persimmon bezoars, 4 dateplum persimmon bezoars, 4 hawthorn bezoars and 3 unknown causes; 14 patients were within half a month, 2 between half and one month, 2 between one and three months, and 3 more than three months; 15 patients had bezoars of 2 - 6 cm in size and 6 more than 6 cm. The gastric bezoars in 14 patients disappeared after medical conservative treatment. Of the patients with bezoars of 2 - 6 cm in size, 13 patients were within half a month, and 1 between 1 and 3 months. Seventeen patients complicated with gastric ulcers. The patients failed to medical therapy were treated endoscopieally or surgically. Conclusion： Medical conservative treatments with high-dose PPI and alkalization agents may be the first choice to dissolve the gastric bezoars, and have better efficacy in patients with duration within half a month and bezoars less than 6 cm in size. In patients with longer duration and bigger bezoars, medical therapy could alleviate their symptoms and gastric ulcers, facilitate the further endoscopic or surgical treatment.