无痛性溃疡合并上消化道出血86例

Painless ulcer combined with upper gastrointestinal bleeding in 86 cases

目的探讨无痛性溃疡合并上消化道出血的规律性。方法由专人操作，采用日本产OlympusGIF—K2型纤维胃镜，对86例无痛性溃疡合并上消化道出血的患者进行系统的观察，作为观察组；另选择同期就诊的有痛性溃疡40例作为对照组。必要时钳取黏膜组织2—6块，用10％的甲醛固定，石蜡包埋HE染色镜检；对部分患者进行6个月的随访。结果观察组86例中球部溃疡65例，胃溃疡15例，幽门管溃疡3例，复合性渍疡3例；对照组40例中球部溃疡34例，胃溃疡2例，幽门管溃疡2例，复合性溃疡2例；除26例球部溃疡未取材外，余均由病理证实；两组比较差异无统计学意义（x2=3．16，P〉0．05），但观察组失血量明显高于对照组（X2=10．16，P〈0．01）。结论无痛性溃疡合并上消化道出血的患者占同期溃疡病334例患者的25．75％，临床上十分常见。应强调早期胃镜检查、局部止血、内科治疗的重要性。

Objective To investigate the regularity of painless ulcer combined with upper gastro- intestinal bleeding. Methods Method used by certified operations, 86 cases of painless ulcer combined with upper gastrointestinal bleeding were observed systemiely by Japan Olympus CIF-K2 type fiber endos- copy as observation group ; Forty cases of pain ulcer were cboosed as control group, if necessary, Protrac- tor mucosa 2 -6 blocks, with 10% formalin fixed paraffin embedded, HE dyed microscopic examination; Some cases were followed-up in six months. Results Among the 86 cases in observation group, there were 65 cases of bulb ulcer, 15 cases of gastric ulcer, 3 cases of pyloric canal ulcer, 3 cases of complex ulcer. Among the 40 patients in control group, there were 34 cases of bulb ulcer, 2 cases of gastric ulcer ulcer, 2 cases of pyloric canal, 2 cases of complex ulcer; Twenty-six cases of ulcer was not taken, the others were confirmed by pathology; There was no significant difference between the two groups （X2 = 3.16, P 〉 0. 05 ） ; But bleeding volume in the observation group was significantly higher than that in the control group（ X2 = 10. 16, P 〈 0. 01 ）. Conclusions Painless ulcer combined with upper gastrointesti- nal bleeding accounting for 25.75% of ulcer disease, it is common in clinic. Early gastroscopy, local he- mostasis and medical treatment are important.