胃肠科结肠镜检查结直肠息肉阳性比率的分析

目的确定医院消化科首次接受结肠镜检查患者的结直肠息肉检出率。方法为一项回顾性研究,所有患者于2018年1月至2023年1月天津市康复疗养中心消化科首次接受结肠镜检查,排除检查前明确具有结直肠癌、息肉或炎症性肠病病史的患者,收集的数据包括患者的人口统计学资料、结肠镜检查结果和检查后并发症的发生情况。全部数据使用统计学软件SPSS 22.0进行分析。结果在符合纳入标准的1000例患者中(男性580例,女性420例),205例患者被发现至少有1处结直肠息肉,息肉检出率为20.50%,男性结直肠息肉检出人数明显高于女性,差异有统计学意义(χ^(2)=6.529,P=0.011)。结直肠息肉患者最常见的发生部位是乙状结肠(29.27%)和降结肠(23.41%)。结肠镜检查并发症的总发生率约为0.90%,且性别上差异无统计学意义(χ^(2)=0.036,P=0.849)。结论医院结肠镜检查能发现一定比例的结直肠息肉,是一种安全有效的检查方法。

降伏胃肠顽疾的良医——介绍西安市红庙坡医院胃肠科主任刘君

会当凌绝顶，一览众山小。几年前登上泰山，顿感天下之大；几年后认识了刘君，方知人间确有良医。

中医临床思维模式培养在胃肠科规范培训中的作用

目的:观察中医临床思维模式培养在胃肠科规范培训中的作用。方法:以2019年医院胃肠科未实施中医临床思维模式指导下的临床规范化护理培训时状况,作为实施前。以2020年医院胃肠科实施中医临床思维模式指导下的临床规范化护理培训时状况,作为实施后。从实施前后参与胃肠科临床规范化护理培训的护理人员中分别抽取17名,进行研究。观察实施前后的中医护理质量考核评分、临床培训质量考核量表评分、中医临床思维能力评分、临床规范化护理培训满意度评分。结果:实施后中护理人员的中医护理质量考核评分、临床培训质量考核量表评分、中医临床思维能力评分、临床规范化护理培训满意度评分均明显高于实施前(P<0.05)。结论:将中医临床思维模式指导下的临床规范化护理培训用于胃肠科,在提升胃肠科临床规范化护理培训水平中的作用显著,在提高临床培训质量,帮助胃肠科护理人员更好地掌握中医特色护理知识、护理操作技能、提高中医临床思维能力和培训满意度方面,显示出更大的效果。

QCC管理在胃肠科管理中的实施效果观察

目的:分析QCC管理在胃肠科管理中的应用措施和实施效果。方法:随机选取医院2016年6月~2017年6月期间的60例胃肠科住院患者,作为临床研究对象。2016年6~12月期间的30例患者设为对照组,2017年1~6月期间的30例患者设为观察组。对照组中行常规临床管理,观察组中加行QCC管理。统计两组不良护理事件发生率、并发症发生率、护理满意度,分析QCC管理效果。结果:观察组的不良护理事件发生率低于对照组(P<0.05)。观察组的并发症发生率显著于对照组(P<0.01)。观察组患者的护理满意度高于对照组(P<0.05)。结论:QCC管理在胃肠科管理中的应用效果显著,规避不良护理事件,减少并发症,提升患者满意度。

胃肠科病人营养风险与营养支持状况分析

目的:分析胃肠科病人营养风险与营养支持状况,为临床更合理开展患者营养支持工作提供参考。方法:应用定点连续抽样方法,并经营养风险筛查工具NRS 2002对医院中消化内科与的胃肠外科病人行营养风险筛查,统计病人在住院期间所接受营养支持量以及具体时间。结果:1285例胃肠科病人中,营养风险发生率为43.0%;营养不足发生率为13.1%;超重发生率为17.1%,肥胖发生率为4.4%。在营养风险与营养不足发生率上消化内科明显高于肠胃外科病人,在超重与肥胖发生率上消化内科明显低于胃肠外科病人,具有统计学差异,P<0.05;消化内科营养支持率明显低于胃肠外科营养支持率,差异具有统计学意义,P<0.05;消化内科营养支持时间为(7.5±2.4)天明显低于胃肠外科,差异具有统计学意义,P<0.05。结论:胃肠科病人营养风险发生率较高,经常规营养风险筛查,并根据胃肠营养指南规范营养支持,可促进营养支持的合理性。

造口护肤粉在临床护理中的妙用

胃肠科护士在临床中处理引流管口渗出及肠瘘的情况较多,给护理工作带来一定困难,经常渗出及漏液的患者皮肤会出现疼痛、红肿等情况,严重者可出现皮肤破损等,我们在临床中采取了多种方法进行处理,现把效果既快又好的方法报告如下。材料与方法：康乐宝造口护肤粉,主要是由羧甲基纤维素钠组成,具有良好的吸收能力,能使皮肤经常保持干爽。适用于引流管渗出刺激皮肤、术后出现肠瘘、肠液流出刺激皮肤、腹泻刺激肛周皮肤等。每次用温水清洗干净后晾干或擦干,

注射用美洛西林钠与胃复安存在配伍禁忌

医师在治疗胃肠科疾病,通常使用注射美洛西林钠进行围术中的抗感染工作,也采用莫非氏管滴入胃复安,但是混合后出现明显的混浊现象,且有絮状沉淀物生成。

消化内科常见的护理风险与临床护理管理对策研究

分析胃肠科常见的护理危险因素,并根据护理危险因素制定相应的临床护理管理对策。方法:分析了2019年2月至2020年10月期间在本院的胃肠科住院病患200例,对胃肠科患者护理风险的影响结果进行了分析,对比了护理干预前后的事故发生概率,调查了患者对护理的满意程度。数据显示胃肠科介入治疗后护理危险事件发生率明显低于干预前,统计学差异显示有意义(P<0.05);干预后胃肠科患者护理满意度明显高于干预前,统计学差异显示有意义(P<0.05)。结论显示 根据危险因素显示临床护理管理能有效避免护理风险事件的发生,患者对护理工作的满意程度得到提升。

Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.RESULTSThe population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.CONCLUSIONGIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

Pathologic complete response confirmed by surgical resection for liver metastases of gastrointestinal stromal tumor after treatment with imatinib mesylate

A 39-year-old male underwent distal gastrectomy for a high grade gastrointestinal stromal tumor(GIST) . Computed tomography(CT) and magnetic resonance imaging(MRI) 107 mo after the operation,revealed a cystic mass(14 cm in diameter) and a solid mass(9 cm in diameter) in the right and left lobes of the liver,respectively. A biopsy specimen of the solid mass showed a liver metastasis of GIST. The patient received imatinib mesylate(IM) treatment,400 mg/day orally. Following the IM treatment for a period of 35 mo,the patient underwent partial hepatectomy(S4 + S5) . The effect of IM on the metastatic lesions was interpreted as pathologic complete response(CR) . Pathologically verified cases showing therapeutic efficacy of IM have been rarely reported.

Gastrointestinal autonomic nerve tumors:A surgical point of view

AIM: Gastrointestinal autonomic nerve tumors are uncommon stromal tumors of the intestinal tract. Their histological appearance is similar to that of other gastrointestinal stromal tumors. We report two cases and performed an analysis of the literature by comparing our findings with the available case reports in the medical literature.METHODS: Two patients were admitted with abdominal tumor masses. One occurred in the stomach with large multiple liver metastases and the second originated in Meckel's diverticulum. The latter site has never been reported previously. Both patients underwent surgery. In one patient gastrectomy, right liver resection and colon transversum resection were performed to achieve aggressive tumor debulking. In the other patient the tumor bearing diverticulum was removed.RESULTS: Postoperative recovery of both patients was uneventful. Histological examination, immunohistochemical analysis and electron microscopy revealed the diagnosis of a gastrointestinal autonomic nerve tumor. The patient with the tumor in Meckel's diverticulum died 6 mo after surgery because of pneumonia. The patient with liver metastases have been alive 13 years after initial tumor diagnosis and 7 years after surgery with no evidence of tumor progression. In light of our results, we performed athorough comparison with available literature reports.CONCLUSION: Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the only available curative approach to date, and long term survival is possibleeven in large metastasized tumors.

Role of surgical intervention in managing gastrointestinal metastases from lung cancer

AIM:To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal(GI)-tract metastases,focusing on therapeutic options and outcomes.METHODS:Our institution(the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008,of which 21 developed symptomatic GI metastases.This study reviewed all of the patients' information,including survival data,pathological reports,and surgical notes.RESULTS:The most common histological type of lung cancer was adenocarcinoma,and 0.26% of patients with lung cancer developed GI metastases.The median duration from lung cancer diagnosis to GI metastases was three months(range,0-108 mo),and the average time from diagnosis of GI metastasis to death was 2.8 mo.Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy.In contrast,small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy.All patients with small bowel or colonic metastases underwent surgical intervention,and their perioperative mortality was 22%.Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively.In patients with multiple GI metastases,the presentation varied according to the locations of the metastases.CONCLUSION:Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction.Physicians should be more alert to symptoms or signs indicating GI metastases.

How helpful is capsule endoscopy to surgeons?

Capsule endoscopy is a new technology that, for the first time, allows complete, non-invasive endoscopic imaging of the small bowel. The efficacy of capsule endoscopy in the diagnosis of suspected small bowel diseases has been established. Important applications for surgeons include observations of obscure gastrointestinal bleeding and small bowel neoplasms.

Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

AIMTo investigate the efficacy of thrombomodulin (TM)-&#x003b1; for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-&#x003b1; were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-&#x003b1; were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-&#x003b1; and patient demographics were also evaluated.RESULTSAbscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-&#x003b1; was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P &#x0003c; 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-&#x003b1; administration (&#x02265; 4 , &#x02264; 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P &#x0003c; 0.05, for all). TM-&#x003b1; was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P &#x0003c; 0.05, for all).CONCLUSIONEarly administration of TM-&#x003b1; and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

Prognostic Factors of Gastrointestinal Stromal Tumors： A Single Institutional Retrospective Experience with Surgical Management over 20 Years

OBJECTIVE To analyze the pathological features and prognosis factors of gastrointestinal stromal tumor （GIST） after primary resection. METHODS Medical records of the diagnosis, surgery, and follow-up of 327 patients with GISTs who underwent surgery between 1988 and 2007 were retrospectively reviewed. The predic-tive factors for the survival of these patients were identi. ed using multivariate analysis. RESULTS In the 327 tumors, 152 （46.5%） were located in the stomach, 89 （27.2%） in the small intestine, 33 （10.1%） in the colon and rectum, and 43 （13.1%） in other sites including the omentum and mesentery. The 3-year and 5-year overall survival rates of the 327 GIST patients were 74.4% and 62.7%, respectively, and univariate survival analysis demonstrated that factors, such as tumor size, mitotic index, NIH categories, Ki-67 index, tumor location, surgical margins, tumor bleeding, and tumor necrosis have significant effect on survival of the patients （P 〈 0.05）. Multivariate analysis demonstrated that the NIH categories, surgical margins, and Ki-67 index were independent prognostic factors for the survival rate. In the group of patients with postoperative recurrence or metastasis, the median survival time of patients who did not receive imatinib treatment was 30 months and that of patients who received imatinib treatment was 59 months. Their 5-year survival rates were 16.4% and 39.4%, respectively, and the difference was statistically significant （P = 0.017）. CONCLUSION Complete resection is the .rst choice of treat-ment for GISTs. It is reasonable to evaluate the prognosis of resect-able GISTs and guide the adjunctive therapy with NIH categories and Ki-67 index. Imatinib treatment can signi.cantly increase the survival rate of patients with recurrent and metastatic GISTs.

Perianal Crohn's disease: Is there something new?

Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.

Recent advances in small bowel diseases:Part Ⅰ

As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were considered.In Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/allergy.These topics were chosen because of their importance to the practicing physician.

Instructions to authors

World Journal of Gastroenterology （ worla J Gastroenterol ISSN 1007-9327 CN 14-1219/R） is a weekly open-access （OA） peer reviewed journal supported by an editorial board consisting of 1179 experts in gastroenterology and hepatology from 60 countries. The biggest advantage of the OA model is that it provides free, full text articles in PDF and other formats for experts and the public without registration, which eliminates the obstacle that traditional journals possess and usually delays the speed of the propagation and communication of scientific research results. The open access model has been proven to be a true approach that may achieve the ultimate goal of the journals, i.e. the maximization of the value to the readers, authors and society.