胶囊内镜对不明原因消化道出血患者临床诊断价值

目的:探讨胶囊内镜对不明原因消化道出血的诊断价值。方法:应用M 2A胶囊内镜检查系统对90例经胃镜、肠镜检查阴性的消化道出血患者进行检查。结果:90例不明原因消化道出血患者共进行92次胶囊内镜检查,检查成功率为94.57%(87/92),其中急性大量出血组检查成功率为84.0%(21/25),慢性显性出血组检查成功率为98.51%(66/67),两者经χ2检验有显著性差异(P<0.05)。在检查成功的患者中,胶囊内镜的病变检出率为85.06%,假阴性率17.24%。急性大量出血组病变检出率80.95%,假阴性率23.81%;慢性显性出血组病变检出率86.36%,假阴性率15.15%,经χ2检验均无显著性差异(P>0.05)。结论:胶囊内镜对不明原因消化道出血有较高的检出率,可以作为小肠出血的首选检查方法。

贲门失弛缓症治疗89例临床观察

目的:探讨贲门失弛缓症治疗的有效方法。方法:选择贲门失弛缓症患者89例,A组28例内镜下气囊扩张术治疗,B组32例应用肉毒杆菌毒素局部注射治疗,C组29例肉毒杆菌毒素联合小气囊扩张治疗。结果:治疗后A组有效率96.43%,B组有效率96.88%,C组有效率100%,三组比较无显著性差异;治疗后2年A组有效率85.71%,B组有效率71.88%,C组有效率93.10%,C组优越于A、B两组。结论:经内镜注射肉毒杆菌毒素联合小气囊扩张治疗贲门失弛缓症近期疗效尚好,远期疗效有待进一步观察。

The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients＇ data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis： age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time （PT）, gastric ulcer （small curvature）, duodenal ulcer （bulbus back wall）, Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy. RESULTS： Seventy male （58%） and 51 female （42%） patients with a median age of 70 （range： 21-96） years were treated. Their in-hospital mortality was 14%. While 12% （11/91） of the patients died after conservative therapy, 20% （6/30） died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer （n = 36; 30%）, gastric ulcer （n = 35; 29%）, esophageal varicosis （n = 12; 10%）, Mallory-Weiss syndrome （n = 8, 7%）, erosive lesions of the mucosa （n = 20; 17%）, cancer （n = 5; 4%）, coagulopathy （n = 4; 3%）, lymphoma （n = 2; 2%）, benign tumor （n = 2; 2%） and unknown reason （n = 1, 1%）. A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer （bulbus back wall） were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer （bulbus back wall） andpatients＇ gender （male） were of prognostic importance for the clinical outcome （mortality） of patients with a bleeding ulcer.CONCLUSION： Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient＇s vital threat posed by an UGI bleeding.Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.

Optical coherence tomography and Doppler optical coherence tomography in the gastrointestinal tract

Optical coherence tomography(OCT) is a noninvasive,high-resolution,high-potential imaging method that has recently been introduced into medical investigations.A growing number of studies have used this technique in the field of gastroenterology in order to assist classical analyses.Lately,3D-imaging and Doppler capabilities have been developed in different configurations,which make this type of investigation more attractive.This paper reviews the principles and characteristics of OCT and Doppler-OCT in connection with analyses of the detection of normal and pathological structures,and with the possibility to investigate angiogenesis in the gastrointestinal tract.

Severe hyperkalemia following blood transfusions:Is there a link?

Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover,appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.

Gastric stimulation for weight loss

The prevalence of obesity is growing to epidemic proportions,and there is clearly a need for minimally invasive therapies with few adverse effects that allow for sustained weight loss.Behavior and lifestyle therapy are safe treatments for obesity in the short term,but the durability of the weight loss is limited.Although promising obesity drugs are in development,the currently available drugs lack efficacy or have unacceptable side effects.Surgery leads to long-term weight loss,but it is associated with morbidity and mortality.Gastric electrical stimulation(GES) has received increasing attention as a potential tool for treating obesity and gastrointestinal dysmotility disorders.GES is a promising,minimally invasive,safe,and effective method for treating obesity.External gastric pacing is aimed at alteration of the motility of the gastrointestinal tract in a way that will alter absorption due to alteration of transit time.In addition,data from animal models and preliminary data from human trials suggest a role for the gut-brain axis in the mechanism of GES.This may involve alteration of secretion of hormones associated with hunger or satiety.Patient selection for gastric stimulation therapy seems to be an important determinant of the treatment's outcome.Here,we review the current status,potential mechanisms of action,and possible future applications of gastric stimulation for obesity.

胶囊内镜检查前两种清肠剂肠道准备对比分析

目的观察检查当日口服硫酸镁与分两次口服福松加口服补液盐对胶囊内镜检查前肠道清洁效果与受检者主观感受。方法将50例胶囊内镜检查患者随机分为观察组和对照组。观察组于检查前1 d 20：00及检查当天5：00分别服用口服福松加口服补液盐,对照组检查当日5：00口服硫酸镁。根据胶囊内镜检查所见肠道清洁程度（1~10分）及患者主观感受（1~10分）评价效果。结果观察组肠道清洁效果略好于对照组,而就患者主观感受而言口服福松加口服补液盐不良反应轻,患者更易于接受。结论分两次口服福松加口服补液盐是比较理想的胶囊内镜检查前的肠道准备方法。

肝硬化患者肠镜下息肉高频电凝切除的观察与护理

目的探讨肝硬化患者肠镜下息肉高频电凝切除的护理方法与并发症。方法回顾性分析43例肝硬化患者肠镜下息肉高频电凝切除术的的手术操作、护理配合和并发症防治。结果 43例患者69枚息肉全部在内镜下顺利切除。患者发生术中出血4例(9.3%),术后迟发性出血3例(7.0%),但经内镜下止血及内科保守治疗,出血停止,未出现大出血、穿孔等严重并发症。结论肝硬化患者肠镜下息肉切除是一项安全、有效的微创技术,其术中出血与迟发性出血与肝功能Child-pugh的分期、息肉大小、是否粗蒂以及内镜医生操作经验有关。