【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common emergencies of the digestive system. With the continuous development of digestive endoscopy technology and widespread use of proton pump inhibitors, the morbidity and mortality of ANVUGIB have declined, but there are still numerous difficulties to be solved in clinical treatment. The International Consensus Group in 2019 updated the international consensus guideline in 2003 and 2010 with new clinical recommendations on fluid resuscitation, risk assessment, pre-endoscopic treatment, endoscopic treatment, drug therapy, and secondary prevention, etc. This paper interprets the update to provide references for the clinical treatment of ANVUGIB.
Objective To explore the feasibility and safety of liver transplantation （LT） in treatment of upper gastrointestinal hemorrhage in patients with portal hypertension， and to compare the therapeutic effects with conventional operation （CO）. Methods The clinical data of 303 patients with bleeding portal hypertension from Feb. 2009 to Feb. 2012 in the department of hepatobiliary and pancreatic surgery of First Affiliated Hospital of Zhejiang University were retrospectively analyzed. One hundred and one patients received LT procedure （LT group）， whereas the other 202 patients received CO procedure （CO group）. Postoperative follow-up period was 8-44 months （average 26 months）. Results Liver function before operation in CO group was significantly better than that in LT group（P＜0.01）. The mortality of CO group and LT group were 7.4%（14/189） and 3.0%（3/101， P=1.00）， respectively. The rebleeding rate of patients underwent LT was 2.0%（2/101）， significantly lower than that of CO group 〔9.5%（18/189）， P＜0.05〕. The vanish rate of esophagogastric varice in patients underwent LT was 86.1%（87/101）， significantly lower than that of CO group 〔54.5%（86/189）， P＜0.01〕. Conclusions LT treatment for bleeding portal hypertension is feasible and safe. Patients with good liver function despite hemorrhage history may be managed satisfactorily with conventional surgery. LT is the only curative treatment for patients with portal hypertension in end-stage liver disease.
Objective To systematically evaluate the effectiveness and safety of China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding. Methods Such databases as PubMed, MEDLINE, Springer, The Cochrane Library, CNKI, VIP, CBM and WanFang data were searched to collect the randomized controlled trials (RCTs) about China-made omeprazole in treating acute non-variceal upper gastrointestinal bleeding, and the references of included studies were also retrieved. The retrieval time was from inception to December 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was conducted by using RevMan 5.1 software. Results A total of 11 RCTs were included. Among all 1 075 patients, 544 were in the treatment group, while the other 531 were in the control group. The results of meta-analysis showed that, there were no significant differences in the total effective rate (OR=0.68, 95%CI 0.35 to 1.33, P=0.26) and safety (RR=1.33, 95%CI 0.45 to 3.91, P=0.96) between the China-made omeprazole and imported omeprazole. Conclusion China-made omeprazole is effective and safe in treating acute non-variceal upper gastrointestinal bleeding in comparison with the imported omeprazole.
目的:觀察用白眉蛇毒血凝酶(邦亭)治療上消化道出血的療效。方法 上消化道出血患者90例,隨機分為治療組和對照組,所有病例均給予擴容及調整水電解質紊亂,靜滴奧美拉唑42.6mg,每日1次;靜滴卡絡磺鈉60mg,每日1次,重度貧血者予輸血。治療組再應用邦亭4 KU加生理鹽水20mL口服,每日2次,對照組用去甲腎上腺素8mg加生理鹽水90mL,每日分3次口服。結果 治療組總有效率93.75%,對照組總有效率8095%,兩組臨床療效差異有統計學意義(Plt;0.05)結論:白眉蛇毒血凝酶是一種有效的、安全的治療上消化道出血的藥物,在臨床止血治療中值得推廣應用。
ObjectiveTo investigate the relationship between chronic obstructive pulmonary disease (COPD) and respiratory failure in patients with upper gastrointestinal bleeding and recent prognosis. MethodsWe retrospectively analyzed the clinical data of 73 patients with COPD and respiratory failure treated from February 2009 to May 2011. The patients were assigned to the observing group (n=33) and control group (n=40). General characteristics, improvement rates, mortality rates, lengths of hospital stay, endotracheal tube rates and arrhythmia rates were compared between the two groups. ResultsAge, sex, and medical history of the patients were similar in both groups (P>0.05). Compared with the control group, the improvement rate was lower (P<0.001), the mortality rate (P<0.001), length of hospital stay (P<0.001), endotracheal tube rate (P<0.05) and arrhythmia rate (P<0.05) were all higher in the observing group after treatment. ConclusionUpper gastrointestinal bleeding is a high risk factor for short-term prognosis patients with COPD and respiratory failure.
目的:探索上消化道出血患者焦慮發生情況和相關因素分析。方法:采用問卷調查法對70 例上消化道出血患者發生情況進行研究,分析焦慮發生與患者性別、年齡、文化程度、醫療費用支付方式、出血次數、臨床癥狀、疾病了解程度及合并疾病的相關性。結果:上消化道出血患者焦慮發生率為58.6 %。女性患者焦慮發生率明顯高于男性患者,出血量多的患者焦慮發生率明顯高于出血量少的患者,出血次數、有無合并癥與焦慮有明顯相關性。結論:正確認識焦慮是開展負性情緒干預的前提,針對上消化道出血患者焦慮發生相關因素,積極開展心理疏導,是保障手術順利進行的重要環節。
目的:比較國產生長抑素與進口生長抑素治療消化性潰瘍出血的經濟效果。方法:將120例消化性潰瘍伴出血的患者隨機分成國產生長抑素及進口生長抑素組,分別給予國產生長抑素、進口生長抑素治療3天,觀察療效,并進行藥物經濟學評價。 結果: 國產生長抑素、進口生長抑素治療上消化道出血成本分別為558元和4116元,有統計學差異(P＜005);有效率分別為925%和968%,無統計學差異 (Pgt;005),成本—效果比分別為60324和425207,有統計學差異(P＜005)。結論: 從藥物經濟學角度分析,國產生長抑素治療消化性潰瘍出血較進口生長抑素更為經濟。