OBJECTIVE To sum up the experience of diagnosis and treatment of intrinsic upper gastro-intestinal membrane, 13 cases in children were studied retrospectively. METHODS There were 10 boys and 3 girls, the major symptoms were vomiting and epigastric distension. Eleven cases were treated by membranectomy with intestinal plasty, and 2 cases were treated by retrocolic side to end duodenojejunostomy. RESULTS All cases had good results without severe complications. CONCLUSION The children who have typical symptom of upper digestive tract should be considered duodental and upper jejunal membrane, and should be proved by contrast radiology. The membranectomy with intestinal plasty is the better operative method.
Objective To investigate the effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. Methods Seventy-six patients who received traditional treatment between October 2020 and March 2021 were included in the traditional treatment group, and 82 patients who entered the emergency fast track for dangerous upper gastrointestinal bleeding between April 2021 and September 2021 were included in the fast-track treatment group. The patients in the traditional treatment group were treated with the traditional single-subject diagnosis and treatment mode, and the patients in the fast-track treatment group were treated according to the multidisciplinary diagnosis and treatment procedures of emergency fast track for dangerous upper gastrointestinal bleeding. The length of emergency stay, 24-hour endoscopic completion rate, effective rate, and length of hospital stay were compared between the two groups. Results The length of emergency stay [(3.75±3.19) vs. (6.51±4.72) h], the effective rate (96.3% vs. 85.5%) and the length of hospital stay [(8.26±2.51) vs. (11.07±2.79) d] were significantly better in the fast-track group than those in the traditional treatment group (P<0.05). There was no significant difference in the 24-hour endoscopic completion rate between the two groups (96.3% vs. 96.1%, P>0.05). Conclusion Compared with the traditional treatment mode, the fast-track treatment mode can significantly improve the treatment efficiency, and reduce the lengths of emergency stay and hospital stay.
目的 探討胃切除術后近期上消化道大出血的原因及再手術治療。 方法 對我院1986~2002年間收治的14例胃切除術后近期（24～72 h內）上消化道大出血行再手術治療的病例資料進行回顧性分析。 結果 本組14例，術后吻合口出血4例，殘胃粘膜損傷出血2例，殘胃腸套疊出血2例，十二指腸殘端出血1例，遺漏十二指腸球后潰瘍及賁門粘膜撕裂出血各1例，原因不明出血3例，均經再次手術治療后痊愈。 結論 胃切除術后近期上消化道大出血原因多為操作不當及病灶遺漏所致，出血灶直視下縫扎為有效止血方法。
目的:研究上消化道大出血的外科處理辦法。方法:選因上消化道大出血而進行手術者共34例,尋找術前病因及出血部位,對不同病因和部位出血病例進行了相應的手術治療。結果:所有病例無1例死亡。術后出現吻合口滲血2 例,經止血,對癥治療出血停止。無1例再出血就診。結論: 對上消化道大出血患者,針對不同的情況,可分別采用全胃切除術、接近全胃切除術、迷走神經切斷加胃大部分切除術、迷走神經切斷加幽門成形等外科手術方式處理。
Objective To analyze and summarize the clinical characteristics of foreign body incarceration in upper digestive tract, and to explore the risk factors of its complications. Methods The clinical data of patients with foreign bodies in the upper digestive tract treated in the Affiliated Hospital of Zunyi Medical University between January 1, 2012 and December 31, 2021 were retrospectively analyzed, including demographic data, foreign body type, incarceration site, incarceration time, causes, symptoms, treatment methods and complications of foreign body incarceration. Logistic regression analysis was used to explore the risk factors of complications. Results A total of 721 patients were finally included, ranging in age from 3 months to 90 years old, with an average age of 26.76 years. The proportion of foreign bodies in the upper digestive tract in patients ≤14 years old was the highest (51.18%), and the duration of foreign body incarceration<12 hours was the highest (55.34%). The most common sharp foreign bodies in the upper digestive tract were animal bones (228 cases), and the most common round shaped foreign bodies were coins (223 cases). The most common impaction site was the upper esophageal segment (85.02%). 105 patients (14.56%) had complications, and perforation was the most common (5.55%). Logistic regression analysis showed that age [odds ratio (OR)=0.523, 95% confidence interval (CI) (0.312, 0.875), P=0.014], foreign body type [OR=0.520, 95%CI (0.330, 0.820), P=0.005], incarceration site [OR=2.347, 95%CI (1.396, 3.947), P=0.001], incarceration time [OR=0.464, 95%CI (0.293, 0.736), P=0.001] were the influencing factors of complications. Conclusions The majority of foreign bodies in the upper digestive tract are animal bones. The incidence of complications increase in patients with age ≥ 60 years, sharp foreign body edges, incarceration in the upper segment of the esophagus, and long incarceration time. It is recommended to remove the sharp foreign bodies incarcerated in the upper segment of the esophagus from the elderly as soon as possible.
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
目的 總結經頸靜脈肝內門體靜脈分流術（TIPS）治療未合并肝癌的門靜脈高壓癥患者行脾切除術后反復上消化道出血的療效。方法 對未合并肝癌或膽管癌的門靜脈高壓癥合并上消化道大出血患者行脾切除術后復發出血患者行TIPS術治療，并隨訪1～5年（平均3.2年）的資料進行總結與分析。結果 36例脾切除術后再出血者行TIPS術， 手術均獲成功，圍手術期死亡率為2.78％（1/36），死亡原因是肝性腦病。隨訪期間患者術后再次復發出血率為5.71％（2/35）。結論 TIPS對脾切除治療門靜脈高壓癥后反復出血病例的效果良好。
ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.
Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.