目的:总结老年上消化道出血的临床特点.方法:将我院2010年1月至2012年12月收治的上消化道出血患者422例分为老年组(n=200)和非老年组(n=222),比较两组的临床资料.结果:引起上消化道出血最主要的原因均为消化性溃疡,老年组中胃溃疡、胃癌的发生率均明显高于非老年组(P＜0.05),而十二指肠溃疡和食管静脉曲张的发生率则均明显低于非老年组(P＜0.05);老年组患者无腹痛率及伴随疾病率均显著高于非老年组(P＜0.01).结论:老年上消化道出血以胃溃疡和胃癌多见,同时伴有较多的并发症,死亡率较高.

目的:比较急性胆源性与高脂血症性胰腺炎(AHP)的临床特点.方法:将本院2005年1月至2010年12月收治的145例急性胰腺炎(AP)根据病因分为急性胆源性胰腺炎(ABP)84例、AHP36例及其他25例.对AHP与ABP的临床特征进行比较,并分析高脂血症(HL)与AP的相关性.结果:与ABP相比,AHP发病年龄低,男性发病率高.临床评分相同情况下,AHP在脂肪肝发生率、糖尿病发生率、重症急性胰腺炎、血脂方面高于ABP,血清淀粉酶和肝功能受损则低于ABP,差异均有统计学意义(P<0．05).结论:AHP以中青年男性患者为主,具有病情重、血脂高和血清淀粉酶低等不同于一般急性胰腺炎的临床特征.

目的:了解肝硬化合并自发性细菌性腹膜炎(SBP)患者的病原菌及其耐药情况.方法:回顾性分析肝硬化合并SBP细菌培养阳性者82例的临床资料.结果:肝硬化患者合并SBP的病原菌中革兰阴性菌占67%,革兰阳性菌占29%,白色假丝酵母菌占4%;第三代头孢菌素与喹诺酮类药物的耐药率明显增加,而临床上使用较少的氨基糖苷类抗菌药物对大肠埃希菌的耐药率较低;美罗培南、亚胺培南、替考拉宁和万古霉素的耐药率低.结论:尽可能对肝硬化合并腹水患者进行腹腔穿刺检查,根据药敏试验结果合理选择抗菌药物.

目的:探讨肝硬化与肝源性溃疡及幽门螺杆菌(HP)感染的关系.方法:对我院近10年来符合标准的200例行胃镜检查的肝硬化患者(肝硬化组)及67例慢性肝炎患者(慢性肝炎组)的临床资料进行回顾性分析.结果:肝硬化组的溃疡发病率(32.0%,64/200)高于慢性肝炎组(22.4%,15/67),但差异无统计学意义(P>0.05).肝硬化组中,溃疡发病率在肝功能A、B、C级分别为19.5%(15/77)、36.5%(31/85)和47.4%(18/38),A级与B级、A级与C级相比差异均有统计学意义,P<0.05.有溃疡者的HP阳性率40.6%(25/64)明显高于无溃疡者的16.9%(24/136),P<0.05.元、轻、中、重度门脉高压性胃病者溃疡发病率分别为23.4%(25/107)、30.0%(18/60)、60.0%(12/20)和69.2%(9/13);有、无门脉高压性胃病者溃疡的发病率相比有显著性差异.结论:肝硬化患者的肝源性溃疡发病率高于慢性肝炎患者,肝功能分级越差,溃疡发病率越高.肝源性溃疡的发生与HP感染及门脉高压性胃病有明显相关.

目的:了解肝硬化患者肺功能异常与肝病之间的关系.方法:选取2007-05/2008-03我院及中山大学附属第一医院住院肝硬化患者50例.肺功能检测患者第一秒用力呼气量(FEV1)、一秒率(FEV1/FVC),单次呼吸法检测肺一氧化碳弥散量(DLCO)、比弥散量(KCO,即单位肺泡的DLCO).将肝硬化患者分别按患者肝掌、蜘蛛痣、显性黄疸、白蛋白减低、脾亢、门静脉增宽等的异常与否分成阳性组(+)和阴性组(-),比较组间FEV1、FEV1/FVC、DLCO、KCO均值的差异.结果:约34%患者出现通气功能障碍,以限制性通气为主:有72%的患者出现弥散功能减退,为最主要的肺功能改变.Child-Pugh积分与KCO呈负相关(r=-0.351,P<0.05);白蛋白水平与FEV1、KCO呈正相关(r=0.334,0.336,均P<0.05);门静脉宽度与FEV1、DLCO呈负相关(r=-0.389,-0.417,均P<0.05);脾厚度与DLCO、KCO呈负相关(r=-0.644,-0.536,均P<0.01).血红蛋白浓度和脾脏厚度是DLCO的独立预测因子(P<0.05).结论:弥散障碍在肝硬化患者中发生率较高,门静脉高压的长期作用与之有密切关系.

肝肺综合征是发生于晚期肝病的严重并发症,其可引起低氧血症,从而使肝硬化患者的病死率增高。该病发病机制复杂,起病隐匿,症状缺乏特异性,临床上通常未给予足够的重视,早期诊断及治疗较困难。近年来,有关肝肺综合征的病因以及诊治的研究取得了长足的进展,该文对此作一综述。

肿瘤干细胞是当今生物医学领域中的一个新热点,它有可能为临床肿瘤预防、诊断和治疗的研究及应用提供一套全新的思路。该文就胰腺肿瘤干细胞的分离鉴定、自我更新途径、与肿瘤转移的关系及治疗应用前景作一综述。

肝源性溃疡是发生于慢性肝病,特别是肝硬化伴门静脉高压基础之上的胃或十二指肠溃疡。其发病机制较为复杂,临床表现不典型,缺乏规律性,病程长,易反复,难治愈。为提高对该病的认识,作者就国内外近期文献作一综述。

BACKGROUND & OBJECTIVE:For gastric stromal tumor (GST), the low incidence and high diversity in endoscopic and pathologic manifestations lead to misdiagnosis. This study was to explore the features of GST in endoscopy and clinicopathology.METHODS:Clinical data of 42 GST patients, treated at the Second Affiliated Hospital of Sun Yat-sen University from Jan. 1996 to Jan. 2006, were analyzed for their clinicopathologic and endoscopic features. The expression of CD117, CD34, smooth muscle actin (SMA), Desmin and S-100 were detected by immunohistochemistry. Their correlations to clinicopathologic features of GST were analyzed.RESULTS:Of the 42 cases of GST, 21 (50.0%) were at the fundus, 14 (33.3%) at the body, and 7 (16.7%) at the antrum; 17 (40.5%) were benign, 14 (33.3%) borderline, 11 (26.2%) malignant. Endoscopically, GST presented submucosal hemispheroid or polypoid protuberant lesions with clear border. While the positive rate of gastroendoscopic biopsy was low. Of the 42 cases, 29 were spindle cell type, 5 were epithelial cell type, and 8 were mixed type. The positive rates of CD34 and CD117 were 92.86% and 78.57%.CONCLUSIONS:GST has unique morphologic features. Combined detection of CD117 and CD34 benefits the diagnosis of GST.

目的 观察评价贲门失弛缓症的内镜直视下气囊扩张术的疗效.方法 选择92例贲门失弛缓症并经过内镜下气囊扩张术治疗的患者,术后6个月、1年、2年定期随访,详细询问病史,并经内镜和钡餐检查对原有的吞咽困难等症状缓解程度进行评估.结果 92例患者吞咽困难症状均有显著改善.1次扩张有效率达86.9%,2次有效率可达100%.术中可见贲门黏膜撕裂、渗血,未见致命性出血及穿孔等并发症.结论 内镜下气囊扩张术治疗贲门失弛缓症可获得良好的近期和远期疗效,具有安全、简便、价廉的特点,是治疗贲门失弛缓症的首选方法.

Objective: To investigate the clinical epidemiological features of upper gastrointestinal bleeding (UGIB) induced by non-steroidal anti-inflammatory drugs(NSAIDs). Methods: Patients who were hospitalized in our ward because of UGIB from Jan, 2000 to Dec, 2006 were divided into two groups according to consumption of NSAIDs or not in the week previous to the onset of bleeding. Results: 366 patients were investigated with 103 in NSAIDs group and 263 in non-NSAIDs group. There was no significant difference in sex, way of bleeding, bleeding site in stomach or duodenum, presence of erosion and the need of endoscopic injection therapy or not between the two groups. However, the patients in NSAIDs group were older than those in non-NSAIDs group. Hemoglobin level was lower in NSAIDs group (P < 0.001). There was more gastric ulcer and complex ulcer in the NSAIDs group than in non-NSAIDs group (P < 0.001). NSAIDs users had more erosion and ulcers (P < 0.001). Helicobacer pylori (Hp) was present in 65.05%% of the non-NSAIDs group and 26.24% of the NSAIDs group (P < 0.05). In an another study, we found that age of the patients, history of UGIB, Hp state affect the clinical characteristics of NSAIDs UGIB. Conclusions: The clinical characteristics of NSAIDs associated UGIB should be better understood so as to decrease the occurrence of NSAIDs UGIB and its complication.

目的通过对抗生素所致伪膜性肠炎(PMC)分析,总结临床经验教训,提高诊治水平。方法对73例临床使用抗生素引起PMC的患者从年龄、合并疾病、抗生素的使用种类、时间、发病时间及治疗方法等方面进行回顾性总结及分析。结果PMC多发于合并有长期慢性疾病、年龄大、体质差、手术打击后及抗生素应用不规范的老年患者。结论抗生素应用不合理是引起PMC的主要原因,对长期大量使用抗生素的老年患者出现腹胀、腹泻现象时,结合结肠镜的特征表现首先应考虑有无PMC。及早停用抗生素,使用足量和足疗程的甲硝唑和万古霉素是治疗PMC的有效方法。

肝结核较为少见,多同时合并肺结核。其病情隐匿,容易造成误诊或漏诊。作者对肝结核的诊断和治疗作一综述,旨在提高对肝结核的认识,减少临床的误诊或者漏诊。

Objective To investigate the clinical epidemiological features of peptic ulcer bleeding induced by nonsteroidal anti-inflammatory drugs(NSAIDs). Methods Clinical data of peptic ulcer bleeding from 1991~2004 were retrospectively analyzed. Results Among 694 cases of peptic ulcer with bleeding,26.80% had history of taking NSAIDs recently. The NSAIDs group had little clinical ,higher average age(44.16±13.25 ys versus 35.23±11.49 ys ),P0.05), more female(26.34% versus 15.55%, P0.01) and more gastric ulcer (28.50% versus 20.67%, P0.01) than the non-NSAIDs group. The rate of surgical treatment did not differ significantly(P0.05) between groups. Conclusions NSAIDs is a common cause for inducing bleeding of peptic ulcers. More attention should be paied to prevent its side effects in gastrointestinal tract.

Objective To study the clinical pathological characteristics and endoscopic features of gastric remnant cancer(GRC)as well as the factors influencing prognosis of gastric remnant cancer.Methods The data of patients with GRC between 1990 ～ 2006 were collected.According to the clinical data and the endoscopic diagnostic criteria with multiple biopsies,102 patients were enrolled.The data of the positive detection rate,gender,age,clinical manifestations,course of disease,pathology,surgical modality,Helicobacter pylori(H.pylori)infection,site of lesion,endoscopic features and survival rate of the patients were analyzed.Results The detection rate of GRC was 4.78%,males was more than females with main occurrence in elderly patients(70.59%).The course of disease more than 10 years reached 96.1% with a mean interval of 16.6 years.The incidences of GRC after operation for gastric ulcer and duodenal ulcer were similar(5.30% vs.5.05%,P 0.05).The incidence of GRC after Billroth Ⅱ was higher than that of Billroth Ⅰ(3.28% % vs.1.50%,P 0.05).The positive rate of GRC in patients with H.pylori infection was higher than that of gastric renmnant patients without cancer in the same period(66.67% vs.29.68% P 0.01).The clinical features of GRC were nonspecific;the site of GRC lesion was most commonly located in the anastomotic region.One-year,3-year and 5-year survival rates of the patients with radical resection were significantly higher than those with palliative resection(100% vs.26.3%,65.2% vs.11.4%,33.8% vs.0,respectively,P 0.05).Conclusions Among the patients with gastric remnant cancer,more than 10 years of history,Billroth Ⅱ operation and H.pylori infection are the high risk factors for GRC,and endoscopy with biopsy is currently the main method for the diagnosis.The prognosis of GRC is correlated closely with the pathological stage and the probability of the radical resection.

[Objective] To analyze the clinical and endoscopic features of antibiotic-associated pseudomembranous colitis,and summarize clinical lessons,in order to improve the level of diagnosis and treatment.[Method] The clinical data of 73 patients with antibiotic-associated pseudomembranous colitis in the Second Affiliated Hospital of Sun Yat-sen University from 1994 to 2005 was analyzed retrospectively according to their respective ages,complications,the types of antibiotics,time of onset and treatments,et al.[Results] Pseudomembranous colitis was a common gastrointestinal complication in old patients with chronic diseases,old age,weak constitution,postoperation and antibiotic abusing.[Conclusion] Antibiotic abusing is the main cause of pneudomembranous colitis.Most of the symptoms in the old patients treated with superfluous antibiotics were exhibited as abdominal pain,watery diarrhea.The diagnosis can be confirmed by the sigmoidoscopic features,and it would be treated successfully with oral Vancomycin Metronidazole rationally after withdrawal of antibiotics promptly.

十二指肠憩室多为一种先天性疾病,早在1710年由CHOMEL描述,临床上并不少见,在消化道憩室病中其发生率仅次于结肠,男女发病率无差异,多见于年龄50岁以上者。十二指肠憩室主要好发于降部内侧,尤以乏特壶腹周围为多,临床上与胆胰疾病的关系密切。

借兴办“分院”扩大自身规模、以更有效地扩大市场份额,是近年来各大医院采取的新的竞争手段,抓好门诊工作往往是这类医院能否成功开好局的关键。突出人性化的建筑设计,营造舒适的就医环境;利用门诊作为对外宣传和展示其服务水平的窗口;发挥专家优势,灵活调配人力和医疗资源,达到有效控制成本,是新办医院稳步发展的基本策略。强化门诊工作的管理,把门诊量的持续增长作为衡量新办医院美誉度的主要标杆,是增强新办医院竞争力的一项有效措施。

目的探讨老年脂肪肝的独立危险因素及其临床特点.方法回顾性分析192例老年脂肪肝和221例非老年脂肪肝病人的临床资料,并随机抽取非脂肪肝的老年患者82例作为对照组.对老年脂肪肝组和对照组的血脂等变量进行回归分析,比较老年脂肪肝和非老年脂肪肝的临床特点和肝功能的改变.结果酗酒(OR=36.678)、体重指数(OR=20.795)、甘油三酯(OR=2.702)、2型糖尿病(OR=2.569)和空腹血糖(OR=1.836)与老年脂肪肝的形成有关.老年脂肪肝组高血压、冠心病的发生率高于非老年脂肪肝组,而肥胖、高脂血症、乙型与丙型肝炎病毒感染的比例显著低于非老年脂肪肝组.老年脂肪肝组ALT升高的比例(21.9%)显著低于非老年脂肪肝组(39.4%),A/G<1.5的比例(26.0%)高于非老年脂肪肝组(15.4%).结论酗酒、肥胖、高甘油三酯血症、2型糖尿病和空腹血糖升高为老年患者发生脂肪肝的独立危险因素.老年脂肪肝患者更易合并高血压和冠心病.老年脂肪肝患者的肝功能改变以慢性损害多见.

OBJECTIVE To analyze the associated risk factors, clinical characteristics and laboratory abnormalities of type 2 diabetes patients with fatty liver. METHODS The data of type 2 diabetes cases with fatty liver were collected in our hospital. 63 cases of type 2 diabetes without fatty liver were selected randomly as control during the same period. The associated variables were analyzed by using logistic regression model. The clinical data and liver function were compared between two groups. RESULTS The proportion of obesity and hyperlipidemia was higher in type 2 diabetes patients with fatty liver than without fatty liver. Body mass index (BMI) (OR: 4.392) was positive correlation to fatty liver in the patients with type 2 diabetes. In contrast, insulin sensitivity index (ISI) (OR: 0.000) and regular insulin treatment (OR: 0.058) were negative correlation to it. The abnormal frequencies of aspartate aminotransferase (AST, 16.0%), alanine aminotransferase (ALT, 25.2%), the ratio of AST/ALT less than 1 (52.8%) and gamma-glutamyltransferase (GGT, 31.9%) of type 2 diabetes patients with fatty liver were significantly higher than those without fatty liver (3.2%, 6.4%, 36.5% and 11.1% respectively). CONCLUSION Obesity and insulin resistance might increase the risk of fatty liver in the patients with type 2 diabetes. Patients of type 2 diabetes with fatty liver show higher serum lipid level and more obvious damages of liver function than those without fatty liver