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胃食管反流病的外科治疗
胃食管反流病(gastroesophageal reflux disease,GERD)是上胃肠动力障碍性常见疾病,是由于食管下端括约肌压力的降低或者一过性松弛以及食管裂孔疝等原因,致胃食管反流频繁,过多胃、十二直肠内容物反流入食管损伤食管下端黏膜引起烧心、返酸、胸痛等症状及反流性食管炎 ,可导致食管溃疡、狭窄甚至癌变和短食管[1-2].根据其内镜下表现,胃食管反流病可分为非糜烂性反流病、反流性食管炎和Barrett's食管.GERD十分常见,在西方国家,人群中约有7 %~15%有胃食管反流症状,老年人1/4患有此病.
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食管胆红素监测诊断小儿十二指肠胃食管反流的意义
十二指肠胃食管反流(DGER)是指十二指肠内容物反流入食管.十二指肠液的主要成分是胆汁、碳酸氢盐和胰酶,它们是消化过程中不可缺少的物质.但除了胃酸和幽门螺杆菌外,胆汁被认为是上消化道的第3个内源性黏膜攻击因子[1-3].
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胃食管反流病病人的幽门螺杆菌是否应该根除
幽门螺杆菌(Helicobacter pylori,Hp)和胃食管反流病(gastroesophageal reflux disease,GERD)的关系目前是胃肠病学研究领域的热点问题.Hp在GERD病人中感染率平均在40%左右[1].对于其根除的利与弊存在很大的争议,现将有关各方面的意见综述如下.
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食管癌病人术后胃食管反流和胃排空延迟的护理
胃食管反流和胃排空延迟是影响食管癌病人术后生存质量的两个重要因素.1996年1月-2005年8月完成各期食管癌根治术1 856例,发生严重胃食管反流和胃排空障碍者26例,病人表现为进食后反流、胸闷、烧心、呕吐、夜间睡眠时呛咳等,腹部肠鸣音弱,血生化各项指标无异常.通过仔细观察,采取行之有效的治疗和护理,病人康复出院.现将护理总结如下.
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Objective: To observe the effect of electroacupuncture (EA) combined with Stretta radiofrequency treatment on contents of motilin (MTL) and gastrin (GAS) in gastroesophageal reflux disease (GERD) patients.
Methods: A total of 90 eligible GERD cases were randomly allocated into three groups, 30 in each group. Patients in the EA group were treated with EA, patients in the radiofrequency group were treated with Stretta radiofrequency, and patients in the observation group were treated with EA combined with Stretta radiofrequency. Assessment was made after a course of treatment.
Results: The recovery, improvement and failure cases and total effective rate in the EAgroup were 2, 18, 10 and 67.7% respectively, versus 13, 13, 4 and 86.7% in the radiofrequency group and 20, 9, 1 and 96.7% in the observation group. The therapeutic efficacy in the observation group was significantly better than that in the other two groups (P<0.01). After treatment, symptom scores of regurgitation, heartburn and substernal burning pain in all three groups were significantly reduced (P<0.05); the reduction in the observation group was more significant than that inthe other two groups (P<0.05),and the reduction in the radiofrequency group was more significant than that in the EA group (P<0.05). After treatment, the contents of MTL and GAS in all three groups were increased; and the increase in the observation group was more significant than that in the other two groups (P<0.05).
Conclusion: EA combined with Stretta radiofrequency treatment can significantly improve the clinical effect of GERD patients, improve regurgitation, heartburn and substernal burning pain and increase the contents of MTL and GAS. -
胆汁反流与胃食管反流病
GERD 是临床常见疾病。我国近期的一项大型流行病学调查显示,有 GERD 症状的患者约占3.1%[1]。虽然 GERD 为良性疾病,但是其症状和相关并发症严重影响患者生命质量,而且给患者本人、家庭,以及社会都带来巨大经济负担,对其发病机制的探索一直是本领域的研究热点。GERD 的发病机制非常复杂。随着研究的不断深入,胆汁成为酸反流之外重要的致病因子之一,十二指肠-胃-食管反流(duodenal gastroesophageal reflux,DGER)在GERD 发病机制中的作用日益受到关注,成为近年来研究的焦点之一。
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胆汁反流的成因与机制
胆汁反流又称十二指肠胃反流(duodenogastric reflux,DGR),是指胆汁、胆盐、溶血性卵磷脂、胰酶等十二指肠内容物反流至胃。如反流至食管,则形成十二指肠-胃-食管反流(duodenal gastroesophageal reflux,DGER)。在空腹、餐后偶可出现 DGR,对人体无损害,属生理性反流,但若在某种病理情况下, DGR 发生过频、反流时间过长、反流量过大时,则可导致胃黏膜损害,成为病理性 DGR,是消化道常见的一种病理生理现象。
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~(99)Tc同位素扫描诊断食管裂孔疝及GER的临床观察
本文采用~(99)Tc同位素扫描对12例食管裂孔疝行术前和术后检查.结果证明~(99)Tc同位素扫描可确定GER的程度.这对术式的选择,术后疗效的评定都是一项客观指标.同时还介绍了同位素扫描对GER的诊断,评价,食管裂孔疝与GER的关系.
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小儿下食管括约肌压力测定及其在胃食管返流临床中的初步应用
本文对71名正常小儿和15例有GER症状的患儿进行了LESP测定.结果表明我国小儿LESP和LESL的正常参考值分别为16.27±5.09m mH g和2.40±0.93cm且随年龄而趋于增加.LESP测定有助于GER的诊断,当LESP低于10mmHg时,提示LES功能不全.LESP测定是一项操作简便、快速而安全的食管功能性检查方法,值得在小儿GER临床中开展应用.
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西米替丁、西沙必利治疗伴胃食管反流的支气管哮喘的临床研究
诱发哮喘的原因非常多,而胃食管反流(GER)是儿科常见的上消化道动力紊乱,近年来研究表明GER是引起和加重哮喘的一个重要因素.本文对14例哮喘伴胃食管反流的患儿运用抗反流治疗,并进行对照研究,以观察抗反流治疗对伴GER的哮喘的治疗作用,并进一步证实GER与哮喘的内在联系.