内镜下氩离子凝固术联合质子泵抑制剂治疗疣状胃炎临床观察

目的探讨内镜下氩离子凝固术（APC）联合质子泵抑制剂治疗疣状胃炎的疗效。方法 88例疣状胃炎患者随机分为治疗组和对照组,治疗组内镜下氩离子凝固术联合质子泵抑制剂（奥美拉唑）治疗,对照组应用质子泵抑制剂（奥美拉唑）治疗,疗程为4周,对两组幽门螺杆菌（Helicobacter pylori,Hp）阳性者,同时应用阿莫西林、甲硝唑进行治疗,疗程为7d。4周后复查胃镜,判定疗效。结果治疗组临床症状改善和内镜病灶消失的有效率显著高于对照组（P〈0.01）,Hp根除率两组无统计学差异（P〉0.05）。结论 APC术联合质子泵抑制剂治疗疣状胃炎疗效确切、安全可靠,临床值得推广。     

氩离子凝固术对疣状胃炎疗效的临床研究

背景:疣状胃炎是一种特殊类型的慢性胃炎,目前尚无特异性治疗方法。目的:探讨氩离子凝固术(APC)治疗疣状胃炎的疗效。方法:选取2010年9月～2012年7月上海市青浦区朱家角人民医院经内镜检查确诊的疣状胃炎患者65例,随机分为治疗组和对照组。幽门螺杆菌(Hp)阳性者先行四联疗法根除Hp。治疗组患者行APC治疗后给予质子泵抑制剂(PPI)和胃黏膜保护剂治疗8周,对照组接受PPI和胃黏膜保护剂治疗8周。比较两组的治疗效果。结果:经APC治疗后,患者临床症状明显改善。治疗组的病灶数目减少程度明显高于对照组(P<0.05)。22例对照组患者药物治疗疗效不明显,转组接受APC治疗后,病灶数目显著降低(P<0.05)。结论:APC可有效治疗疣状胃炎,且安全性良好。     

雷贝拉唑在成熟型疣状胃炎氩离子凝固术后的疗效观察

氩离子凝固术(argon beam coagulation，ABC)是内镜下治疗消化道疾病的新方法，1999年国内首次用于治疗成熟型疣状胃炎，针对治疗后患者出现不同程度的治疗部位疼痛及创面形成等情况，通常采用制酸剂和胃黏膜保护剂促进术后疼痛的缓解和创面的愈合。本研究拟对新型质子泵抑制剂雷贝拉唑对患者的疼痛缓解程度、创面黏膜愈合情况进行评价。     

无痛苦胃镜下APC治疗疣状胃炎的临床价值

目的探讨在无痛苦胃镜下氩离子体凝固术（APC）治疗疣状胃炎的临床价值。方法选择胃镜诊断为成熟型疣状胃炎56例，随机分为治疗组和对照组，治疗组36例采用德国ERBE公司生产的APC300EA型内镜专用氩气刀在无痛苦胃镜下对疣状胃炎进行氩离子凝固术治疗。对照组20例单纯给予质子泵抑制剂或H：受体拮抗剂治疗。两组均于治疗1个月后进行胃镜复查。结果治疗组36例疣状病灶均消失，无穿孔等并发症发生。对照组20例疣状病灶无明显消退。结论在无痛苦胃镜下APC治疗疣状胃炎是一种疗效确切、安全性好、不良反应少、患者无痛苦、经济实用而简便易操作的好方法，值得基层医院的临床推广。     

胃镜下热极治疗疣状胃炎的临床研究

目的观察内镜下热极治疗疣状胃炎的临床疗效。方法对31例疣状胃炎采用内镜下热极治疗，术后给予奥美拉唑20mg．每日2次，共4周。对照组仅给予奥美拉唑20mg．用法相同。两组中幽门螺杆菌阳性者加用阿莫西林1．0，每日2次，甲硝唑0．4，每日2次，共1周。结果治疗组疣状糜烂愈合和临床症状缓解显著高于对照组（P〈0．01～0．05）。结论内镜下热极治疗疣状胃炎疗效确切，操作简单，值得临床推广应用。     

疣状胃炎与幽门螺旋杆菌感染的关系及其临床治疗的探讨

目的探讨幽门螺旋杆菌（HP）及其产毒株（Tox＋HP）在疣状胃炎发生中的作用,了解胃黏膜肠上皮化生及上皮内瘤变在疣状胃炎（VG）时的发生情况,观察药物（质子泵抑制剂,三联疗法抗HP）及内镜下微波疗法对于疣状胃炎的确切疗效。方法通过胃镜检查将疣状胃炎分为成熟型（MVG）和非成熟型（UMVG）两类,每例均进行病理观察,HP感染分为HP感染阴性和阳性,根据以上情况将患者分为8组,分别予以药物治疗及微波治疗,比较各组HP及Tox＋HP感染、胃黏膜肠上皮化生及上皮内瘤变及不同疗法的效果情况。结果疣状胃炎时HP感染率高于对照组,以Tox＋HP感染为主;胃黏膜肠上皮化生及上皮内瘤变在成熟型胃炎组明显高于对照组,UMVG组稍高于对照组,但是无显著性差异;对于UMVG,单纯药物治疗1月治愈好转率达88％～94％,微波疗法治愈好转率近100％;对于MVG,单纯药物治疗1月治愈好转率达28％～35％,微波疗法治愈好转率近100％。结论HP尤其Tox＋HP的感染在疣状胃炎的发生中起了重要的作用,在疣状胃炎尤其MVG时胃黏膜肠上皮化生及上皮内瘤变发生率高于对照组,说明疣状胃炎有癌变倾向;单纯药物（质子泵抑制剂,三联疗法抗HP）疗法对于UMVG有效,对于MVG疗效差;内镜下微波疗法适用于MVG及药物不理想的UMVG患者。     

疣状胃炎氩离子凝固术后质子泵抑制剂疗效的比较

背景：质子泵抑制剂（PPI）埃索美拉唑和奥美拉唑广泛应用于消化性溃疡和反流性食管炎的治疗中，但目前内镜下治疗术后的应用研究较少。目的：比较埃索美拉唑与奥美拉唑对疣状胃炎氩离子凝固术（APC）后腹痛缓解和溃疡愈合的疗效。方法：86例疣状胃炎APC后随机分为两组：A组46例，治疗后次日起予埃索美拉唑20mg／d口服．疗程4周；B组40例，治疗后次日起予奥美拉唑20mg／d口服，疗程4周。观察治疗前后两组患者的腹痛缓解情况和溃疡愈合情况。溃疡愈合情况通过胃镜检查来评估。结果：A组患者服药后第ld腹痛缓解率为84．8％，高于B组的55．0％（心0．001）。A组患者第7d腹痛缓解率为100，0％，高于B组的80．0％（P〈0．01）。两组间疼痛消失平均天数比较，A组显著少于B组（P〈0．001）。A组溃疡愈合率（95．7％）高于B组（92．5％），但差异无显著性（P〉0．05）。结论：埃索美拉唑和奥美拉唑在疣状胃炎APC后溃疡的愈合方面具有相同疗效，但在腹痛缓解方面埃索美拉唑优于奥美拉唑。     

小剂量奥美拉唑联合瑞巴派特治疗Heficobecter pylori相关慢性浅表性胃炎临床研究

目的评价小剂量奥美拉唑（0）联用瑞巴派特（R）对H．pylori相关性慢性浅表性胃炎的临床症状、内镜下黏膜变化及组织学炎症改善作用。方法采用随机平行对照临床研究。将96例H．pylori感染的慢性浅表性胃炎患者，随机分为OR组（32例）、0组（32例）、R组（32例）。治疗第1周，3组均予H．pylori根除三联方案。第2～6周，0组予洛赛克MUPS10mg每日1次13服；R组予膜固思达100mg每日3次口服；OR组予MUPS10mg每日1次口服，联合膜固思达100mg每日3次口服。结果治疗结束，3组临床症状改善均有显著性变化。OR组、0组临床症状改善均比R组显著。第6周末复查胃镜，镜下黏膜情况3组差异无统计学意义；OR组、R组组织学炎症消退均比0组明显。结论治疗H．pylori相关性慢性浅表性胃炎，小剂量奥美拉唑联合瑞巴派特，比两药单用能够更好缓解临床症状。促进炎症消退。     

胃镜电凝术配合中药治疗疣状胃炎50例

[目的]观察内镜下电凝术配合中药治疗疣状胃炎的临床疗效。[方法]90例疣状胃炎患者随机分为2组。治疗组胃镜电凝术后配合中药治疗;对照组胃镜电凝术后奥美拉唑治疗;2组疗程均为30 d。[结果]治疗组患者临床症状缓解和胃内疣状结节消失显著高于对照组（P〈0.01）。[结论]胃镜下电凝术配合中药治疗对疣状胃炎有较肯定的疗效。     

质子泵抑制剂联合胃黏膜保护剂和胃肠动力药治疗消化性溃疡27例

[目的]观察质子泵抑制剂（PPI）联合胃黏膜保护剂与胃肠动力药对消化性溃疡的临床疗效。[方法]入选61例消化性溃疡患者为研究对象,其中34例（实验组）采用PPI联合胃黏膜保护剂和促胃肠动力药治疗4周;27例（对照组）单用PPI治疗4周。对2组治疗后临床症状、胃镜及幽门螺杆菌检查结果进行比较。[结果]在进行抗溃疡治疗4周后,实验组的总有效率为94．1％,对照组的总有效率为74．1％,2组比较差异有统计学意义（P〈0．05）。[结论]PPI联合胃黏膜保护剂和促胃肠动力剂可明显提高治疗消化性溃疡的临床疗效。     

幽门螺杆菌阳性的疣状胃炎治疗112例

目的:了解疣状胃炎与H pylori感染的关系方法:胃镜确诊H pylori阳性的疣状胃炎患者112例随机分组,分别以雷贝拉唑钠、阿莫西林、克拉霉素根除H pylori治疗(A组)和雷贝拉唑钠抑酸治疗(B组).治疗后1 mo评价症状、胃镜改善情况和H pylori根除情况.显效者随访至治疗后6 mo再次评价症状和胃镜改善情况、检测H pylori.结果:治疗1 mo后A组症状和胃镜改善情况明显好于B组,两组比较有显著性差异(89.3% vs 75.0%;91.1% vs 76.8%,P<0.05).所有显效者随访至治疗后6 mo,A组复发率11.1%,B组复发率50.0%,A组明显低于B组.两组复发者H pylori均为阳性,未复发者H pylori阳性率为37.7%,二者对比有显著性差异(P<0.05).结论:疣状胃炎与H pylori感染密切相关.     

胃康宁治疗糜烂性胃炎临床应用和实验研究

本文用中药胃康宁治疗糜烂性胃炎５４例，并与用西药甲氰米哌治疗的２０例作对照，结果表明，两组病人服药４周后经胃镜检查，结果中药组糜烂治愈率为９０．７％，西药组为６５％，两组比较有显著差异（Ｐ＜０．０１）。通过对盐酸所致急性胃炎和消炎病所致胃粘膜损伤的大鼠实验表明，胃康宁对大鼠胃粘膜有很好的保护作用。     

内镜热极动物实验和治疗糜烂性胃炎的应用

目的：观察评价经内镜热极治疗糜烂性胃炎的可能性,疗效和操作方法。方法：对狗胃粘膜作热凝实验和对４３例糜烂性胃炎经正规抗酸、抗菌药物处理后,采用热极热凝治疗,并观察其效果。结果 在临床应用中,糜烂性胃炎内镜下热极治疗一次治愈率为８６．０％（３７／４３）,而且均未出现明显并发症。结论 内镜下热极治疗难治性糜烂性胃炎是一种补充的治疗方法。     

Efficacy of the heater probe in peptic ulcer with a non-bleeding visible vessel. A controlled, randomised study.

A controlled, randomised study was performed to evaluate the efficacy of treatment with heater probe in the prevention of rebleeding from peptic ulcer with a non-bleeding visible vessel. One hundred and one patients were randomised into two groups: patients to be treated by heater probe (n = 51) and controls without active treatment (n = 50). In the heater probe group rebleeding occurred in five patients (10%) v 13 (26%) in the control group (p = 0.03), with a comparative risk of 0.38 in favour of the heater probe group. The difference in proportions of successful treatment for each group was 16.2% in favour of the heater probe (95% CI = 2 to 31%). Haemorrhage directly related to heater probe treatment occurred in four patients. In three of them bleeding was easily controlled by further heater probe pulses. There were no other complications and no death in the heater probe group. One patient in the control group died of pulmonary embolism. No significant differences in the length of stay in hospital, blood transfusions, surgical rates, or death were found; the design of the study, however, precluded an adequate assessment of these variables, because the heater probe was an optional rescue treatment when high surgical risk patients rebled. These results suggest that the heater probe is an effective and safe procedure in the prevention of recurrent haemorrhage in peptic ulcer with a non-bleeding visible vessel.     

内镜下射频消融配合胃三联治疗慢性胃炎隆起糜烂型的临床观察

目的:探讨射频局部消融配合胃三联治疗慢性胃炎隆起糜烂型的疗效．方法:内镜下符合慢性胃炎隆起糜烂型诊断,H pylori阳性的患者106例,随机分为治疗组:射频消融 洛赛克omeprazole、阿莫西林 Amoxicillin、克拉霉素Clarithromycin(简称胃三联)治疗,对照组:单纯胃三联治疗．结果:治疗组隆起糜烂病灶平复率、临床症状有效率分别为100％和94．1％,对照组隆起糜烂病灶平复率、临床症状有效率分别为 27．2％和58．2％,优于对照组(P<0．05)．H pylori 根除率治疗组88．2％,对照组85．7％,二者之间无显著差异(P>0．05)．结论:射频局部消融配合胃三联治疗慢性胃炎隆起糜烂型疗效确切、操作简单、安全．     

EFFECT OF ARGON PLASMA COAGULATION IN PATIENTS WITH UPPER GASTROINTESTINAL ACTIVE HEMORRHAGE

Background: Acute upper gastrointestinal hemorrhage is a common and life‐threatening medical emergency. Despite a large number of endoscopic methods for hemostasis, active bleeding lacks an adequate therapeutic remedy. The aim of the present study was to evaluate the hemostatic effect of argon plasma coagulation on upper gastrointestinal active bleeding, especially in comparison with heater probe and pure ethanol injection therapy. Methods: Sixty‐eight patients with 77 lesions presenting active bleeding were treated endoscopically and divided into three groups depending on the procedures, that is, argon plasma coagulation group (27 patients with 32 lesions), heater probe group (20 patients with 22 lesions) and pure ethanol injection group (21 patients with 23 lesions). The three groups were similar with respect to all background variables. Episodes of rebleeding were retreated with the same modality as used previously. Results: The primary hemostatic rate in the argon plasma coagulation group was 81.3%, that in the heater probe group was 77.3%, and that in the pure ethanol injection group was 87.0%. The permanent hemostatic rate in the argon plasma coagulation group was 75.0%, that in the heater probe group was 63.6%, and that in the pure ethanol injection group was 78.3%. When examined in terms of Forrest's criteria, the argon plasma coagulation group in Forrest's type I b and the pure ethanol injection group in type I a showed the highest permanent hemostatic rate. Conclusions: Argon plasma coagulation is most suitable in arresting oozing hemorrhage. If pure ethanol injection therapy is possible, it is more effective than other therapies in the case of spurters.     

养胃冲剂治疗慢性浅表性胃炎的临床研究

目的研究养胃冲剂治疗慢性浅表性胃炎的临床疗效.方法将160例慢性浅表性胃炎患者随机分为两组.治疗组(120例)用养胃冲剂,对照组(40例)用胃炎康治疗,对照观察两组疗效.结果治疗组对慢性浅表性胃炎患者胃粘膜水肿、斑点状充血或麋烂炎症程度、肠化及非典型增生均有较好的防治作用,对胃院痞满、纳呆、胃痛、暖气等症状具有较好疗效.两组总有效率分别为92.5%、75.0%,两组比较有显著性差异(P＜0.05).结论养胃冲剂主治脾胃虚弱型浅表性胃炎,对肝胃不和型、气滞血瘀型患者也有较好疗效.     

Comparison of endoscopic injection therapy versus the heater probe in major peptic ulcer haemorrhage.

One hundred and twenty patients presenting with major peptic ulcer haemorrhage were randomised in a clinical trial comparing endoscopic injection and heater probe therapy. The two groups were well matched with regards to age, admission haemoglobin concentration, the presence of shock, non-steroidal anti-inflammatory drug usage and endoscopic findings. Permanent haemostasis was achieved in 87% of the injection group and 85% of the heater probe group. Hospital mortality, transfusion requirement and duration of admission were similar in both groups. Endoscopic injection and the heater probe represent equally effective therapy for peptic ulcer bleeding.     

慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌感染序贯根除的疗效

目的 探讨慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌的感染率及序贯根除的临床效果。方法300例慢性乙型肝炎患者通过胃镜进行组织活检,病理证实为慢性萎缩性胃炎,均通过组织WS染色及14C．尿素呼气试验（UBT）检测幽门螺旋杆菌,其中195例阳性者随机分为治疗组105例和对照组90例,治疗组先给予雷贝拉唑＋阿莫西林5d,随后给予雷贝拉唑＋克拉霉素＋甲硝唑5d,进行10d序贯治疗,对照组给予传统三联既雷贝拉唑＋克拉霉素＋阿莫西林7d疗法,治疗结束4周后予14C—UBT复查。结果慢性乙型肝炎患者伴萎缩性胃炎幽门螺旋杆菌的感染率为65．0％,传统方法幽门螺旋杆菌的根除率约为70．0％,治疗组幽门螺旋杆菌的根除率达92．3％,两者比较,10d序贯疗法明显优于7d疗法（P〈0．05）,两组副作用发生率无明显差异。结论慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌的感染率较高,序贯治疗有较好的根除效果。