RÉSUMÉ
Sarcopenia is a common complication in patients with liver cirrhosis, with an incidence rate of up to 40%-70%, which increases the incidence rate of complications in patients with liver cirrhosis and seriously affects patients' quality of life and survival time. Sarcopenia in liver cirrhosis has a complex pathogenesis, and its clinical manifestations are easily ignored. No consensus has been reached on diagnostic criteria, and there are few targeted therapeutic drugs. Therefore, it should be taken seriously by clinician and the research on pathogenesis and therapeutic drugs should be strengthened.
RÉSUMÉ
Objective To analyze the causes of delayed hemorrhage after colonoscopic treatment in colorectal diseases and the value of second colonoscopic treatment.Methods A retrospective study was conducted on 45 patients with colorectal protrusion lesions (polyps,adenoma,early carcinoma and lipoma) in the Daping hospital of the Third Military medical University from January 2010 to December 2016.The patients suffered from delayed hemorrhage after argon knife coagulation,submucosal resection,submucosal dissection or nylon snares colonoscopic treatment.The mode and clinical outcome of second colonoscopic treatment were summarized by aiming at the reasonsof delayed hemorrhage.Results The predilection sites of delayed hemorrhage were in turn rectum (28.89 ％),sigmoid colon (24.44 ％) and ascending colon (22.22 ％).Adenoma and intraepithelial neoplasia lesions were easier to occurr (88.89 ％).The types of delayed hemorrhage were mainly blood oozing at the lesion resection wound surface as well as blood gushing or ejection.The second colonoscopic treatment modes in these cases were mainly titanium clipping and ring clipping and suturing.Five cases were treated by submucosal injection of adrenaline (1 ∶ 10 000) combined with argon knife coagulation.Thirtyfive cases conducted argon knife coagulationcombined with titanium clipping,3 cases conducted titanium clipping and 2 cases adopted ring clipping hemostasis.Forty-two cases stopped bleeding by once colonoscopic treatment,while 3 cases suffered from re-bleeding,the colonoscopic treatment was performed again,1 case stopped bleeding after using titanium clipping and ring clipping hemostasis again,while other 2 cases were transfered to the surgery department for conducting colectomy.All 43 cases of delayed hemorrhage in this group were cured and discharged after successful hemostasis by colonoscopy.The firm wound treatment after colonoscopic treatment was very important for preventing delayed hemorrhage,and the underlying diseases and postoperative diet management were also the important factors of delayed hemorrhage.Conclusion Timely second colonoscopic examination and treatment can obtain satisfactory clinical effects in the patients sufferring from delayed hemorrhage after colonoscopic treatment.
RÉSUMÉ
Background:Non-variceal vascular originated gastrointestinal bleeding has been attracted more and more attention in clinical practice. Because of the poor efficacy of conventional drug therapy and the high rebleeding rate,endoscopic therapy or interventional therapy have become the first choice. Aims:To investigate the therapeutic value of endoscopic therapy and interventional therapy in non-variceal vascular originated gastrointestinal bleeding. Methods:Retrospective analysis was performed in 77 patients with non-variceal vascular originated gastrointestinal bleeding who underwent endoscopic therapy or interventional therapy from January 2010 to May 2016 at Daping Hospital of the Third Military Medical University. The therapeutic efficacy of the two therapies was compared. Results:In 77 patients,48 patients received endoscopic therapy and 29 patients received interventional therapy. Compared with interventional therapy group, hemoglobin was significantly higher (P = 0. 007)and Blatchford score was significantly lower in endoscopic therapy group (P = 0. 021). Stomach lesion was found in 22 patients,25 in duodenum,18 in small intestine,9 in colon and 3 in rectum. Angiodysplasia lesion was found in 35 patients,ulcer combined with angiodysplasia in 26 patients,arterial rupture in 13 patients,and angiotelectasis in 3 patients. Rebleeding occurred in 7 patients underwent endoscopic therapy within 72 hours. No rebleeding was found in patients underwent interventional therapy,however,1 patients died from pulmonary embolism. Conclusions:Most patients with upper gastrointestinal angiodysplasia can benefit from endoscopic therapy. Surgery may be a better choice for those with more severe mucosal damage and rebleeding within 72 hours after treatment. Interventional treatment may be a first choice for those who have bleeding from small intestinal angiodysplasia,lower hemoglobin and a higher Blatchford score.
RÉSUMÉ
Background:With the deepening of researches on etiology of gastrointestinal bleeding,bleeding caused by pancreatic diseases has been understood better by the clinicians. Upper gastrointestinal bleeding (UGIB)is an uncommon but highly lethal complication of pancreatic diseases. Aims:To analyze the clinical characteristics of UGIB caused by pancreatic diseases for improving the diagnosis and management of this condition. Methods:A total of 22 inpatients who were diagnosed as UGIB caused by pancreatic diseases from Sep. 2010 to Sep. 2016 at Daping Hospital,the Third Military Medical University were recruited and analyzed retrospectively. Results:There were 15 males and 7 females;the disease was more prevalent in young patients than in middle-aged and elderly patients (45. 5% vs. 31. 8% and 22. 7%). The top five causes of bleeding were as follows:stress ulcer related to acute pancreatitis (36. 4%),pancreatic pseudocysts related to chronic pancreatitis (18. 2%),severe acute pancreatitis (13. 6%),post-operative bleeding related to pancreatic surgery (9. 1%)and left-sided portal hypertension (9. 1%). The diagnosis was commonly made by gastroscopy, abdominal contrast-enhanced CT and angiography. Ten patients received medical therapy only,6 were treated by surgical operation,5 by endoscopic hemostasis,and 1 by angioembolization. Hemostasis was achieved in 18 patients (81. 8%), and rebleeding occurred in 4 patients,of which two received medical therapy initially. Two elderly patients died of uncontrollable bleeding and multiple organ failure,respectively. Conclusions:UGIB caused by pancreatic diseases are prone to occur in young and middle-aged males. Pancreatitis and its complications are the major cause of this condition. Medical therapy is ineffective for most of the patients and a multidisciplinary approach of endoscopy,transarterial intervention and surgery is recommended.
RÉSUMÉ
Objective To explore the clinical characters,treatment and prognosis of gastrointestinal Dieulafoy lesion in China.Methods Dieulafoy was used as search term,the literatures about Chinese patients with Dieulafoy lesions from January 1998 to October 2016 were retrieved in the Chinese literature library including China National Knowledge Infrastructure,VIP network,Wanfang database and China Biology Medicine disc,and a total of 515 literatures,5 145 patients were enrolled and analyzed.The gender,age,geographical distribution,location of the lesion,treatment and prognosis of the disease were summarized.Results Among the 5 145 patients (male 3 959,female 1 186) with Dieulafoy disease,the ratio of male to female was 3.34∶1.00.The age was from 3 to 95 years,and mean age was 51 years.The lesion location was mainly in stomach (88.82％,4 570/5 145) and second was small intestine (8.28％,426/5 145).In stomach,the lesions were mainly located in gastric corpus,fundus and cardia.The small intestinal Dieulafoy lesions were mainly located in duodenum.The main manifests were sudden hematemesis,melena,and hematochezia.The treatments mainly was endoscopic treatment (72.56％,3 733/5 145),and second was surgery (25.27％,1 300/5 145).Among the5 145 patients withDieulafoy disease,5 099 patients (99.11％) were cured and 46 patients (0.89％) died.The proportions of endoscopic treatment,interventional therapy and first endoscopic treatment within 24 hours in tertiary hospitals were all higher than those of nontertiary (all P＜0.01).The cure rate of tertiary hospitals (99.22％,3 674/3 793) was significantly higher than that of nontertiary hosptials (98.54％,1 421/1 442) (x2 =0.89,P＜0.05) and the mortality was significantly lower than that of nontertiary hospitals (P＜ 0.05).Conclusions The male is more susceptible to Dieulafoy lesion which occurred at any age than the female in China.The predilection sites of Dieulafoy lesion were stomach and duodenum.The primary treatments were endoscopic treatment and surgery,and the disease usually had a good prognosis.
RÉSUMÉ
Objective To investigate the clinical significance of ultrasound guided biopsy of peritoneum in diagnosis of unex-plained ascites .Methods A total of 95 patients with unexplained ascites after conventional examination were collected ,then under-went ultrasound inspection which showed thickened peritoneum and the relations to surrounding tissues around the planned perito-neum puncture point ,and conducted the peritoneal biopsy .Results A total of 95 were successfully biopsied with 2 -4 peritoneal tissues .Pathological examination showed that 37 cases (38 .9% ) were diagnosed as peritoneal metastatic carcinoma ,41 cases (43 . 1% ) with peritoneal tuberculosis ,5 cases (5 .2% ) with peritoneal mesothelioma ,1 case (1 .1% ) with eosinophilic granuloma ,4 ca-ses (4 .2% ) with fibrous hyperplasia ,and 7 cases (7 .4% ) with chronic inflammatory cell infiltration .The positive rate of ultra-sound guided peritoneal biopsy was 88 .4% .Conclusion The ultrasound guided biopsy of peritoneum is of clinically great signifi-cance in diagnosis of unexplained ascites .