胃结石 ppt课件

Gastricbezoar胃结石 延安医院消化科陈思瑾 Acaseofgastricbezoar 刘XXF 47y因 反复右上腹痛1年 再发加重2周 住我院普外科 考虑慢性胆囊炎急性发作 患者要求保守治疗后转入我科后 行胃镜检查发现胃角溃疡 A1 以及胃体部一褐色胃石 约5 0 6 0 追问病史 2周前曾进食柿饼 Questionsaboutgastricbezoar WhatWhyHow INTRODUCTION Gastricbezoarisamassfoundtrappedinthegastrointestinalsystem usuallythestomach Bezoars BZ arethemostcommonforeignbodiesofgastrointestinaltract ClinicalmanifestationsvarydependingonthelocationofBZfromnosymptomstoacuteabdominalsyndrome 急腹症 Whenlocatedinsmallbowel theyfrequentlycausesmallbowelobstruction SBO INTRODUCTION Since1000BC bezoars BZ indigestivetractshavebeendetectedinsomeanimalsandhumans ThefirstreportofhumantrichobezoarwascreditedtoBaudamantin1779 In1896Stelznerreportedthefirstpreoperativelydiagnosedtrichobezoar TBZ Thereportedincidencewas0 4 Bezoarsarerare beingfoundinlessthan1percentofpatientsundergoinguppergastrointestinalendoscopy TYPESOFBEZOARS BezoarsareclassifiedaccordingtotheircompositionThemajortypesarephytobezoars 植物性胃石 trichobezoars 动物性胃石 andpharmacobezoars 药物性胃石 此外还有继发性胃石及混合性胃石 Phytobezoars Phytobezoars Phytobezoars composedofvegetablematter arethemostcommontypeofbezoar Thediospyrobezoar persimmonfruit accountsforthemajorityofcases Lupinibeans usedbyhealerstotreatarthriticpain havealsoformedabezoar Phytobezoars Trichobezoars RapunzelSyndrome Trichobezoars Trichobezoars composedofhair usuallyoccurinyoungwomenwithpsychiatricdisorders Trichotillomania hairpulling andtrichophagia haireating usuallyprecedetrichobezoarformation Asmallnumberofpatientshavebeenreportedinwhomthegastrictrichobezoarhasalongtailandextendsthroughoutthesmallboweltothececum Thiscondition knownastheRapunzelsyndrome occursalmostexclusivelyinyounggirls EmilyF 7yvoicednocomplaintsherpediatriciannotedanontenderpalpablemassinthechild sstomach患病前父母离异 Pharmacobezoars Pharmacobezoars Pharmacobezoars composedofingestedmedications havebecomeincreasingrecognized Examplesincludeextendedreleasenifedipine 硝苯地平缓释片 theophylline 茶碱 enteric coatedaspirin 肠溶型阿司匹林 sodiumalginate 海藻酸钠 andsucralfate 硫糖铝 epidemiology RegionSeasonGenderAgeDiethabit Clinicalfeatures 胃结石临床表现多种多样 病程在6个月以内的称为急性 超过6个月的称为慢性症状 早期不明显 与结石大小及病程相关体征 合并症 梗阻 出血 穿孔 胃食管反流 Diagnoseandassistantexamination DiagnoseAssistantexamination therapyandtreatment 内科治疗外科治疗内镜治疗 Coca ColaandGastricbezoar Coca ColaandGastricbezoar Cola smechanismofdissolutionofbezoarsisnotwellunderstood Thesuggestedmechanismsare 1 themucolyticeffectofNaHCO3 2 thedigestionofthebezoarbyCO2bubblesand 3 thecola sacidity whichissimilartothatofgastricacid BeomJaeLee Jong JaePark etalAtotalof17patients range 48to78years withsymptomaticgastricphytobezoarstreatedwithcolaandadjuvantendoscopictherapywerereviewed A Initialendoscopicview Ahugedarkbrownish coloreddiospyrobezoarwasnotedinthestomachB Endoscopicviewofonedayafter3Lofcolalavage Thesizeofbezoarwasdecreased C Endoscopicprocedure Theremnantbezoarwascapturedandfragmentedintofourpiecesbybasket D Endoscopicprocedure Thefragmentedbezoarwascrushedandretrievedbygraspingforce Initialendoscopicview Endoscopicviewofhugedarkbrownishcoloreddiospyrobezoarinthestomach Endoscopicviewofonedayafter3Lofcolalavag