Surgical treatment of inflammatory bowel disease _

ncycgdxhl · Wysłany: Nie 23:46, 06 Mar 2011

Surgical treatment of inflammatory bowel disease

J]. DisColonRectum, 2005,48 (7): 1337.1342. * Clinical blend of gastric leiomyosarcoma and 1 case of upper gastrointestinal bleeding [Article ID] 1009-2188 (2006) 02-0084-01 Wang Huan Zhi, Zhu entitled to (1. Linxia County First People's Hospital, Linxia 731800; 2. Lanzhou University First Hospital, Lanzhou 730000, China) [Key words] stomach cancer; leiomyosarcoma; gastrointestinal bleeding [CLC] R735.2 [Document code] B1 medical records of patients, men, l8-year-old, was eating before admission 2d 2h After the sudden appearance of nausea, vomiting of blood out of tan about 200ml, mixed with a small amount of stomach contents, without treatment, no obvious incentive to vomit again the next day the blood of about 100ml,[link widoczny dla zalogowanych], with thin black paste it 3 times, for a total of about 400ml,[link widoczny dla zalogowanych], with the first dizziness, fatigue admission. Physical examination: vital signs were stable, showing severe acute sickly, pale, abdomen soft, no abdominal varices, gastrointestinal type and peristaltic wave,[link widoczny dla zalogowanych], deep tenderness in the upper abdomen, can reach a l0cm × 15cm mass, mass medium, the boundary yet clear, poor activity, liver spleen not palpable, negative Murphy's sign, bowel sounds 3 ~ 6 ~ / min. Blood: white blood cell count 11.29 × 10g / L, HGB100g / L; biochemical tests: AST76IU / L, AIJT52IU / L, TP3-4g / L, ALB19.69g / L, GLO14.3g / L, TBIL4.3umol / L, K2.99mmoL / L, BUN7.1mmol / L; coagulation: tq'-s17 .9 S, FIB1.79g / L. CT examination showed the left lobe of the liver lesions, endoscopy showed antral mucosa congestion, old blood clot. Actively provide hemostasis, inflammation, fluid and nutritional support after 40h treatment, the patient suddenly again [Received Date] 2005-08-27 [Author] WANG Huan-chi, First People's Hospital of Linxia County, MD. 2 hematemesis about 2000ml, undetectable blood pressure, pulse is not palpable, P150 ~ / min, confusion, by actively rescue emergency general anesthesia after laparotomy. Surgery See: no intra-abdominal bleeding, exudate, anterior lesser curvature in the stomach, there was a 10cm × 12cm mass, the liver on the very top left, showing expansive growth, hard, no adhesion with the surrounding organs . The probe from the stomach and lesser curvature mass muscle pulp, no swollen lymph node, liver, gallbladder, pancreas, spleen and colon were normal. Carry out partial gastrectomy (BI I type). See you after the removal of gastric mucosa specimens as normal valgus, in gastric antrum clot ruptured blood vessel was found at a diameter of about 3mm with active bleeding. Patients treated with conventional therapy, with enteral nutrition, 7d after the resumption of diet after 2 weeks of the indexes returned to normal, cured and discharged. Histopathological examination: fusiform cells, nuclear length rod, and a large deep-staining, showing the majority of mitotic cells arranged in dense infiltration of lymphocytes between the diagnosis of gastric leiomyosarcoma, no lymph node metastasis. 2 to discuss gastric leiomyosarcoma originate from malignant gastric smooth muscle tissue,[link widoczny dla zalogowanych], originating in the fundus and gastric body, clinically rare, mostly from malignant from benign smooth muscle tumors, showing expansive growth, may be single or multiple. Leiomyosarcoma of the stomach can be divided into: ① limitations, the growth of the stomach; ② infiltration, the infiltration in the fundus; ③ outside of the stomach,[link widoczny dla zalogowanych], the omentum and the surrounding tissue growth (in this case is this); ④ mixed, internal and external growth to the stomach, small tumor had no obvious symptoms, abdominal discomfort and sometimes gastrointestinal symptoms similar to ulcer disease, large tumor line may ca palpable mass, and more free weight loss, fatigue and other symptoms, so patients with early attendance rate is not high, and many more According to the patients with a preoperative history, clinical manifestations, CT and gastroscopy considered primary liver tumors. If the preoperative condition of endoscopy ultrasound source can be clear of tumor. CT slices after repeated viewer and consultation with the radiologist, although the tumor was found in the right hepatic lobe, and no obvious signs of gastric pressure, but the lower edge of the right hepatic tumor and the potential boundaries are still visible, but not to liver infiltration, and boundaries of the lesser curvature stomach is unclear but that may come from the stomach lesser curvature mass. As clinicians, imaging characteristics of this disease are not familiar with, and view films not careful enough, in addition to the disease caused by a rare case of upper gastrointestinal bleeding, it is easily misdiagnosed. Early surgical removal of the preferred treatment to avoid liver and bleeding, do not advocate dissection, because the disease spread to bloody way for the transfer, without chemotherapy, and finally confirmed by pathological diagnosis.