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Abstract: A 51-year-old male patient was found to be suffering from gastritis during physical examination, and now he went to the hospital for gastroscopy because of stomach distension, acid reflux and other uncomfortable symptoms. The patient was diagnosed as carcinoma in situ of the stomach through various pathological examinations, followed by endoscopic mucosal resection, postoperative placement of a gastric tube, gastrointestinal decompression for 1 day, as well as cardiac monitoring and acid suppression treatment, and finally the patient was discharged with relief of symptoms.
Basic information】Male, 51 years old
Disease Type】Gastric carcinoma in situ
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】March 2022
Treatment plan] Endoscopic mucosal resection + gastrointestinal decompression + acid suppression therapy (sodium esomeprazole for injection)
Treatment period】7 days of inpatient treatment and 1 month of outpatient follow-up
Treatment effect】The disease has been controlled, and all indicators are improving
I. Initial consultation
A few months ago, the patient came to the clinic with a physical examination sheet showing gastritis, and we asked him about his specific condition. After no significant relief, he came to the clinic. Gastroscopy showed 2 white rice-grain-sized tissues in the stomach, suggesting focal high-grade intraepithelial neoplasia in the stomach, and laboratory tumor markers showed elevated carcinoembryonic antigen and CA15-3, so the patient was admitted to hospital for treatment of gastric carcinoma in situ.
Treatment process
After admission, the patient continued to improve the basic biochemical examination such as routine blood, blood glucose, blood lipid, liver and kidney function, and the results were not significantly abnormal.
1, endoscopic mucosal resection: after discussion with his family, endoscopic mucosal resection was performed on the third day of admission, and the postoperative specimen was sent to the pathology department for section examination, showing negative H. pylori and high-grade intraepithelial neoplasia.
2, gastrointestinal decompression: postoperative placement of a gastric tube for gastrointestinal decompression for 1 day, along with cardiac monitoring and close observation of the patient’s basic vital signs.
3, acid suppression therapy: also use injectable esomeprazole sodium for continuous intravenous pumping of acid suppression therapy, and change to intravenous drip after 48 hours.
4, nutritional support: after 48 hours, a light liquid diet is available.
III. Treatment effect
After endoscopic mucosal resection and other supportive treatments, the patient’s symptoms such as abdominal distension and acid reflux were significantly relieved, and the postoperative signs were monitored smoothly. After discharge, the patient followed the doctor’s prescription and corrected the bad habits, and was seen in the outpatient clinic one month later.
IV. Notes
1. We are glad that the patient’s condition is under control after treatment. After the operation, the patient needs to fast from water for 2 days and be given nutritional support, and after 2 days, eat warm and cool liquid food, then eat warm and cool whole liquid food and gradually transition to normal diet. Prohibit drinking alcohol, spicy and stimulating foods, and drugs to promote intestinal peristalsis for half a month, and conduct regular gastroscopy review according to the doctor’s instructions and recommendations.
2. After surgery, patients should pay more attention to their own recovery, monitor their body signs in time to avoid uncomfortable reactions or causing infections, etc.; 3. After surgery, patients should pay more attention to rest, avoid overexertion, maintain sufficient sleep, go to bed early and wake up early, adjust their lifestyle, exercise moderately according to the situation, but not strenuous exercise. Pay attention to the quality of personal rest, adjust according to the weather, consider whether it is necessary to increase or decrease clothing, and pay attention to personal warmth. Reasonable dietary arrangements, small and frequent meals, meals should not be too fast, while ensuring adequate chewing to reduce the burden on the stomach and intestines, and a light diet, mainly steamed and boiled, with less fried and indigestible food.
4, patients should quit smoking, quit drinking, and develop good and correct habits. Patients are mostly irritable, restless and depressed because of illness. At this time, family members must pay more attention to persuasion, guide patients to cope with the disease correctly and positively, and keep their mood happy.
V. Personal insight
1.To correctly understand the clinical symptoms and manifestations of gastric carcinoma in situ, if there is any physical unhealthiness, seek medical consultation in time to avoid aggravation of symptoms. Patients with gastric carcinoma in situ should follow medical advice after surgery, drink medicine on time and review gastroscopy regularly.
2.Patients with gastric carcinoma in situ should pay attention to monitoring after surgery to avoid adverse reactions. After discharge from hospital after surgery, pay more attention to rest, maintain sufficient and quality sleep and avoid straining. Reasonable arrangement of diet, mainly light diet, mainly liquid food in the early stage, and then gradually resume normal diet.
3, after the disease, patients are generally nervous, afraid of whether their condition will evolve into a more serious disease, fear of disease, making their own depression, negative negative emotions, these emotions are not conducive to the treatment and recovery of the disease, so family members should first of all calm the patient’s emotions, help patients to build confidence to overcome the disease, while exhorting patients, actively cooperate with the doctor’s treatment, and strive for early recovery.