2022年 · 第60卷第10期

PatientFemale, 32 years old, was admitted to hospital on 13 November 2021 with the main cause of "hyperemesis gravidarum 2 months, gastric adenocarcinoma found 1 week". The patient experienced vomiting at 8 weeks gestation, which was similar to the pregnancy reaction and was not taken seriously. Vomiting was significantly aggravated at 16 weeks of pregnancy, vomiting immediately after eating, and weight progressively lost 12 kg, so I went to the local hospital for treatment. Gastroscopy revealed "gastric cancer with complete pyloric obstruction" and biopsy revealed "poorly differentiated adenocarcinoma"; An attempt to implant a jejunal nutrition tube failed. So he went to the emergency department of our hospital. Physical examination: height 160 cm, weight 31 kg, body mass index 12.1 kg/m²Chronic disease cachexia, anemic appearance, pale palpebral conjunctiva, pregnancy abdominal type; Hemoglobin 89 g/L, albumin 29 g/L, Nutritional Risk Screening 2002 score 4. Upper gastrointestinal tract angiography; Antrum pyloric obstruction, duodenum not developed, considering complete pyloric obstruction (Figures 1A, 1B). After admission, symptomatic treatment such as fluid rehydration was performed, and the interventional department of our hospital attempted to implant jejunal nutrition tube again failed. Laparoscopic exploration and jejunostomy were performed in the emergency department on November 13. During the operation, the tumor was located in the gastric antrum, and the circumferential growth penetrated the serosa, invading the transverse mesocolic, and a leukoplakia of about 0.5 cm was seen on the wall of the small intestine about 40 cm away from the duodenal suspensory ligament. The operation was smooth, and a jejunal nutrition tube and a gastric tube were placed. After operation, they were treated with fluid rehydration, acid suppression, potassium supplementation, albumin supplementation, enteral and parenteral nutrition support. On November 19th, ethacridine lactate was injected with amniocentesis, and on November 20th, induction of labor and ultrasound monitoring of uterine curettage were performed. Postoperatively, they were given cefmetazole + metronidazole anti-inflammatory and bromocriptine mesylate withdrawal. Alpha-fetoprotein 192 μ g/L was checked on December 7. On December 15th, gastric reconstruction of abdominal and pelvic CT enhanced scan showed that the gastric antrum occupied space and the corresponding gastric cavity narrowed, considering the possibility of gastric cancer; The pancreatic head was pressed and displaced to the right and posterior; The anterior edge of the lesion is locally immediately adjacent to the posterior edge of the left inner lobe of the liver (Fig. 1C). The preoperative clinical stage of gastric cancer was cT4bNxM0, at least stage IIIA. After fasting and water, gastric tube was placed to drain gastric juice, and complete enteral nutrition support was performed through jejunostomy. Whole protein enteral nutrition preparation of 1 000~1 200 ml/d was selected, with a total energy of 1 000~1 200 kcal/d (1 cal =4.185 J).

ChildFemale, 8 months old. Due to the "diagnosis of primary hyperoxaluria type I for 5 months, and the development to uremic stage of renal failure for 2 months", he went to our hospital on November 3, 2021 for further treatment. The child suffered from sudden shock and respiratory and cardiac arrest at the age of 3 months. After cardiopulmonary resuscitation, ventilator-assisted ventilation, extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy for 2 weeks in the local hospital, the cardiopulmonary function gradually recovered. Anuria after withdrawal of ECMO treatment; The results of pathological examination of renal puncture biopsy showed that a large amount of calcium salt was deposited in renal tubules. Combined with the detection of two heterozygous mutations of AGXT gene, the diagnosis of primary hyperoxaluria type I was confirmed. The children were treated with dialysis three times a week (each dialysis session was 12 to 24 hours). Each parent had one heterozygous mutation in AGXT gene. The child was 68 cm long and weighed 6.7 kg. CT findings after admission suggested that the density of both kidneys was increased (Figure 1). The children were evaluated as hyperoxaluria type I, chronic renal failure, uremia, and had no contraindications for organ transplantation. They were added to the waiting list for liver and kidney transplantation.