原发性十二指肠恶性肿瘤11例诊治体会

1985年 1月至 1998年 1月我院共收治原发性十二指肠肿瘤 11例 ,现将诊治体会报告如下。 　　临床资料：本组男 5例，女 6例，年龄 39～ 71岁，平均年龄 57岁。病程 10天至 8个月，平均 2.4个月。临床表现有腹痛 8例，呕吐 6例，黄疸 3例。腹部包块 2例，黑便 1例。胃肠钡餐检查 7例中 ,6例诊断十二指肠恶性肿瘤，另 1例诊断为十二指肠球部溃疡。胃镜检查 3例中 ,2例诊断十二指球部恶性肿瘤，另 1例未发现病灶。 B超检查 9例中 ,3例发现胆道扩张， 4例发现右上腹包块（其中 2例考虑十二指肠肿瘤， 1例考虑结肠肿瘤， 1例诊断胆总管下端肿瘤…     

35例原发性十二指肠恶性肿瘤的诊断分析

目的 总结原发性二十指肠恶性肿瘤临床特征及诊断方法。方法回顾性分析35例原发性十二指肠恶性肿瘤患者的临床资料。结果原发性十二指肠恶性肿瘤以腺癌为主28例（80％）,绝大多数位于十二指肠降部26例（74％）。男：女为1．5：1;主要表现为上腹疼痛（65％）、黄疽（61％）、消化道出血（48％）、呕吐（40％）、体质量减轻（35％）,乳头区以外肿瘤常有呕吐、消化道出血,平滑肌肉瘤多有腹块。诊断手段主要有纤维胃镜、胃肠钡餐、B超、CT和内窥镜逆行胰胆管造影（ERCP）,其中纤维胃镜对球部肿瘤确诊率高,B超与ERCP联合检查可提高十二指肠乳头区肿瘤检出率,胃肠钡餐有助于十二指肠其他部位肿瘤的诊断。结论原发性十二指肠恶性肿瘤以腺癌为主,好发于十二指肠降部,早期临床表现无特异性,纤维胃镜检查并活检可早期发现肿瘤;联合影像学检查可提高其检出率与确诊率。     

原发性十二指肠非乳头区肿瘤的诊断及手术治疗(附54例报告)

目的 总结原发性十二指肠非乳头区肿瘤的诊断和手术治疗经验.方法 回顾性分析2001～2011年收治的54例原发性十二指肠非乳头区肿瘤患者的临床资料.结果 肿瘤位于乳头上区26例,乳头下区28例;恶性39例,良性15例.临床表现主要为上腹痛、恶心呕吐、黑便、腹胀.术前经胃十二指肠镜检查52例,阳性43例(82.7％);全部行腹部CT检查,确诊率74.1％;上消化道造影24例,阳性16例(66.7％);小肠镜检查12例,确诊率100％;超声内镜检查13例,阳性8例(61.5％).良性肿瘤患者均行手术切除,术后5年生存率100％.恶性肿瘤患者中,行根治性切除术28例(胰十二指肠切除术17例,十二指肠节段切除8例,远端胃切除3例),手术切除率66.7％,术后1、3、5年生存率分别为77.1％、48.6％、28.2％.其余患者7例行短路手术,4例非手术治疗,均于1年内死亡.结论 十二指肠非乳头区肿瘤临床表现无特异性,早期诊断困难.胃十二指肠镜、腹部CT及消化道造影是十二指肠肿瘤的主要检查方法,小肠镜对十二指肠乳头下区肿瘤诊断有指导性意义.胰十二指肠切除术及十二指肠节段切除术是十二指肠非乳头区恶性肿瘤的主要手术方式.     

胃粘膜“一点癌”的X线胃镜诊断与病理组织学对比观察

收治经胃钡气双重造影、胃镜检查、胃粘膜活检病理论断为胃癌，而手术切除标本节段连续切片组织学检查未再发现癌组织的胃粘膜“一点癌”８例。对其诊断标准、胃钡气双重造影、胃镜诊断价值及其肠上皮化生的关系及预后进行了讨论。     

胃肠道间质瘤20例临床分析

胃肠道间质瘤(GIST)是胃肠道常见的非上皮性肿瘤。1994年4月～2004年7月,我院收治20例GIST。现分析报告如下。临床资料：本文男12例,女8例;年龄35～70岁,平均55岁;病程1h至5a。病变位于胃12例,十二指肠2例,小肠3例,结肠3例。表现为消化道出血3例,其中2例呕血伴黑便,余为单纯黑便;恶心呕吐3例,腹痛7例,腹部包块5例,吞咽困难1例,元症状1例。胃镜检查8例,确诊2例;X线钡餐检查2例,未确诊;B超、CT检查15例,确诊2例;肠系膜动脉造影检查2例,未确诊。所有病例均经病理证实。     

原发性小肠肿瘤129例诊治分析

回顾性分析129例原发性小肠肿瘤患者的临床资料。结果显示，129例中良性肿瘤6例，恶性肿瘤123例；位于十二指肠83例，空肠20例，回肠16例。良性肿瘤以脂肪瘤为主，恶性肿瘤以腺癌最为常见，其次为恶性间质瘤。内镜检查对十二指肠肿瘤的诊断率较高，CT、B超、消化道钡餐检查可提示肠腔内有肿块。行手术切除123例，术后均康复出院。认为小肠肿瘤以十二指肠腺癌最为多见，早期诊断较为困难，手术是主要治疗方法。     

原发性小肠肿瘤27例临床分析

本报道原发性小肠肿瘤27例，肿瘤分布。十二指肠7例．空肠、回肠各10例．其中良性肿瘤9例，以平滑肌瘤多见；恶性肿瘤18例，以腺癌多见，其次为平滑肌肉瘤和淋巴肉瘤．腹痛、消化道出血、腹部包块、肠梗阻及贫血、消瘦是小肠肿瘤的常见症状和体征。本组临床诊断与术后及病理诊断对照，误诊率达48．1％。作就小肠肿瘤的发生率、临床特点及诊断方法进行了讨论，认为提高小肠肿瘤特别是恶性肿瘤的早期诊断率，对治疗和预后至关重要。     

空肠巨大憩室并出血1例报道

消化道出血是消化系统中的急重症疾病,病因多样,空肠憩室是其中的少见原因之一,诊断相对困难,临床上主要检查手段可选用消化道钡餐、小肠插管气钡双重造影、小肠镜、胶囊内镜、选择性肠系膜动脉造影、核素扫描,另外腹部增强CT在诊断中也具有重要价值。我科于2018年2月诊断1例因空肠巨大憩室致消化道大出血病例,运用多种检查手段确诊,并予以外科手术治愈。     

35例原发性十二指肠癌的诊断及治疗分析

目的总结原发性十二指肠癌的诊治经验,提高其诊治水平。方法回顾分析2001年1月～2007年12月我院经内镜及手术确诊的35例原发性十二指肠癌患者的临床资料。结果本组病例肿瘤位于十二指肠球部6例;十二指肠降部26例;十二指肠水平部3例。其中乳头状腺癌8例、管状腺癌23例、黏液腺癌2例,类癌1例,恶性间质瘤1例。胃镜确诊率为77.4%;上消化道钡餐造影确诊率为52.4%。CT确诊率为46.7%;B超确诊率为10.3%;MRCP确诊率为6.9%。行胰十二指肠切除术22例,十二指肠乳头切除、乳头成形术6例,胃空肠吻合术3例,单纯肿物切除术1例,姑息性旁路手术2例。结论原发性十二指肠癌发病部位以十二指肠降部尤其乳头周围部为多,病理以腺癌为主;本病诊断首选内镜检查,其次是十二指肠气钡双重造影;手术切除尤其是胰十二指肠切除术是最常用、最可靠的治疗方法。     

小儿消化道出血病因研究

目的探讨适合于不同年龄小儿消化道出血的病因诊断方法方法选择因消化道出血来本院诊治的患儿1286例,年龄55天～14岁.病程2d～6+a.诊断标准上消化道出血:出血部位为Treitz韧带以上的消化道(包括食管、胃、十二指肠、胰腺、胆道).临床表现主要为呕血和(或)排柏油样黑便.下消化道出血:主要部位为Treitz韧带以下的消化道(十二指肠、空肠连接处以下).主要表现为便血,色鲜红、暗红、果酱样,可混有粘液、脓液,急性大量出血时亦可有呕血.1286例除全身疾病引起的143例外,由消化道局部病变引起出血者1143例,其中按诊断标准属上消化道出血372例(32.5%),采用纤维内镜检查372例,胃肠钡餐造影12例.属下消化道出血771例(67.5%),纤维结肠镜检查771例,X线腹部平片107例,胃肠钡餐造影54例,钡灌肠10例,气钡双重造影2例,核素99mTc腹部闪烁扫描及小肠动脉血管造影共29例.结果 1286例消化道出血患儿经检查明确诊断1240例,确诊率96.4%,其中上消化道出血确诊为溃疡病205例(55.1%),各种类型胃炎及十二指肠球炎119例(31.98%),次为食管静脉曲张、食管贲门撕裂症、胃粘膜脱垂、胃柿石症、十二指肠息肉等,明确病因346例(93.1%).下消化道出血确诊为直、结肠息肉486例(63.1%),结肠炎83例(10.8%),次为溃疡性结肠炎、坏死性小肠炎、P-J综合征、肠结核、克隆病、小肠憩室及血管病变,明确病因751例(97.4%).结论小儿消化道出血临床常见,尽早作出病因诊断是提高治愈率的关键,应根据不同年龄、不同出血部位选择有效的诊断方法,以提高病因诊断率     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。