思他宁联合早期内镜治疗急性胆石性胰腺炎

目的探讨应用思他宁联合早期内镜治疗急性胆石性胰腺炎(AGP)的疗效.方法应用思他宁联合早期逆行胰胆管造影术(ERCP)、经内镜鼻胆管引流(ENBD)及经内镜乳头括约肌切开(EST)治疗AGP 32例,其中轻症胰腺炎21例,重症胰腺炎11例.结果治愈30例,2例重症胰腺炎内镜治疗后转外科手术治疗,1例术后死亡.结论思他宁联合内镜治疗AGP是安全和有效的,对明确诊断AGP者应及早应用思他宁及内镜介入治疗.     

应用EST技术治疗急性胆源性胰腺炎的临床体会

目的 探讨内镜下乳头Oddi括约肌切开术(endoscopic sphincterotomy,EST)在急性肌源性胰腺炎(acute gallstone pancreatitis,AGP)诊治中的应用价值。方法 将入选的189例AGP患者随机分为EST治疗组(n=79)和对照组(n=110),并根据APACHE Ⅱ评分,将每组再进一步分为重症组和轻症组,两组患者均给予中西医结合治疗。EST治疗组在入院后24h内行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+EST,如发现胆总管或胆胰共同通道有结石,则行网篮、气囊取石或碎石器碎石后取石,如结石多、结石直径大或取石未净,则EST术后再行鼻胆管引流术(endoscopic nasobilliary drainage,ENBD)。结果 对重症AGP,EST治疗组的并发症发生率转开腹手术率、住院天数及住院费用均明显低于对照组(P<0.05);而轻症AGP,两组之间无显著差异结论 早期应用EST技术治疗重症AGP是有效的和安全的。     

生长抑素及其类似物在预防胆总管结石内镜逆行胰胆管造影术后胰腺炎中的作用

目的 探讨生长抑素及其类似物预防胆总管结石内镜逆行胰胆管造影（ERCP）术后胰腺炎的作用。方法188例胆总管结石患者随机分为思他宁组62例、善宁组63例及对照组63例。思他宁组患者于ERCP术前15min给予思他宁250μg加入5％葡萄糖250ml中缓慢静滴，ERCP术后继续用思他宁250g加入5％葡萄糖静滴维持12h。善宁组分别于术前30min、术后即刻及术后8h皮下注射善宁0．1mg。对照组患者仅给予5％葡萄糖500ml静滴。ERCP术前、术后4h及24h查血清淀粉酶并观察有无急性胰腺炎的临床表现。结果思他宁组及善宁组术后4h血清淀粉酶分别为（231-±24）IU／L、（208±29）IU／L，两者比较差异无统计学意义，但均低于对照组（502±31）IU／L，P〈0．05；术后24h分别为（207±14）IU／L和（243±25）IU／L、234±22IU／L，三组差异无统计学意义，P〉0．05。术后至4h、24h，思他宁组分别有16例（25．81％）、9例（14．51％）发生高淀粉酶血症；有1例（1．61％）发生急性胰腺炎，无重症胰腺炎发生；善宁组分别有18例（28．57％）、9例（14．28％）发生高淀粉酶血症；有1例（1．58％）发生急性胰腺炎，无重症胰腺炎发生；对照组分别有33例（52．38％）、19例（30．15％）发生高淀粉酶血症；6例（9．52％）发生急性胰腺炎，其中重症胰腺炎1例；思他宁组及善宁组均低于对照组，（均P〈0．05）。结论生长抑素及其类似物可预防ERCP术后淀粉酶升高及胰腺炎的发生。     

应用EST技术治疗急性胆源性胰腺炎的临床体会

目的探讨内镜下乳头Oddi括约肌切开术(endoscopic sphincterotomy, EST)在急性胆源性胰腺炎(acute gallstone pancreatitis, AGP)诊治中的应用价值.方法将入选的189例AGP患者随机分为EST治疗组(n=79)和对照组(n=110),并根据APACHE Ⅱ评分,将每组再进一步分为重症组和轻症组,两组患者均给予中西医结合治疗.EST治疗组在入院后24 h内行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP) +EST,如发现胆总管或胆胰共同通道有结石,则行网篮、气囊取石或碎石器碎石后取石,如结石多、结石直径大或取石未净,则EST术后再行鼻胆管引流术(endoscopic nasobilliary drainage, ENBD).结果对重症AGP,EST治疗组的并发症发生率、转开腹手术率、住院天数及住院费用均明显低于对照组(P<0.05);而轻症AGP,两组之间无显著差异.结论早期应用EST技术治疗重症AGP是有效的和安全的.     

善宁联合大承气汤治疗重症胰腺炎

目的 观察善宁联合大承气汤治疗重症急性胰腺炎的疗效。方法 将63例重症急性胰腺炎患者随机分为2组：治疗组32例，为善宁联合大承气汤组；对照组31例，为善宁组。观察患者治疗后腹痛缓解时间、血淀粉酶、C 反应蛋白变化、并发症、手术率、死亡率、住院天数及住院费用等多项指标。结果 善宁联合大承气汤治疗重症急性胰腺炎能显著降低血C反应蛋白水平，控制腹痛，减少并发症、手术率、死亡率，缩短住院天数和降低住院费用。但血淀粉酶2组相比差异无显著性。结论 应用善宁和大承气汤治疗重症急性胰腺炎有协同作用，疗效优于单一的西药治疗。     

大黄联合西医综合治疗急性重症胰腺炎的价值探讨

目的 探讨中药大黄联合西医综合治疗急性重症胰腺炎的应用价值。方法 60例急性重症胰腺炎病人随机分为两组，对照组采用西医综合治疗，包括禁食、早期鼻胆(胰)管引流、抑制胰酶、抗炎、早期肠内营养等，治疗组在对照组基础上早期加用中药大黄联合治疗。结果 治疗组临床症状缓解时间缩短，实验室指标明显改善。结论 早期应用中药大黄联合西医综合治疗急性重症胰腺炎具有一定的应用价值。     

65例急性梗阻型胆源性胰腺炎外科治疗分析

目的 探讨急性梗阻型胆源性胰腺炎(AOGP)外科治疗的有关问题.方法 对65例梗阻型AGP患者的临床资料进行回顾性分析,轻症急性梗阻型胆源性胰腺炎(MAOGP)42例,保守治疗38例,急诊后期手术4例;重症急性梗阻性胆源性胰腺炎(SAOGP)23例,均行早期或急诊手术.结果 本组病例痊愈64例, 1例因伴心脏病、糖尿病、多器官功能衰竭及腹腔感染术后2周内死亡.结论 对伴有化脓性胆管炎的AOGP者早期宜行急诊手术,轻型梗阻性AGP早期积极非手术治疗,胰腺炎治愈后2～4周内择期手术治疗胆石病,可以降低复发率、并发症发生率和病死率.     

急性胆源性胰腺炎急诊内镜治疗的临床研究

目的 探讨内镜下EST联合ENBD对急性胆源性胰腺炎的治疗作用.方法 对82例急性胆源硅胰腺炎患者在抗炎、抑酶等综合治疗的基础上,行内镜(1～3 d内)ERCP及EST或ENBD等治疗.结果 82例急性胆源性胰腺炎(包括15例重症胰腺炎)均治愈,其中3例发生迟发性十二指肠乳头括约肌切口出血,经内科保守治疗,未发生 严重内镜治疗的并发症,有效地减轻了患者腹痛和降低了血淀粉酶,缩短了病程,疗效满意.结论 早期的内镜治疗急性胆源性胰腺炎安全、疗效好,值得临床推广.     

内镜联合早期肠内营养治疗急性重症胆源性胰腺炎31例

目的: 观察内镜联合早期肠内营养治疗急性重症胆源性胰腺炎的临床效果.方法: 对我院2005-2008年收治的急性重症胆源性胰腺炎患者31例行内镜ERCP+EST+ERBD, 同时放置肠内营养管行早期肠内营养,并与36例常规治疗联合肠内外营养的患者进行比较. 分别对患者术后主观症状、临床检查、化验检查、TNF-α、血清内毒素含量、CT结果、患者总住院费用及住院时间的指标进行比较.结果: 入选患者可顺利完成内镜治疗, 对早期肠内营养能较好的耐受. 内镜联合早期肠内营养方案对患者主观症状的改善、临床指征的改善、实验室检查、TNF-α、内毒素血症、CT结果、患者住院费用、住院时间方面整体优于传统治疗联合肠内外营养组.结论: 内镜联合早期肠内营养治疗急性重症胆源性胰腺炎是安全、有效、经济的治疗方案.     

联合应用生长抑素和生长激素治疗重症急性胰腺炎疗效观察

目的探讨联合使用生长抑素和生长激素治疗重症急性胰腺炎的疗效。方法将31例重症急性胰腺炎患者随机分为对照组和观察组,分别给予善宁、生长激素联合善宁治疗,观察两组平均住院天数、严重并发症的发生率,中转手术和死亡的例数,治疗前后血清总蛋白及白蛋白变化。结果观察组的住院天数、并发症发生率、中转手术率、病死率均明显低于对照组（P均〈0．05）;观察组治疗后血清总蛋白及白蛋白水平与对照组比较有统计学差异（P均〈0．05）。结论联合应用生长抑素和生长激素是早期治疗重症急性胰腺炎的有效方法。     

Endoscopic submucosal tunnel dissection salvage technique for ulcerative early gastric cancer

Endoscopic submucosal dissection is an effective treatment modality for early gastric cancer (EGC), though the submucosal fibrosis found in ulcerative EGC is an obstacle for successful treatment. This report presents two cases of ulcerative EGC in two males, 73- and 80-year-old, with severe fibrosis. As endoscopic ultrasonography suggested that the EGCs had invaded the submucosal layer, the endoscopic submucosal tunnel dissection salvage technique was utilized for complete resection of the lesions. Although surgical gastrectomy was originally scheduled, the two patients had severe coronary heart disease, and surgeries were refused because of the risks associated with their heart conditions. The endoscopic submucosal tunnel dissection salvage technique procedures described in these cases were performed under conscious sedation, and were completed within 30 min. The complete en bloc resection of EGC using endoscopic submucosal tunnel dissection salvage technique was possible with a free resection margin, and no other complications were noted during the procedure. This is the first known report concerning the use of the endoscopic submucosal tunnel dissection salvage technique salvage technique for treatment of ulcerative EGC. We demonstrate that endoscopic submucosal tunnel dissection salvage technique it is a feasible method showing several advantages over endoscopic submucosal dissection for cases of EGC with fibrosis.     

急性胃肠穿孔76例诊治体会

目的：探讨急性胃肠穿孔的临床特点和诊疗措施。方法对该院2009-03～2013-03收治的76例急性胃肠穿孔患者的临床资料进行回顾性分析。结果手术治愈57例，保守治愈3例，转院6例，自动出院6例，死亡4例。结论急性胃肠穿孔发病急、病情凶险，尽早诊断和采取合理有效治疗措施，可减少并发症，提高治愈率。     

内镜窄带成像技术在早期胃癌及异型增生诊断中的应用

目的探讨内镜窄带成像技术（NBI）对早期胃癌及异型增生的诊断价值。方法217例普通胃镜和（或）NBI下表现异常者,依次采用普通放大、NBI结合放大、靛胭脂染色并放大观察,评价各检查方法图像的清晰度,并在NBI模式下于改变最显著部位活检行病理学检查。胃癌和重度异型增生者行内镜超声检查（EUS）,早期胃癌和重度异型增生者行内镜下治疗或手术治疗。结果在观察病变轮廓方面,NBI与染色内镜或普通内镜之间差异均有统计学意义,NBI最清晰,尤其是对于局灶性浅表性病变的观察;对于胃小凹的形态观察,NBI或染色内镜均优于普通内镜;在对胃黏膜微血管的观察中,NBI具有绝对优势。217例中发现轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例。NBI模式下,胃小凹形态分为6种类型,异型增生主要表现为Ⅴ1型及Ⅳ型,早期胃癌主要表现为Ⅵ型。NBI放大内镜下3例早期胃癌可见新生或粗大血管,其中2例观察到螺旋形毛细血管。结论NBI技术操作简便,对胃黏膜病变轮廓显示清晰,放大后更可清晰观察到胃小凹及微血管形态,有助于提高早期胃癌及异型增生的靶向活检准确率。     

Use of endoscopic fibrinogen-thrombin in the treatment of severe hemoptysis

Bronchial artery embolization (BAE) is the treatment of choice in the majority of patients with severe hemoptysis. However, this procedure may be unavailable and even fail or be counterindicated in 4-13% of cases. In these cases, the efficacy of fibrinogen-thrombin (FT) instilled endoscopically as treatment for massive hemoptysis was assessed. Between August 1993 and February 1996 a prospective clinical study was performed. FT instillation was indicated in all patients with severe hemoptysis (> 150 ml/12 h) in whom BAE had failed, was counterindicated or not available. FT was instilled endoscopically. Patients were followed up until June 2001. Eleven of 101 patients (11%) with hemoptysis > 150 ml/12 h in whom BAE was not possible or proved ineffective were included. The severe hemoptysis was controlled immediately in all cases. During the follow-up period (mean: 39.4 months), early relapse of the severe hemoptysis occurred in two patients (18%) and a long-time relapse in one. Mean procedure duration was 3 min and no attributable complications were observed in any case. In conclusion, these results suggest that topical treatment with FT could be considered in the initial endoscopic evaluation of patients with severe hemoptysis while awaiting BAE or surgery, or as alternative treatment to arterial embolization when the latter is not available, has proved ineffective or is counterindicated.     

Ampullary obstruction monitoring in acute gallstone pancreatitis: a safe, accurate, and reliable method to detect pancreatic ductal obstruction

OBJECTIVE: The aim of this study was to determine the value of ordinary clinical and laboratory data, including the monitoring of ampullary gallstone obstruction in the early phases of the disease, in the diagnosis of acute gallstone pancreatitis (AGP). METHODS: One hundred and thirty-two patients were studied. The inclusion criteria were admission within 48 h from the onset of symptoms, clinical presentation compatible with AGP, bile-free gastric aspirate, elevation of serum amylase and bilirubin, and ultrasonographic demonstration of cholelithiasis. Monitoring of ampullary obstruction included severity of pain, presence of bile in the gastric aspirate, and serial serum bilirubin determinations. The clinical diagnosis of AGP was confirmed or excluded by surgical exploration, and that of ampullary obstruction by intraoperative cholangiography (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The overall accuracy of the diagnostic tests for AGP was high: sensitivity, 0.94; specificity, 0.99; positive predictive value, 0.95; and negative predictive value, 0.99. Detection of spontaneous ampullary decompression was correct in 100% of the patients, and that of ampullary obstruction, in 61%. The accuracy of this test was sensitivity, 1.0; specificity, 0.92; positive predictive value, 0.61; and negative predictive value, 1.0. CONCLUSIONS: Clinical criteria and ordinary laboratory determinations are sufficiently accurate to discriminate between patients with AGP and those with other acute abdominal pathologies. Careful monitoring of patients' pain, quality of nasogastric aspirate, and serum bilirubin level can accurately identify the few cases with persistent ampullary obstruction. Those patients can then be selected for intervention to restore the ampullary patency and prevent progression of acute pancreatitis.     

重症急性胆源性胰腺炎内镜治疗回顾性研究

目的：评价治疗性逆行胰胆管造影术（ERCP）对重症急性胆源性胰腺炎（SABP）的疗效及安全性。方法：回顾分析65例SABP患者内镜治疗情况,比较早期及择期内镜治疗成功率、症状缓解及对预后的影响。结果：65例患者ERCP成功60例（成功率92．3％）。其中急诊ERCP成功率87．7％,择期ERCP成功率100％。33．83％ERCP未见胆管结石。对于无胆道梗阻的SABP患者,比较急诊与择期ERCP组患者的腹痛缓解、体温、白细胞计数、肝功能、淀粉酶等恢复正常时间无显著性差别（P〉0．05）。结论：SABP行治疗性ERCP的诊治创伤小、有效。对于急性期SABP无明确胆道梗阻及感染,早期ERCP增加治疗风险及不成功率;病情稳定后择期ERCP可增加成功率并减少风险,不会加重病情。     

急性胆源性胰腺炎的内镜下介入治疗

目的 :综合评价早期内镜下介入治疗急性胆源性胰腺炎的方法、疗效及并发症等。方法 :10 3例胆源性胰腺炎患者中 ,5 7例在 72h内行早期内镜下介入治疗 ,4 3例保守治疗 ,保守治疗中的 19例择期内镜检查及治疗 ,3例外科手术治疗。结果 :早期内镜治疗组 80 .70 %患者临床症状得到迅速缓解 ;保守治疗组 6 2 .79%也可迅速缓解。全部内镜治疗后 3例出现胰腺炎加重。结论 :早期内镜介入治疗对于急性胆源性胰腺炎是一种有效而安全的方法 ,对于有明显黄疸、感染、结石嵌顿的病例应急诊内镜下治疗 ;对于病情较轻、黄疸不重的患者可先保守治疗后再行择期内镜治疗     

重型溃疡性结肠炎的临床特点与治疗转归

目的评价重型溃疡性结肠炎（UC）的临床疗效及治疗转归,寻找提示疗效及预后的相关因素.方法回顾性分析41例住院重型UC患者的病例资料.记录临床表现及诊疗经过,对柳氮磺胺吡啶（SASP）/5氨基水杨酸（5-ASA）、皮质激素、免疫抑制剂等药物疗效进行评价,并对手术病例进行分析.结果重型UC患者占同期住院UC患者的28.5%（41/144）,其中17.1%（7/41）伴肠道外表现;92.7%（38/41）为全结肠型病变,初发型、慢性持续型及慢性复发型分别占36.9%（15/41）、36.9%（15/41）和26.8%（11/41）;控制急性发作主要药物为激素,占61.0%（25/41）;31例（75.6%）重型UC经药物治疗缓解,7例（17.1%）最终手术治疗.发病年龄轻、全结肠病变、低血红蛋白、低血清白蛋白是提示药物疗效差、需手术治疗的相关因素.结论对于重型UC,除积极系统的药物治疗外,应及时评估药物疗效及手术需求.     

Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

AIM： To investigate possibility and clinical application of fecal calprotectin in determining disease activity of ulcerative colitis （UC）. METHODS： The enzyme-linked immunosorbent assay （ELISA） was used to measure the concentrations of calprotectin in feces obtained from 66 patients with UC and 20 controls. C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, acid glycoprotein （AGP） were also measured and were compared with calprotectin in determining disease activity of UC. The disease activity of UC was also determined by the Sutherland criteria. RESULTS： The fecal calprotectin concentration in the patients with active UC was significantly higher than that in the inactive UC and in the controls （402.16 ± 48.0 μg/g vs 35.93 ± 3.39 μg/g, 11.5 ± 3.42 μg/g, P 〈 0.01）. The fecal calprotectin concentration in the inactive UC group was significantly higher than that in the control group （P 〈 0.05）. A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. The area under the curve of the receiver operating characteristics （AUCR~c） was 0.975, 0.740, 0.692 and 0.737 for fecal calprotectin, CRP, ESR and AGP, respectively. There was a strong correlation between the fecal calprotectin concentration and the endoscopic gradings for UC （r = 0.866, P 〈 0.001）. CONCLUSION： Calprotectin in the patient＇s feces can reflect the disease activity of UC and can be used as a rational fecal marker for intestinal inflammation in clinical practice. This kind of marker is relatively precise, simple and noninvasive when compared with other commonlyused markers such as CRP, ESR and AGP.