溃疡性结肠炎患者血C反应蛋白活性与尿白蛋白含量的变化及其临床意义

目的探讨血C反应蛋白（cRP）活性与尿白蛋白（AU）含量在溃疡性结肠炎（UC）患者病情活动性与严重性评价中的意义。方法采用试剂盒与免疫散射比浊法检测25例缓解期UC患者，32例活动期UC患者及30例健康对照者的血浆CRP活性、Au含量。并对活动期患者行肠镜及病理组织学检查，评价病情轻重程度。结果活动期患者组血CRP活性、AU含量显著高于缓解组与对照组（P〈0．01），且二者与UC病情活动性、病情分型均呈显著正相关，与内镜表现分级呈中度正相关，与病理组织学分级无相关性。结论血CRP活性、AU含量可作为评价UC患者病情活动性及严重程度的良好指标。     

经皮内镜结肠造口治疗梗阻性排便

目前梗阻性排便的常规治疗方法有肠道调节、口服泻药、生物反馈、经皮骶骨神经刺激、逆行灌肠等，但各有一定比例的失败率及并发症。通过阑尾造口或结肠管道行顺行灌肠获得过一些成功，但因其带来的并发症及阑尾造口必需的腹腔镜或剖腹手术而仍有替代的必要。永久造口通常效果较好，但部分患者拒绝接受。该文报道1例通过经皮内镜结肠造口（PEC）治疗梗阻性排便的病例。PEC曾被应用于治疗习惯性乙状结肠扭转、急性结肠假性梗阻、结肠炎等。     

MPCNL在老年输尿管上段结石患者中的应用价值

目的 探讨微创经皮肾镜顺行取石术(MPCNL)在老年输尿管上段结石患者中的应用价值,以期为临床治疗老年输尿管上段结石的术式选择提供参考依据.方法 选取2010年3月～2012年10月本院泌尿外科收治的182例老年输尿管上段结石患者为研究对象,根据术式的不同分为两组.行逆行输尿管镜碎石术(URL)治疗患者103例(URL组),行微创经皮肾镜顺行取石术治疗患者79例(MPCNL组).收集两组患者性别构成、年龄、结石大小、并发症种类、手术时间、术后住院日、并发症发生率、结石清除率及伴发疾病情况,并进行统计学分析.结果 两组患者平均年龄、性别构成比、结石大小、并发症种类、手术时间、并发症发生率及伴发疾病情况组间比较差异不明显,结果无统计学意义(P＞0.05),MPCNL组术后平均住院日较高于URL组(t=6.931,P=0.000),结石清除率较URL组明显升高(x2=26.506,P=0.000),差异有统计学意义.结论 MPCNL较URL在治疗老年输尿管上段结石方面能更有效的提高结石清除率,可作为临床中治疗老年输尿管上段结石的首选方案.     

小儿急性肠套叠空气灌肠及水压灌肠治疗效果比较

目的比较超声监视下水压灌肠与X射线下空气灌肠治疗小儿肠套叠的临床效果。方法选取2008年8月至2017年8月收治的肠套叠患儿4 344例,按照治疗方法不同,设为2个时段。2008年8月至2012年11月行空气灌肠(2 056例),2012年12月至2017年8月行水压灌肠(2 288例)。统计两种治疗方法的整复成功率、失败率、复发率等数据,比较两种治疗方法的疗效及并发症情况。结果水压灌肠组整复成功率为96.55%(2 209/2 288),高于空气灌肠组的90.32%(1 857/2 056),差异有统计学意义(P0.05);但水压灌肠组复发率(10.50%)高于空气灌肠组(7.22%),差异有统计学意义(P0.05);水压灌肠组穿孔率(0.57%)低于空气灌肠组(0.83%),差异有统计学意义(P0.05)。病人的发病时间与复位率呈负相关。结论与X射线下空气灌肠比较,超声监视下水压灌肠对小儿肠套叠复位成功率更高,严重并发症发生率更低,值得临床推广。     

内镜下高频电治疗消化道息肉临床分析

目的探讨内镜下高频电治疗消化道息肉的临床效果。方法对36例(50枚)消化道息肉实施内镜下高频电治疗,术后定期复查内镜,观察治疗效果。结果 36例(50枚)息肉均成功切除。术后2例发生出血,内镜下予以止血,未发生穿孔等严重并发症。术后1a复查胃镜,未见复发病例。结论实施内镜下高频电治疗消化道息肉,操作简单、并发症少、有效率高。     

NCT不敏感的局部晚期乳腺癌的新辅助内分泌治疗疗效分析

目的探讨新辅助内分泌治疗在局部晚期乳腺癌中的应用价值及与临床病理因素的相关性。方法对36例新辅助化疗不敏感的ER阳性、绝经后局部晚期乳腺癌行阿那曲唑治疗3个月,评估其疗效,并分析与组织学分级,PR,Her-2,p130Cas表达的关系。结果临床评价有效率为61.1%(22/36),超声评价有效率为55.6%(20/36),内分泌治疗后完成手术28例,病理完全缓解率为2.8%(1/36)。有效率与组织学分级有关,与PR,Her-2,p130Cas的表达情况无关。结论对于新辅助化疗不敏感的ER阳性、绝经后局部晚期乳腺癌,采用阿那曲唑进行新辅助内分泌治疗是安全有效的。     

腹腔镜联合辅助化疗及内镜治疗进展期结直肠癌合并腺瘤的应用研究

目的：探讨腹腔镜结直肠癌切除术加辅助化疗加二期内镜下治疗结直肠癌合并根治术切除范围外结直肠腺瘤的临床应用价值。方法：2005年1月-2010年6月对54例进展期结直肠癌合并根治术切除范围外结直肠腺瘤（〉1．0cm）的患者（研究组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）加二期内镜下腺瘤切除的综合治疗,对同期396例单发进展期结直肠癌患者（对照组）行腹腔镜结直肠癌切除术加辅助化疗（FOLFOX4方案）。通过并发症发生率、长期随访等评价治疗效果。结果：2组患者在年龄、性别、手术方式、手术时间、术中出血量、并发症发生率、平均住院时间、肿瘤大小、淋巴结转移、TNM分期及1、3和5年存活率差异无统计学意义（P〉O．05）。研究组辅助化疗后对合并腺瘤进行内镜下切除治疗,4例出血经保守治疗后成功止血,未发生穿孔、狭窄等严重并发症;3例患者术后病理组织学检查为腺瘤癌变,其中2例癌变局限于腺瘤中,1例癌细胞侵犯达黏膜下层,该例患者再次行腹腔镜下切除,术后随访无复发。结论：腹腔镜联合辅助化疗及内镜为合并结直肠癌根治术切除范围外腺瘤的患者提供了一种安全有效的微创治疗方法,值得临床推厂和应用。     

肝硬化门脉高压性胃病临床分析

目的:探讨肝硬化门脉高压性胃病(PHG)严重程度与肝功能损害程度、食管静脉曲张(EV)程度及内镜下套扎术(EVL)治疗之间的关系。方法:95例PHG患者均行常规胃镜检查,分析PHG与肝功能Chi l d-pugh分级和食管静脉曲张程度之间的关系;其中41例次行内镜下套扎术治疗,术后1个月、3个月复查电子胃镜,观察PHG严重程度的变化。结果:95例PHG患者中轻度PHG43例,重度PHG52例;在重度PHG患者中肝功能Chi l d-pugh分级C级比例及合并有重度EV的比例均显著高于轻度PHG患者(P<0.05);EVL治疗一月后复查胃镜有重度PHG发生率明显高于治疗前(P<0.05);但治疗三月后复查与治疗前无差异。结论:肝硬化PHG严重程度随着肝功能分级和食管静脉曲张程度的增加而增加;内镜下套扎术治疗可在短时间内加重PHG。     

小儿肠套叠47例临床治疗分析

目的总结小儿肠套叠的诊断及治疗体会。方法回顾性分析47例肠套叠患儿的临床资料。结果本组患儿中行空气灌肠44例,其中42例(87.2%)整复成功。手术治疗5例(含空气灌肠整复失败2例),其中行套叠肠管切除Ⅰ期肠吻合术3例(2例合并Meckel憩室),行套叠肠管复位术2例。本组患儿住院期间无近期并发症发生,均治愈出院,无死亡病例。随访3¹8个月,无远期并发症发生。结论早期诊断,合理实施治疗手段是提高小儿急性肠套叠治愈率和改善预后的重要保证。     

中药灌肠结合综合护理干预治疗慢性溃疡性结肠炎的疗效观察

目的:分析中药灌肠结合综合护理干预治疗慢性溃疡性结肠炎(UC)的临床疗效。方法:选取2020年3月至2021年12月,本院收治的60例UC患者,使用单双号分发法随机分为观察组和对照组,每组各30例。对照组采用中药灌肠干预,观察组在此基础上增加综合护理干预。比较2组患者心理状态及生活质量等指标,分析中药灌肠结合综合护理干预的应用效果。结果:干预后,2组焦虑和抑郁评分均明显下降,且观察组评分低于对照组(P<0.05);观察组患者的生活质量评分明显优于对照组(P<0.05)。结论:UC患者采用中药灌肠结合综合护理干预,可以有效改善患者心理状态,提升其生活质量,临床效果显著,值得推广应用。     

炎症性肠病135例临床分析

目的探讨溃疡性结肠炎(UC)和克罗恩病(CD)的诊断和治疗方法。方法回顾性分析1985～2004年的135例符合中华医学会消化病分会制定的炎症性肠病诊断治疗规范标准的病人的临床、肠镜及治疗方法和效果。结果31例CD主要临床症状为糊状腹泻,腹痛多位于脐周或右下腹,内镜下主要表现为节段性、非对称性的黏膜炎症,阿弗他溃疡。104例UC主要表现为反复发作的黏液脓血便,腹痛多位于下腹和左侧,内镜下主要表现为多发性浅表溃疡、弥漫性充血糜烂、假息肉。UC结肠镜确诊率为100%,但CD结肠镜确诊率仅为41.9%。UC内外科治疗完全缓解率33.6%,有效率82.7%;CD完全缓解率为22.6%,有效率为64.5%,UC的治疗有效率明显高于CD(P<0.05)。结论结肠镜是诊断UC的最有效方法,CD的诊断须依靠临床、内镜、X线及手术探查资料进行综合评价。合理的内科治疗和选择性外科治疗可提高IBD治疗效果。     

Relevance of fecal calprotectin and lactoferrin in the postoperative management of inflammatory bowel diseases

The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulcerative colitis(UC) patients has been less investigated although few promising results come from small, crosssectional studies. Therefore, the current post-operative management still requires endoscopy 6-12 mo after intestinal resection for CD in order to exclude endoscopic recurrence and plan the therapeutic strategy. In patients who underwent restorative proctocolectomy, endoscopy is required whenever symptoms includes the possibility of pouchitis. There is emerging evidence that fecal calprotectin and lactoferrin are useful surrogate markers of inflammation in the post-operative setting, they correlate with the presence and severity of endoscopic recurrence according to Rutgeerts' score and possibly predict the subsequent clinical recurrence and response to therapy in CD patients. Similarly, fecal markers show a good correlation with the presence of pouchitis, as confirmed by endoscopy in operated UC patients. Fecal calprotectin seems to be able to predict the short-term development of pouchitis in asymptomatic patients and to vary according to response to medical treatment. The possibility of both fecal markers to used in the routine clinical practice for monitoring IBD patients in the postoperative setting should be confirmed in multicentric clinical trial with large sample set. An algorithm that can predict the optimal use and timing of fecal markers testing, the effective need and timing of endoscopy and the cost-effectiveness of these as a strategy of care would be of great interest.     

The aggressiveness of urinary tract urothelial carcinoma increases with the severity of chronic kidney disease

OBJECTIVE

To assess, in a retrospective cohort, urinary tract urothelial carcinoma (UT‐UC) in patients with various stages of chronic kidney disease (CKD) and their clinicopathological features, as patients with end‐stage renal disease (ESRD) have a higher incidence of UT‐UC, but the relationship between early stages of CKD and characteristics of UT‐UC are less well known.

PATIENTS AND METHODS

The study included 267 patients with pathologically confirmed UT‐UC from January 1994 to December 2006; all had a physical examination (blood pressure), and measurements of laboratory data (serum creatinine, serum haemoglobin) and pathological data. The glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation. Patients were divided into three groups by individual GFR (mL/min), i.e. >60 (no/mild CKD), 30–60 (CKD stage 3) and <30 (CKD stage 4/5).

RESULTS

The CKD stages included 81 (30.3%) patients with none/mild CKD, 121 (45.3%) with CKD stage 3 and 65 (24.3%) with CKD stage 4/5. There was a significant and parallel increase in the frequency of UT‐UC as CKD severity increased from none/mild CKD to stage 3 (11% vs 55%), and from CKD stage 3 to 4/5 (55% vs 71%; P < 0.05). Pathologically, the frequency of high‐grade and high T stage UT‐UC in patients with CKD stage 3 (90% and 35%, respectively) and CKD stage 4/5 (91% and 29%, respectively) were significantly greater than in the group with none/mild CKD (P < 0.001). Advanced age and more distant metastasis were independent risk factors for patient survival.

CONCLUSION

The aggressiveness of UT‐UC increased with the severity of CKD, and this might have important clinical consequences.     

Clinical significance of intercellular adhesion molecule-1 in ulcerative colitis

This study was conducted to assess the clinical significance of intercellular adhesion molecule-1 (ICAM-1) in ulcerative colitis (UC). The subjects were 53 cases of UC and 43 control cases. ICAM-1 was expressed to a greater degree in the UC specimens. Serum ICAM-1 concentrations in the UC group showed values that were lower than those in the control group (P = 0.0081). Serum ICAM-1 concentrations were found to vary according to degree of clinical severity, activity, and affected range. Considering the cases of surgery, there was only one case in which a lowering of early postoperative values was found. In all cases in which therapeutic drugs including steroids were not administered, late postoperative values were significantly increased. ICAM-1 dynamics in UC were frequently seen in tissue and exhibited a significantly low value in blood serum; however, the influence of clinical severity, activity, diseased area, measuring time, and therapeutic drugs need further study.     

Transurethral endoscopic treatment of patients with upper tract urothelial carcinomas using neodymium‐YAG and/or holmium‐YAG laser ablation

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To report our experience of treating patients with original and recurrent upper tract urothelial carcinomas (UC) using endoscopic lasers, with holmium‐YAG and/or neodymium‐YAG laser ablation, and for whom tumour stage and grade were obtained by endoscopic biopsy.

PATIENTS AND METHODS

From March 2003 to March 2007, 15 patients with upper tract UC were treated with endoscopic laser ablation as the primary management. Patients were followed up by intravenous urography, computed tomography, urine cytology and/or ureteroscopic surveillance at 3‐ to 12‐month intervals. The median (range) follow‐up was 25.5 (13–51) months.

RESULTS

Of the 15 patients, five had an upper tract recurrence during the follow‐up. Three of these were treated with total nephroureterectomy and two had a progression in tumour stage or grade. Three patients had residual tumours; they were treated with repeated endoscopic laser treatments and had no recurrence over a median (range) of 24 (13–26) months. The renal preservation rate was 12/15 and the local recurrence rate was six/15 after the initial endoscopy. The median operative duration and tumour size were 60 min and 10 mm, respectively.

CONCLUSION

Patients with low‐grade and ‐stage disease and normal contralateral kidneys also benefit from this approach, if there is an adequate endoscopic biopsy. As the operative duration tended to be associated with the maximum tumour size, this treatment is potentially available for a maximum tumour size of <4 cm; if the tumour is <4 cm surgery will require <120 min.     

Low biopsy volume in ureteroscopy does not affect tumor biopsy grading in upper tract urothelial carcinoma

ObjectivesUrothelial carcinomas (UC) from the upper urinary tract represent 7%–10% of all kidney malignancies. With current ureteroscopic (URS) techniques, small tissue samples are usually the only available histopathologic material for evaluation, representing a diagnostic challenge. Precision in diagnosis is essential for treatment decision making. There has been much debate as to whether tumor grade and stage found on biopsy agree with final pathology. The purpose of this study is to evaluate whether URS biopsy volume affects tumor grading and staging agreement between biopsy and nephroureterectomy (NU) specimens.Materials and methodsWe reviewed 137 URS biopsies in 81 patients with suspected upper urinary tract UC performed from April 2002 to April 2011. Of those, 54 patients had both the URS biopsy and NU performed at our institution and were available for review. Biopsy dimensions were recorded to calculate estimated ellipsoid volume, and 2 urological pathologists independently evaluated histologic grade (ISUP/WHO 2004), (based on pleomorphism and mitosis) and depth of invasion. Statistical analysis was performed to evaluate URS biopsy and NU specimen grade and stage concordance. In addition, univariable and multivariable analyses was performed to assess the effect of biopsy volume on agreement.ResultsOf the 54 patients studied, low grade and high grade UC biopsy were found in 8 (15%) and 46 (85%), URS biopsies, respectively. Regarding biopsy stage, 51 (94%), 1 (2%), and 2 (4%) were stage Ta, T1, T2, respectively. Grade concordance was 92.6%, (95% CI: 82.4%–98.0%). Stage concordance was 43% (95% CI: 28.7%–55.9%). Multivariable analysis showed biopsy volume did not affect tumor assessment of grade (P = 0.81) or stage (P = 0.44).ConclusionsHistologic grade assigned on the URS biopsy sample accurately predicts histologic grade in the resected specimen (92.6%), even when the biopsy volume is small. Grading in URS biopsies provides sufficient information for clinical decision making that is independent of sample volume.     

The endoscopic spectrum of segmental colitis associated with diverticulosis

Objective An endoscopic classification of ‘Segmental colitis associated with diverticulosis’ (SCAD) is lacking. Our aim was therefore to assess the endoscopic spectrum of SCAD, comparing it with the histological and clinical features. Method A prospective study was performed from January 2004 to October 2007. Diagnosis of SCAD was made on the basis of specific endoscopic and histological patterns. Results A total of 6230 consecutive colonoscopies were performed during the study period. SCAD was diagnosed in 92 (1.48%) patients, with four endoscopic patterns: pattern A, ‘crescentic fold disease’ (52.20%); pattern B, ‘Mild‐to moderate ulcerative colitis‐like’ pattern (30.40%); pattern C, ‘Crohn’s disease colitis‐like’ pattern (10.90%); pattern D, ‘Severe ulcerative colitis‐like’ pattern (6.50%). Most patients with patterns A (58.33%, P < 0.018) and B (89.29%, P < 0.00001) showed histological alterations resembling moderate ulcerative colitis (UC). In pattern C, larger histological variability was found (P < 0.01). All patients showing pattern D showed the typical histological alteration changes of severe UC (P < 0.0001). In pattern A (60.42%, P = n.s.) and pattern B (46.43%, P = n.s.), diarrhoea was the most common symptom whilst abdominal pain was the most frequent in pattern C (50%, P = n.s.) and pattern D (83.33%, P = n.s.) patients. Conclusions Endoscopic patterns of SCAD may range from mild to severe inflammation. The histopathological findings but not clinical features showed a statistically significant association with the degree of endoscopic severity.     

Comparison of safety and efficacy of ultrasonic and bipolar thermal energy: an experimental study

The safety and efficacy of the Ligasure-8 Generator with the new Ligasure V 5-mm forceps (Valleylab, Tyco Healthcare) (LS) and the Ultracision Harmonic Scalpel Generator 300 with the new 5 mm 36p Harmonic Ace forceps (Ethicon Endo-Surgery ING) (UC) are compared. Twenty New Zealand rabbits were randomly allocated into 2 groups and the short gastric vessels were divided with either LS or UC. The speed of each method, the number of the times it had to be applied, gastric perforation rates and histopathologic findings were recorded. Approximately the same number of applications was necessary for the 2 groups. UC was significantly faster but resulted in contained perforation in 3 cases against 1 for LS (difference statistically not significant). A tendency for deeper and more severe histopathologic damages was seen with UC. For routine fast dissection, UC is satisfactory, but where prevention of thermal injury is important, LS may be more appropriate.     

Diversion procto-colitis: response to treatment with short-chain fatty acids

BACKGROUND/PURPOSE: Diversion procto-colitis (DPC) results from a deficiency of luminal short-chain fatty acids (SCFAs). Endoscopic and histopathologic features of the disorder are almost universally present in defunctioned bowel, but symptomatic DPC is less common. METHODS: Five children with symptomatic DPC underwent endoscopy and rectosigmoid biopsies. An endoscopic index (EI) was used to quantify disease severity. An SCFA mixture was administered into the defunctioned bowel. RESULTS: A good clinical response and improvement in the endoscopic index occurred in all children. Undiversion or rectal excision was carried out in 4 and was curative in each case. One child is awaiting a redo pull through. CONCLUSIONS: DPC should be considered in children with a defunctioned colon presenting with evidence of colitis. Histopathology provides supportive evidence and SCFAs may provide effective relief of symptoms. Stoma reversal or rectal excision is curative.