谈肿瘤与化生

在基层临床工作中经常遇到有关化生的病理报告,诸如子宫颈鳞状上皮化生、胃粘膜肠型化生(肠化)、胃假幽门腺型化生、反流性食管炎时的Barrett食管(食管下段鳞状上皮受胃返流物刺激而化生为柱状上皮细胞)、萎缩性胃窦炎伴肠化生和不典型增生等名称,有必要了解肿瘤与化生的关系。     

西沙必利联用铝碳酸镁治疗反流性食管炎60例临床观察

<正> 反流性食管炎是指由于胃和(或)十二指肠内容物反流入食管引起食管粘膜的炎症、糜烂、溃疡和纤维化等改变,目前尚缺乏满意的治疗方案,作者分别用西沙必利、铝碳酸镁、西沙必利加铝碳酸镁治疗反流性食管炎60例,以期寻找治疗该病的最佳方案。一、研究对象 患者年龄为20-70岁,有反流症状(打嗝、反酸或反食、烧心或胸痛),病程20天至6个月,内镜下表现食管下段粘膜粗糙、糜烂、颗粒样增生、息肉、斑块隆起及溃疡,治疗前1周内未用过H_2受体抑制剂或质子泵抑制剂,西沙必利组18例,铝碳酸镁组16     

胃食管反流病8大诱因

胃食管反流病经反复慢性炎性刺激，食管原有鳞状上皮可被化生的柱状上皮增殖所取代，称为Barrett食管，是食管癌的最危险因素之一。其他并发症有出血、食管狭窄、穿孔、呼吸道炎症。部分患者可出现不明原因的夜间呛咳、喘息等。     

埃索美拉唑、莫沙必利与铝碳酸镁联合应用治疗胃食管反流性咳嗽

目的观察埃索美拉唑、莫沙必利和铝碳酸镁联合应用治疗胃食管反流性咳嗽的临床疗效。方法 35例胃食管反流性咳嗽患者随机为A组(n=12),B组(n=12)和C组(n=11),分别采用埃索美拉唑(20毫克/次,2次/日)+铝碳酸镁(1000毫克/次,3次/日)+莫沙比利(5毫克/次,3次/日)、埃索美拉唑+莫沙比利及铝碳酸镁+莫沙比利治疗。8周后评价临床咳嗽症状变化,8周后评价内镜下有效率。结果治疗8周后,A、B和C组临床症状总有效率分别为91.6%、91.6%和72.7%,内镜下黏膜炎症恢复总有效率分别为100%、91.6%和90.9%,A组临床症状显效率与B和C组有显著性差异(P<0.05),总有效率与C组存在显著性差异;内镜下黏膜改变有效率与C组相比存在显著性差异(P<0.05)。结论埃索美拉唑、莫沙必利和铝碳酸镁联合规律治疗可以改善胃食管反流引起的慢性咳嗽症状。     

联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗胃食管反流病的疗效观察

目的探讨联合应用雷贝拉唑、铝碳酸镁和莫沙比利治疗胃食管反流病的临床疗效。方法将140例GERD患者随机分为A组(n=72),B组(n=68),分别采用A组:雷贝拉唑+莫沙比利+铝碳酸镁和B组:奥美拉唑+多潘立酮治疗。6W后评价临床症状及内镜下有效率。结果治疗6周后,A、B两组患者临床症状总改善率分别为98.6%和88.2%,(χ2=4.289,P<0.05)内镜下有效率分别为97.2%和85.3%,存在显著差异(χ2=6.349,P<0.01)。结论雷贝拉唑+铝碳酸镁+莫沙比利治疗胃食管反流有良好临床疗效。     

特殊类型消化性溃疡及其处理原则

胃和十二指肠球部溃疡是消化性溃疡的常见类型 ,约占消化性溃疡的 95 %。此外 ,或因发生部位及病因的特殊性 ,或因临床表现的不同 ,或因治疗上的差异等 ,与常见类型的消化性溃疡有所不同 ,故称为特殊类型消化性溃疡 ,本专题就常见的几种特殊类型消化性溃疡分别讨论如下。1　 Barrett溃疡是指在 Barrett食管的基础上 ,由胃酸、胃蛋白酶侵蚀所产生的组织缺损。而 Barrett食管则是指不同因素造成的食管复层鳞状上皮被化生的单层柱状上皮及杯状细胞所取代的一种病理变化。Barrett食管的形成主要与胃、食管反流有关 ,因食管固有的复层鳞状上皮…     

荆花胃康胶丸联合质子泵抑制剂治疗胃食管反流病的疗效观察

<正>胃食管反流病(GERD)是由胃、十二指肠内容物反流引起食管症状和/或并发症的一种临床常见病,临床上GERD分为非糜烂性反流病(NERD)、反流性食管炎(RE)和Barrett食管(BE)3种类型。NERD是指存在虽然有反流相关的临床症状,但内镜下未见食管黏膜破损及Barrett食管。RE是指内镜下可见食管远段黏膜破损。BE是指食管远段的鳞状上皮被柱状上皮取代。临床上通过使用质子泵抑制剂、黏膜保护     

兰索拉唑联合铝碳酸镁治疗反流性食管炎疗效观察

目的：观察兰索拉唑联合铝碳酸镁治疗反流性食管炎的疗效。方法：84例经内镜诊断的反流性食管炎患者随机分为3组，每组28例。A组：兰索拉唑口服30mg／d加铝碳酸镁1．0g嚼服，3次／日；B组：兰索拉唑30mg／d口服；C组：铝碳酸镁1．0g嚼服3次／日；疗程均为4周，4周后复查胃镜，评价临床效果及内镜下有效率。结果：4周后三组症状改善率为96．4％，85．7％，71．4％，A组总疗效明显高于B组和C组，差异有显著性（P〈0．05）。A组内镜下食管愈合率为78．6％，总有效率92．8％，明显高于B组和C组（B组67．9％，82．1％，C组35．7％，57．1％），差异有显著性（P〈0．05）。结论：兰索拉唑联合铝碳酸镁治疗反流性食管炎起效快，近期疗效确切，不良反应少。     

胆汁反流性胃炎的治疗分析

目的探讨枸橼酸莫沙必利联合奥美拉唑和铝碳酸镁治疗胆汁反流性胃炎的临床疗效。方法选取2009年12月至2011年12月我院收治的胆汁反流性胃炎患者112例,随机分为A、B两组,各56例。A组患者给予枸橼酸莫沙必利,奥美拉唑和铝碳酸镁治疗,B组患者给予奥美拉唑和铝碳酸镁治疗。30d为一个疗程。结果 1个疗程后,两组治疗前后上腹疼痛,腹胀,恶心,呕吐症状积分比较,具有统计学意义,P<0.05或P<0.01;两组胃镜复查比较,A组总有效率为94.64%,B组总有效率为73.22%,P<0.05,具有统计学意义。结论枸橼酸莫沙必利联合奥美拉唑和铝碳酸镁治疗胆汁反流性胃炎效果较单独使用奥美拉唑和铝碳酸镁治疗胆汁反流性胃炎效果显著,具有一定的临床意义。     

雷贝拉唑联合铝碳酸镁治疗胃食管反流病的疗效分析

目的评价雷贝拉唑联合铝碳酸镁治疗胃食管反流病的临床疗效。方法选取2010年8月至2013年10月收治的胃食管反流病患者40例,随机分为两组,其中观察组20例,采用雷贝拉唑联合铝碳酸镁治疗;对照组20例,采用奥美拉唑联合阿莫西林治疗。用药4周后观察并比较两组患者的反流症状改善程度和食管pH变化。结果观察组反流症状消失19例（95．0％）,反流症状不消失1例（5．0％）;对照组反流症状消失14例（70．0％）,反流症状不消失6例（30．0％）,两组患者反流症状改善程度比较差异有统计学意义（P〈0．05）。食管pH〈4观察组2例（10．0％）,对照组5例（25．0％）;食管pH〉4观察组18例（90．0％）,对照组15例（75％）,两组患者食管pH值变化比较差异有统计学意义（P〈0．05）。结论雷贝拉唑联合铝碳酸镁治疗胃食管反流病的临床疗效好,值得在临床上予以推广。     

Dilated intercellular spaces as a marker of oesophageal damage: comparative results in gastro-oesophageal reflux disease with or without bile reflux

BACKGROUND: The dilation of oesophageal intercellular spaces, clearly apparent in transmission electron microscopy images, is a marker of cellular damage induced by acid. AIM: To analyse the presence of dilated intercellular spaces and to quantify the scores in controls and in patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux accompanied by erosive or non-erosive reflux disease. METHODS: Thirty-eight symptomatic patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux and 12 asymptomatic controls, classified on the basis of pH-metry and bilimetry, underwent endoscopy. Six tissue biopsies were taken from the normal mucosa for light microscopy and transmission electron microscopy evaluation. Dilated intercellular spaces were measured on photomicrographs of the specimens (at least 100 transects were measured for each patient). RESULTS: Twenty-two patients with gastro-oesophageal reflux disease had normal macroscopic mucosa but, at histology, five patients with erosive gastro-oesophageal reflux disease had mild oesophagitis and one had moderate oesophagitis. Seven patients with duodenal gastro-oesophageal reflux had normal mucosa, whilst three with erosive duodenal gastro-oesophageal reflux had mild oesophagitis at histology. At transmission electron microscopy, all controls had dilated intercellular spaces of less than 1.69 microm. Each symptomatic patient had a mean dilated intercellular space value and a mean value of the maximum dilated intercellular space at least three or more times greater than that in controls (P < 0.001). No statistical differences were observed between erosive and non-erosive oesophagitis. CONCLUSIONS: The dilated intercellular space is an extremely sensitive marker of damage in gastro-oesophageal reflux disease, duodenal gastro-oesophageal reflux and non-erosive reflux disease, and serves as the most appropriate marker of damage evaluation in non-erosive reflux disease reported to date. A mean dilated intercellular space of 0.74 micro m provides a cut-off score for damage. No quantitative or qualitative differences in dilated intercellular space scores were found between pure and mixed acid reflux.     

胃食管反流病三种治疗方案的对比性观察

目的 研究埃索美拉唑、莫沙比利、铝碳酸镁治疗胃食管反流病（GERD）的疗效,寻找有效治疗方法.方法 90例初诊为GERD患者按随机数字表法分为A组（30例）、B组（30例）、C组（30例）三组,A组埃索美拉唑40 mg,1次/d.B组埃索美拉唑40 mg,1次/d;莫沙比利5 mg,3次/d.C组埃索美拉唑40 mg,1次/d;莫沙比利5mg,3次/d;铝碳酸镁1.0g,3次/d.治疗4周及治疗8周评价症状缓解情况.结果 治疗4周后A组、B组、C组临床症状缓解率分别为66.7％、83.3％和90.0％,治疗8周后A组、B组、C组临床症状缓解率分别为73.3％、90.0％和96.7％,治疗8周时A组与C组总有效率相比差异有统计学意义（P＜0.05）,A组与B组、B组与C组差异均无统计学意义（P＞0.05）.结论 埃索美拉唑联合莫沙比利、铝碳酸镁治疗GERD可获得较好疗效,提高症状缓解率.     

柴枳夏及汤对胆汁反流性胃炎大鼠胃黏膜的保护作用及机制研究

目的 探讨柴枳夏及汤对实验性胆汁反流性胃炎（BRG）大鼠胃黏膜的保护作用及机制。方法 将Wistar大鼠按照体质量及性别以随机数字表法分为5组：对照组、模型组、铝碳酸镁片（阳性药）组和柴枳夏及汤低、高剂量（生药量12.77、25.54 g/kg）组,除对照组外,ig自制反流液制备大鼠BRG模型。观察对照组及模型组大鼠进食、大小便、毛色、体质量等;肉眼及HE染色后于光镜下观察胃窦黏膜病理组织学变化;ELISA法检测血清GAS及胃窦黏膜PGE2水平。结果 与对照组比较,模型组大鼠出现排稀糊便、便中含红黄色黏液、反应迟钝、体质量显著下降（P<0.05）等特点;肉眼可见胃窦部点片状糜烂,有黄绿色胆汁及较多黄色黏液;胃窦黏膜出现大量炎性细胞浸润和肠上皮化生,炎症及肠上皮化生积分显著提高（P<0.01）;GAS及PGE2水平明显下降（P<0.01）;与模型组比较,柴枳夏及汤高剂量明显改善胃黏膜病理组织损伤形态;减轻炎性细胞浸润和肠上皮化生,显著降低积分（P<0.05、0.01）;显著提高GAS及PGE2水平（P<0.01）。结论 柴枳夏及汤具有明显的保护胃黏膜的作用,其机制可能与调节血清GAS、胃窦黏膜PGE2水平有关。     

奥美拉唑联合莫沙比利治疗反流性食管炎

目的　观察奥美拉唑联合莫沙比利治疗反流性食管炎 (RE)的临床疗效和安全性。方法　将15 6例RE患者随机分为A组和B组各 78例 ,两组均予莫沙比利 5mgtid ,A组加服奥美拉唑 2 0mgqd ,B组加服雷尼替丁 15 0mgbid。分别于治疗前、治疗后 4周、8周观察临床症状及胃镜变化。结果　治疗后 4周临床总有效率A组明显高于B组 (P <0 0 1) ,食管粘膜病损愈合率A组高于B组 (P <0 0 5 ) ;治疗后 8周临床总有效率及食管粘膜病损愈合率比较 ,A组均明显高于B组 (P <0 0 1)。结论　奥美拉唑联合莫沙比利治疗RE疗效明显优于雷尼替丁联合莫沙比利。     

Degeneration and regeneration of respiratory mucosa of rats after exposure to styrene

The recovery process of pathological changes in the respiratory mucosa following exposure to styrene were experimentally studied to improve the understanding of the respiratory toxicity of styrene. Thirty male SD rats were exposed to 150 ppm or 1000 ppm of styrene for 4 h a day over 3 weeks (5 days a week). They were killed for examination at 1 day or 12 weeks after completion of the exposure sequence. Bilateral mucosal samples from the nasal septum and the trachea of the animals were examined for ciliary activity and subjected to electron microscopy. Complete functional and morphological recovery of the nasal and tracheal mucosa was observed at the 12th week post-exposure to 150 ppm of styrene. After exposure to 1000 ppm of styrene, almost normal function and morphology of the tracheal mucosa was found at the 12th week post-exposure, but the nasal mucosa continued to show decreased ciliary activity and an affected morphology.     

DNA synthesis in the gastroduodenal mucosa during acute and chronic stress in the rat

We investigated the effects of acute and chronic stress on the DNA synthesis of the gastroduodenal mucosa of the rat using two different methods of physical stress at various time intervals. Acute stress was produced in the rats being briefly plunged or swimming for two hours (water temperature 37 degrees C). "Sham - transported" rats were used as controls. The results indicate that in the stomach the DNA synthesis was substantially reduced during acute stress in both groups tested (when compared to controls). The DNA synthesis was also reduced in experimental rats after one and two weeks of stress (as compared to day one). By four and eight weeks, the rate of DNA synthesis in the gastric mucosa had significantly increased in the stressed animals. Controls demonstrated significantly lower DNA values following two to eight weeks of stress (as compared to day one). From the outset, the DNA replication values were 2.5 to 3 times higher in the duodenal mucosa than in the gastric mucosa. Following two weeks of stress, the duodenal mucosa of both test groups showed significantly lower DNA values than controls, but significantly higher values after four weeks of stress. By eight weeks, the duodenal mucosa in all rats had reached the same values as that of day one. This was considered a sign of "adaptation to stress" in the duodenal mucosa. The above results suggest that the fluctuations of DNA replication may be connected to compensatory mechanisms aimed at adjusting the gastroduodenal mucosa to protracted stress situations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Characterization of the prostaglandin E2 pathway in a rat model of esophageal adenocarcinoma

Accumulating evidence indicates that the cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) pathway plays a key role in esophageal carcinogenesis. A better understanding of the pathway downstream of COX-2 may reveal novel targets for the prevention of esophageal adenocarcinoma (EAC). The objective of this study was to characterize the profile of genes involved in PGE2 metabolism and signaling in an experimental model of EAC. Esophagojejunostomy with gastric preservation was performed in wistar rats to induce gastroduodenal reflux. Rats were sacrificed 2 or 4 months after surgery. Nine non-operated rats were used to obtain normal (control) esophageal tissues. RESULTS: All rats that underwent esophagojejunostomy developed inflammation. In addition, 90% of the animals showed intestinal metaplasia; of those, 40% progressed to AC. This process was accompanied by a significant increase in esophageal PGE2 levels and the induction of both mRNA and protein levels of COX-2, COX-1, prostaglandin E synthase, 15-hydroxyprostaglandin dehydrogenase, and PGE2 receptors EP3, EP4 and especially EP2, which rose to particularly high levels in experimental rats. In addition, exposure to a selective COX-2 inhibitor (SC58125) or an EP1/EP2 antagonist (AH6809), but not an EP4 antagonist (AH23848B), significantly reduced cell proliferation of esophageal explants in 24 hour-organ culture experiments. Our data suggest that, in addition to COX-2, other components of the PGE2 pathway, including COX-1, may play important roles in the development of EAC induced by gastroduodenal reflux in the rat. Although it must be confirmed in vivo, the EP2 receptor may represent a promising selective target in the prevention of Barrett's associated AC.     

内镜下贲门间隙增宽在诊断反流性食管炎中的价值

目的　探讨贲门间隙增宽在内镜诊断反流性食管炎 (RE)的价值。方法　 2 4例经内镜诊断 RE患者 ,根据反看贲门间隙的大小分为贲门间隙增宽组 (A组 ,12例 )、贲门间隙不增宽组 (B组 ,12例 ) ,分别行食管测压及 2 4h p H监测并与正常对照组 (C组 ,2 0例 )比较。结果　 A组、B组的食管下端括约肌压力 (L ESP)、食管原发蠕动收缩波幅、2 4h p H监测 6项指标均与 C组比较差异有显著性 (P<0 .0 1)。A组与 B组比较 ,食管炎程度差异有显著性 (P<0 .0 5 ) ,L ESP(P<0 .0 1)、食管原发蠕动收缩波幅 (P<0 .0 5 )及 2 4h p H监测 6项指标 (P<0 .0 1)比较差异均有显著性。不同程度 RE与贲门间隙宽度有相关性 (P<0 .0 5 )。结论　内镜下贲门间隙是否增宽是内镜诊断 RE的重要形态学特征 ,在内镜诊断 RE中有一定的价值     

胃黏膜异位64例临床病理特点分析

目的分析胃黏膜异位（heterotopic gastric mucosa,HGM）的临床及病理特点。方法对2011—2013年于我院行胃镜检查提示并经病理确诊的HGM 64例的临床、内镜及病理资料进行回顾性分析。结果 HGM检出率为0.57%,男女比为2.37∶1,年龄（49.83±12.79）岁。食管HGM 32例内窥镜下均可见圆形或椭圆形橘红色区域,与周围食管鳞状上皮分界清晰;幽门螺杆菌（Hp）感染6例（18.8%）。十二指肠HGM 32例全部位于十二指肠球部,镜下可表现为单发类圆形基底部无蒂的息肉样隆起;Hp感染1例（3.1%）。根据是否存在胃腺体分为1和2型,1型较多见,其中食管HGM中1型25例（78.1%）,十二指肠HGM中1型23例（71.9%）。食管HGM和十二指肠HGM中均有1例2型患者出现肠上皮化生。结论 HGM检出率较低,临床行内镜检查时要足够重视,对可疑部位应行病理活检明确其性质。     

2型糖尿病大鼠胃肠手术模型的建立

目的:利用糖尿病大鼠建立手术治疗糖尿病的实验动物模型.方法:SPF级SD大鼠60只,所有动物给予8周的高脂高糖饮食,随后予以腹腔注射链脲佐菌素(40mg/kg)制备糖尿病大鼠模型.造模成功一周后行手术,选取24只随机分为2组,分别为十二指肠空肠旁路手术组(DJB,n=12)、Roux en-y旁路手术组(RYGB,n=12).结果:术后大鼠的总生存率达到83.3％,术后第8周,两组大鼠均存活10只.结论:胃肠道手术的2型糖尿病大鼠模型是可行的,可用于长期观察及检测研究,有助于临床评估相关手术的远期效果.