62例蓝色橡皮大疱痣综合征临床特征分析

[目的]分析国内蓝色橡皮大疱痣综合征(BRBNS)的文献报道,探讨中国BRBNS患者的临床特征。[方法]回顾性分析62例BRBNS患者(包括中国人民解放军309医院收治的4例、国内文献报道的58例)的临床资料,总结BRBNS的临床特征、病变特点、诊治方法及预后。[结果]62例BRBNS患者中男41例,女21例,发病年龄中位数为16.2岁。所有患者均有皮肤病变,61例(97.1%)患者有消化道出血表现。以黑便为主诉者32例(51.6%),贫血为主诉者15例(24.2%),皮肤血管瘤为主诉者7例(11.3%)。病变可累及多部位多脏器。消化道病变中,胃受累最多(74.2%,46/62),小肠其次62.9%(39/62)。[结论]BRBNS是一种罕见的先天性疾病,皮肤和消化道是常累及的部位,多并发消化道出血,有效地治疗方法尚需要进一步研究探讨。     

51例消化道血管瘤的单中心临床分析

<正>背景：血管瘤是血管源性良性肿瘤,多见于头颈部,累及消化道少见,可引起消化道出血、腹痛等症状,严重者可危及生命。目的：探讨消化道血管瘤的临床特点、治疗和预后,为该病的诊治提供合适的方案。方法：回顾性分析2011年8月—2021年10月郑州大学第一附属医院收治的消化道血管瘤患者的一般资料、检查检验结果、治疗方法和转归,并进行总结分析。结果：共纳入51例消化道血管瘤患者,男女之比为1.43∶1,平均年龄为（46.2±19.2）岁。45例（88.24%）为单发消化道血管瘤,其中18例（35.29%）病变位于食管,其次为胃（15.69%）、小肠（15.69%）、结肠（11.76%）、直肠（9.80%）。大多数患者（50.98%）为无症状,15例（29.41%）表现为消化道出血。32例（62.75%）患者接受内镜治疗,其中25例行内镜下黏膜切除术（EMR）,6例行内镜黏膜下剥离术（ESD）,1例行内镜下套扎术;19例（37.25%）患者接受外科手术,包括经肛门直肠病变切除5例,小肠病变摘除术1例,病变消化道切除13例。所有患者术后恢复良好。平均随访时间为（61±32）个月,其中1...     

成人腹型过敏性紫癜的临床和内镜特征

背景：成人过敏性紫癜（HSP）少见,以消化道症状为首发表现时较易误诊。目的：分析成人腹型HSP的临床、内镜特征和治疗方法,以提高该病的早期诊断和治疗水平。方法：2005年1月～2010年12月于北京友谊医院确诊为“腹型紫癜”的22例成人患者纳入研究,对其临床资料进行回顾性分析。结果：本组成人腹型HSP患者以青年为主．14例（63．6％）有明显发病诱因。所有患者均出现皮肤紫癜伴腹痛,多数患者腹痛程度与腹部体征不相符,7例（31．8％）患者腹痛先于皮肤紫癜出现,18例（81．8％）患者有消化道出血表现（显性出血7例,隐血11例）。内镜检查见病变主要累及小肠,病变黏膜散在鲜红色或暗红色出血斑,伴糜烂、浅溃疡。21例患者接受糖皮质激素治疗,激素治疗后腹痛、消化道出血明显缓解。结论：了解成人腹型HSP的临床和内镜特征有助于提高首诊诊断率。激素治疗对腹型HSP的消化道症状有效。     

门奇静脉断流术后早期消化道出血4例

目的探讨门奇断流术、脾切除术后早期消化道出血的发病机制、临床表现和预防及治疗方法.方法回顾1996-08/2000-12行门奇断流术、脾切除术患者的临床资料.结果在40例接受门奇断流术、脾切除术的患者中4例发生早期消化道出血,内镜证实为胃粘膜糜烂,浅表溃疡出血,行保守治疗,其中2例行内镜止血治疗,患者痊愈.结论门脉高压性胃炎、胃粘膜糜烂和溃疡是门奇断流术后早期常发生消化道出血的常见原因,经保守和内镜止血治疗后,出血可以停止.     

118例小肠出血临床回顾性分析

背景:小肠出血病因复杂,检查方法各有局限,因此难以及时确诊并治疗。目的:分析小肠出血的病因、诊治方法和转归。方法:连续纳入2006年10月—2016年10月第三军医大学大坪医院确诊的小肠出血患者118例,对其临床资料进行回顾性分析。结果:本研究纳入的小肠出血患者临床表现以黑便最为常见(41.5%),其次为暗红色血便、粪隐血阳性、鲜红色血便和不明原因贫血。良恶性肿瘤(43.2%)、血管病变(28.0%)和炎症性病变(15.3%)是小肠出血的主要病因。经胶囊内镜、结肠镜、数字减影血管造影(DSA)、全消化道钡餐、多层螺旋CT(MSCT)、CT小肠造影(CTE)明确出血部位和病因后,41例患者行外科手术治疗,7例行选择性血管造影栓塞治疗,2例行内镜治疗,56例行内科保守治疗,均成功止血;11例患者放弃治疗,1例因大出血抢救无效死亡。结论:小肠出血的首要病因是肿瘤,其次是血管病变和炎症性病变。胶囊内镜检查的病变检出率最高,MSCT临床应用最广。除常规治疗外,外科手术、介入和内镜治疗亦为小肠出血的重要治疗方法。     

Caroli病24例临床分析

目的提高临床医师对Caroli病的认识。方法回顾性总结解放军总医院2005年1月至2010年10月24例Caroli病患者的一般资料、临床特点以及治疗方法。结果本组患者男女比例1∶2.4;平均发病年龄20.1岁;临床表现以上腹痛、发热、黄疸、消化道出血为主;胆管结石是最常见的合并症;影像学检查发现21例(87.5%)及胎儿1例;20例行外科手术治疗,其中肝移植2例,随访4个月至5年一般情况良好;2例行内镜下食管胃底静脉曲张硬化剂、组织胶治疗,分别随访3个月、1年无再发出血。结论Caroli病患者起病早,临床表现多样,诊断主要依靠临床表现、影像学检查,外科手术及内镜下治疗是有效的治疗方式。     

Billroth-Ⅱ式胃大部切除术后行经内镜逆行胰胆管造影的安全性分析

目的探讨胃Billroth-Ⅱ式术后经内镜逆行胰胆管造影(ERCP)技术及其安全性。方法对2012年6月-2015年6月兰州军区乌鲁木齐总医院收治的胃Billroth-Ⅱ式术后43例患者行ERCP。结果 43例行ERCP的患者中插管成功39例(90.7%),插管失败2例(4.7%),并发消化道穿孔2例(4.7%)。39例患者中经ERCP诊断为胆总管结石31例(79.5%),其中3例行乳头括约肌切开术、28例行内镜下乳头球囊扩张术取石;诊断为胆管末端良性狭窄6例(15.4%),其中4例行单纯乳头球囊扩张术、2例行胆道塑料支架置入术;诊断为壶腹部肿瘤、胃癌肝门部转移各1例(2.6%),分别置入胆道金属支架、塑料支架。术后急性胰腺炎1例(2.6%)。结论对胃Billroth-Ⅱ式术后患者进行ERCP检查及治疗是安全、有效的,可在临床推广应用。     

氩离子凝固器内镜下治疗的探讨

目的 通过对52例不同消化道疾病的内镜下氩离子凝固术（APC）治疗结果的回顾分析，评估其疗效及安全性。方法 2001年4月对2002年5月对52例门诊及住院患者因各种原因行内镜检查所发现的病变予以内镜下APC治疗，其中消化道出血者29例行止血治疗，消化道息肉样病变23例行APC切除治疗。结果 出血性溃疡中有1例因动脉性喷血而治疗失败转手术，其余均1次治疗成功，止血率达96．5％；对于小于5mm的息肉仅用APC凝固即可清除，大息肉或腺瘤则需先行圈套器切除后再用APC处理残端组织，效果满意且用EndoCut高频电刀切除大的宽基腺瘤安全可靠。本组仅1例出现无症状的局部粘膜下气泡。结论 APC对于大多数大门脉高压性的消化道出血止血效果满意，但对较大口径的动脉性出血则有疑问。APC结合智能电刀处理各种消化道息肉样病变安全可靠。     

Peutz-Jeghers综合征合并肿瘤分析26例

目的: 分析Peutz.Jegllers综合征及合并癌变的临床特征.总结其治疗和随访方案.方法: 回顾性分析荆楚理工学院附属第一、二临床医院1986.09/2006.08间收治的26例Peutz.Jeherts综合征患者的临床资料.结果: 10例患者(38.46%)家族史明确,临床以皮肤黏膜色素沉着、腹痛及便血为主要表现.并发肠梗阻14例(53.85%),消化道出血1O例(38.46%);发生恶变6例(23.08%),其中结肠癌3例,胃癌3例,平均确诊年龄31岁,恶变者的病理组织学分型均为低分化黏液腺癌.内镜下高频电凝息肉切除术、开腹肠道息肉切除及肠部分切除术为主要治疗手段.结论: Peutz.Jeghers综合征患者是恶性肿瘤的高发人群,肿瘤患者发病年龄轻,分化较差.定期复查内镜,以内镜高频电凝积极处理肠息肉,以及筛查肿瘤是提高Peutz-Jegllers综合征远期疗效的有效方法.     

克罗恩病并发急性下消化道大出血13例临床分析

目的 探讨克罗恩病(CD)并发急性下消化道大出血患者的临床特点及疾病转归.方法 收集1998年1月至2007年12月收治的CD并发急性下消化道大出血患者13例,对其临床及随访资料进行回顾性分析.结果 收治确诊的CD患者共230例,其中发生急性下消化道大出血者13例,占5.6%.13例患者中男女之比为3.3:1,其中4例以急性下消化道大出血为首发症状,10例病变累及小肠,能明确出血部位者8例(小肠出血4例,吻合口出血2例,结肠出血2例).13例首次大出血后,接受手术治疗4例,无死亡;接受内科保守治疗9例,死亡3例.随访10例,随访期6～94个月内,再发大出血8例,因再发大出血需手术2例,死亡1例.再发大出血而能继续存活的所有7例患者均以反复出血为惟一或主要临床表现,且病变均累及小肠.结论 部分CD患者可并发急性下消化道大出血,其诊断和治疗均存在一定困难,应引起临床医师的重视.     

Colorectal cancer in hereditary breast cancer kindreds

PURPOSE: This study compared characteristics of colorectal cancer between families with dominant breast cancer inheritance and the general population. The cumulative incidence of colorectal cancer was also studied in genetically determined breast cancer syndrome subjects with BRCA1 and BRCA2 mutations and compared with the general population. METHODS: Subjects included 42 patients with colorectal cancer from 32 clinically determined hereditary breast cancer kindreds based on the autosomal dominant inheritance of breast cancers and early age of onset. The general population colorectal cancer cohort was composed of 755 patients from a tumor registry. Lifetime risk of colorectal cancer was determined in 164 BRCA1 and 88 BRCA2 gene mutation carriers and compared with the general population. Mean age of colorectal cancer onset, anatomic site distribution, histologic stage at presentation, and five year stage-stratified survival rates were compared between clinically determined hereditary breast cancer family members and the general population. RESULTS: The lifetime risk of colorectal cancer in male BRCA1 and BRCA2 mutation carriers was 5.6 percent, which was not different from 6 percent in males from the general population. Likewise, the lifetime colorectal cancer risk in female BRCA1 and BRCA2 mutation carriers was 3.2 percent, which was not different from 5.9 percent in females from the general population. Mean age of onset ± standard error for patients with colorectal cancer was 60±2 years for hereditary breast cancer kindreds compared with 67±0.4 years for the general population (P=0.0004). Colorectal cancer site distribution did not vary between hereditary breast cancer and the general population. Overall colorectal cancer stage distribution was significantly different, with more Stage I and fewer Stage IV cancers in subjects with hereditary breast cancer compared with the general population (P=0.01). Overall five year stage-stratified colorectal cancer survival rate ± standard error was 66±8 percent for hereditary breast cancer kindreds and 46±2 percent for the general population (P=0.023). CONCLUSION: Lifetime cumulative colorectal cancer incidence in subjects with BRCA1 and BRCA2 gene mutations was not different from the general population. However, significant differences in colorectal cancer were noted between hereditary breast cancer family members and the general population. Hereditary breast cancer-associated colorectal cancer had an earlier age of onset, lower tumor stage, and better survival rate than the general population. Except for age of onset, colorectal cancer in hereditary breast cancer kindreds exhibited more favorable characteristics than colorectal cancer in the general population.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.     

Endoscopic ultrasonographic findings in rectal leiomyoma

Abstract A 35 year old man visiting a hospital for his annual check-up in August 1992 was found to have a large rectal tumour on digital examination. Colonoscopy revealed a bulging lesion with normal mucosa. Endoscopic biopsy showed only normal tissue. Endoscopic ultrasonography demonstrated a large hypo-echoic submucosal tumour in the fourth layer (muscularis propria) of the rectal wall. Based on this endoscopic ultrasonographic finding, we diagnosed the tumour as leiomyoma pre-operatively. The tumour was excised by a trans-sacral local excision. The histological diagnosis of the resected specimen was cellular leiomyoma.     

雷替曲塞联合经肝动脉化疗栓塞术治疗晚期大肠癌肝转移的效果观察

目的评价雷替曲塞联合经肝动脉化疗栓塞术在治疗晚期大肠癌肝转移中的疗效。方法选取中国石油天然气集团公司中心医院2012年1月~(-2)015年6月收治的大肠癌术后晚期肝转移的患者80例,将其随机分为研究组和对照组,每组40例。研究组给予雷替曲塞介入下肝动脉灌注化疗联合栓塞治疗,对照组给予静脉输注雷替曲塞单药治疗。以上治疗每4周1次,共进行3~6个周期。观察2组的治疗有效率(RR)、疾病控制率(DCR)、中位疾病进展时间、生存率以及癌胚抗原(CEA)、糖链抗原(CA)19-9、转氨酶、胆红素的下降情况。计数资料组间比较采用χ~2检验,生存分析采用Kaplom-Meier法。结果研究组的RR与对照组(45.0%vs 22.5%)比较,差异有统计学意义(χ~2=4.528,P=0.033);研究组的DCR与对照组(70.0%vs 47.5%)比较,差异有统计学意义(χ~2=4.178,P=0.041)。研究组的中位疾病进展时间与对照组(17.9个月vs 10.5个月)比较,差异有统计学意义(χ~2=24.08,P0.001)。研究组的1、2年生存率分别为80.0%、55.0%,对照组的分别为57.5%、32.5%,2组比较,差异均有统计学意义(χ~2值分别为4.713、4.114,P值分别为0.030、0.043)。研究组化疗栓塞术后2个月的CA19-9、CEA、转氨酶、胆红素水平下降超过50%的病例数均较对照组多,差异均有统计学意义(χ~2值分别为5.333、4.528、5.051、5.013,P值分别为0.021、0.033、0.025、0.025)。结论雷替曲塞联合经肝动脉化疗栓塞术在治疗晚期大肠癌肝转移中有一定的价值,值得临床推广。     

The role of gastrin and cholecystokinin in normal and neoplastic gastrointestinal growth

Abstract Gastrin and cholecystokinin (CCK) act as growth factors for the gastric mucosa and the pancreas, respectively. CCK is also responsible, via the CCK-A receptor, for the pancreatic hyperplasia observed following the feeding of protease inhibitors or pancreaticobiliary diversion. Hypergastrinaemia does not increase the incidence of spontaneous gastrointestinal carcinoma, but does stimulate the proliferation of gastric enterochromaffin-like cells via the gastrin/CCK-B receptor, with a consequent increase in the incidence of gastric carcinoids. Whether gastrin influences mutagen-induced gastrointestinal carcinogenesis is still controversial, but CCK clearly enhances the induction by carcinogens of acinar tumours in the pancreas. While gastrin increases xenograft growth of 50% of gastrointestinal tumours tested, effects on the proliferation of gastrointestinal tumour cell lines in vitro have been more difficult to demonstrate, perhaps because many cell lines are already maximally stimulated by autocrine gastrin. Gastrin mRNA and progastrin, but not mature amidated gastrin, have been detected in all gastrointestinal cell lines tested. Although cell proliferation is inhibited by gastrin/CCK receptor antagonists, the spectrum of antagonist affinities is not consistent with binding to either CCK-A or gastrin/CCK-B receptors. Definition of the molecular structure of the receptor involved in the autocrine loop may lead to novel therapies for gastrointestinal cancer.     

男性乳腺癌患者临床病理特征及诊治分析

目的 分析男性乳腺癌患者的临床病理特征和诊治经验. 方法 收集北京肿瘤医院及北京医院2009年至2014年收治的43例男性乳腺癌患者资料,分析其流行病学特点、临床表现、病理特征以及治疗方法. 结果 本组患者42例(97.6％)以乳腺肿块起病,Ⅰ期和Ⅱ期患者为32例(74.5％),Ⅲ期和Ⅳ期患者为11例(25.5％).40例(93,0％)患者雌激素受体阳性,3例(6.9％)患者人表皮生长因子受体2(HER-2)过表达.以年龄70岁分层,大于70岁和小于70岁患者临床病理特征无差异,但3例HER-2过表达患者均小于70岁.手术治疗患者占38例(88.4％),其中雌激素受体阳性接受他莫昔芬辅助内分泌治疗患者32例(74.4％).随访时间6.1～55.4个月,中位随访时间31个月,7例(16.3％)患者出现复发转移. 结论 男性乳腺癌确诊时分期较晚,预后较差.大多数患者雌激素受体阳性,内分泌治疗具有重要作用.     

Preliminary study on the loss of heterozygosity at 17p13 in gastric and colorectal cancers

AIM: To evaluate the role of p53 in the development and progression of colorectal cancer and gastric carcinoma by analyzing the loss of heterozygosity (LOH) at 17p13.1 and 17p13.3.METHODS: LOH at the p53 gene locus and 17p13.3 were examined in 22 cases of gastric carcinoma and 14 cases of colorectal cancer by Southern blot analysis.RESULTS: Of the 22 gastrocarcinoma cases, 12 (54%) were heterozygous and LOH was detected in 6 (50%) of the 12 informative cases. In the 14 colorectal cancer cases, 10 (71%) were heterozygous, and LOH was detected in 6 (60%) of the 10 informative cases.CONCLUSION: LOH at the p53 gene locus is a frequent event in multiple step carcinogenesis progression. The high frequency of LOH at 17p13.3 suggests that there may be another tumor suppresser gene in that chromosome region.     

KAI1 gene is differently expressed in papillary and pancreatic cancer: influence on metastasis

AIM:To compare KAI1 in cancer of papilla of Vater and pancreas to evaluate whether there are differences in biologic behavior which might account for prognosis.METHODS:We compared the expression in 24 papillay and 29 pancreatic cancers using Northern blot analysis, immunochemical assay and in situ hybridization, and investigated whether early diagnosis or molecular differences predict the outcome in these tumor entities.RESULTS:By Northern blot analysis there is no statistical difference of KAI1 levels in normal and cancerous papilla. No association between KAI1 mRNA expression and tumor stage or tumor differentiation was found in the tumors. By immunohistochemical assay, KAI1 staining in cytoplasm of papillary cancer cells was similar to that of normal papillary cells. By in situ hybridization, the results of KAI1 mRNA expression in normal and cancerous papilla were similar to those with immunohistochemical assay. The normal and cancerous pancreas tissues were also analyzed by the methods used in papillary samples.CONCLUSION:Although the biologic roles of KAI1 have not been clarified, our results suggest that KAI1 may restrict the progression of malignant papillary cancer, but its expression might not have any effect on the characteristics of papillary tumor, whereas by the analysis of KAI1 gene, its reduced expression is closely related to the progression and metastases of pancreatic cancer.     

Hepatocellular carcinoma in cirrhotic liver in Trieste

One hundred consecutive cases of hepatocellular carcinoma (HCC) in cirrhosis observed at autopsy were studied and their pathological aspects were compared with those reported in the literature. The results, which are representative of HCC epidemiology in a geographical area where cirrhosis is mostly due to alcohol abuse, show that similarities in the architectural pattern of HCC and weight of the liver exist between our material and samples with different aetiology and epidemiology. A relationship between the histological grade of HCC and its propensity to metastasize was demonstrated. The reported better prognosis of clear cells per se could not be confirmed, although clear cell HCC occurred exclusively in grade 2. It was also demonstrated that the relationship between grading and staging was strongly influenced by the association of HCC with cirrhosis, which is a fact that is usually overlooked by the common staging (and grading) methods.