放大内镜结合黏膜染色技术诊断溃疡性结肠炎--附116例放大内镜形态分析

溃疡性结肠炎的诊断主要根据结肠镜的检查结果，由于溃疡性结肠炎的黏膜病变及溃疡形态复杂多样，黏膜活检的炎症病变缺乏特异表现，部分病例在内镜下与克隆病、肠结核、淋巴瘤及其它肠道溃疡性病变难以鉴别。放大内镜技术可将黏膜结构放大30～100倍，能有效地发现黏膜的微细病变及病变形态的特征和差异，对降起性病变可根据黏膜表面的pit形态特征作出与病理高度一致的诊断，     

PET—CT对大肠恶性肿瘤原发病灶的诊断价值分析

目的 探讨PET-CT对大肠恶性肿瘤原发病灶的诊断价值.方法 对我院44例经PET-CT检查考虑为大肠恶性肿瘤的患者行结肠镜检查及活检组织病理学检查,以病理学结果为标准进行对比分析.结果 经病理组织学检查,诊断为结直肠癌27例、恶性淋巴瘤1例、结肠腺瘤性息肉8例、未见异常8例.结论 PET-CT诊断大肠恶性肿瘤灵敏度高、假阴性率低.但由于肠道本身的生理摄取、炎症、息肉等良性病变可致FDG-PET高摄取使之假阳性率较高.因此当肠道出现阳性显像时,不可轻易作出恶性肿瘤的诊断,而应行肠镜检查以明确病变性质.     

内镜下黏膜切除术诊断上消化道疾病的临床价值

目的研究探讨内镜下黏膜切除术诊断上消化道疾病的临床应用效果,以期为上消化道疾病的诊断提供新的选择。方法回顾性分析2014年12月至2017年1月收治的282例上消化道病变患者临床资料。首先进行了常规的内镜及活检病理学诊断,然后对所有患者采用了内镜下黏膜切除术(EMR),比较切除后的标本进行病理学检查与术前常规内镜活检的诊断差异。结果 EMR术后诊断结果为:慢性炎症219例(77.66%)、胃癌22例(7.80%)、食管癌19例(6.74%)、淋巴瘤22例(7.80%)。与EMR病理诊断结果比较,常规内镜活检对慢性炎症病变诊断符合率为95.43%,对癌症诊断符合率为14.63%,对淋巴瘤诊断符合率为36.36%,总符合率为79.08%。结论内镜下黏膜切除术可以对常规内镜活检不能明确诊断的患者进行准确诊断,对于上消化道疾病的诊断有较高的临床应用价值。     

回肠末端溃疡性病变145例内镜与病理特点

目的探讨回肠末端溃疡病变的内镜与病理特点。方法回顾性分析6年来回肠末端溃疡性病变的临床、内镜及病理资料。结果 145例回肠末端溃疡性病变中男女之比为0.99∶1。内镜表现以片状溃疡为多见,病变为多发性,病理检查类型例数依次为黏膜非特异性炎症、克罗恩病、肠结核及淋巴瘤。结论回肠末端溃疡性病变临床表现无特异性,明确诊断有赖肠镜联合病理活检。     

应重视肠道疾病临床诊疗中新技术的应用

肠道疾病虽然病变种类繁多,但临床上主要表现为黏膜病变。随着黏膜染色和放大内镜技术、内镜下黏膜剥离活检及黏膜切除、超声内镜、双气囊小肠镜、胶囊内镜以及精细影像学技术的开展,使肠道黏膜一些早期病变得以及时诊断和治疗,促进了临床肠道疾病诊疗水平的提高。但目前这些新技术尚不为多数人所熟悉,为此将其各自的特点总结如下。     

如何通过黏膜活检和超声内镜提供IBD的诊断线索

炎症性肠病(IBD)包括克罗恩病和溃疡性结肠炎,与肠道结核、淋巴瘤等均以肠道溃疡为特征,诊断往往依赖病理诊断金标准。但在临床上由于病理活检取材的局限,常不能提供疾病确诊的病理学依据,因而相互间的鉴别诊断较困难,常为临床上的治疗带来困惑。本文根据作者长期的内镜活检和超声内镜检查经验,介绍如何通过黏膜活检和超声内镜提供IBD的诊断线索,为临床医生确诊该类疾病提供借鉴和帮助。     

通过水下内镜黏膜切除术确诊肠道滤泡性淋巴瘤2例

胃肠道滤泡性淋巴瘤(gastrointestinal follicular lymphoma,GI-FL)发病率较低,占胃肠道非霍奇金淋巴瘤的1%~3.6%[1]。肠道滤泡性淋巴瘤在我国报道较少,长期随访数据较少。本院收治2例肠道病变患者经反复内镜下组织钳活检获取病理组织,无法确诊,通过水下内镜黏膜切除术(underwater endoscopic mucosal resection,UEMR)取得大块病变组织,确诊为肠道滤泡性淋巴瘤,现详述其诊断、治疗及随访过程。     

EMR辅助诊断原发性胃淋巴瘤的价值分析

目的探讨内镜下黏膜切除术(Endoscopic mucosal resection,EMR)在原发性胃淋巴瘤诊断中的作用,以提高对胃淋巴瘤的诊断水平。方法回顾性分析诊治的20例原发性胃淋巴瘤病例,比较内镜下多点挖掘式深活检病理诊断率与EMR切除病变行病理检查诊断率的差异。结果经内镜下多点挖掘式深活检明确诊断为胃淋巴瘤12例,经内镜下黏膜切除术明确诊断为胃淋巴瘤17例,经手术切除标本确诊为胃淋巴瘤为3例。结论内镜下黏膜切除术对胃淋巴瘤的检出率明显高于内镜下多点挖掘式深活检病理诊断率(P0.05),EMR对胃淋巴瘤的诊断具有不可替代的作用,可以做为一种经典的辅助诊断手段。     

内镜超声辅助黏膜下肿瘤诊疗的研究进展

黏膜下肿瘤患者通常无明显临床症状,多在常规胃肠镜检查中偶然发现病灶,表现为表面光滑、向腔内突出且被覆正常黏膜的病变。EUS能提供黏膜下肿瘤的起源层次、大小、生长方式、良恶性等信息,对黏膜下肿瘤的诊断具有较高的敏感度和特异度,目前已成为发现和诊断黏膜下肿瘤的重要手段,尤其对于直径小于0．5cm的病变,更能显示出其优势[5];同时,还可引导活检并获取组织病理学证据,为内镜治疗方案的选择进一步提供依据。我们就目前内镜超声辅助黏膜下肿瘤诊疗的研究进展作一综述如下。     

大肠非霍奇金淋巴瘤的内镜诊断分析

目的探讨原发性大肠非霍奇金淋巴瘤(NHL)的内镜表现,以提高对原发性大肠非霍奇金淋巴瘤的诊断率。方法回顾性分析近6年来我院经手术及病理证实的8例原发性大肠NHL临床和内镜资料。结果病变部位位于盲肠者占62.5%。内镜下表现为弥漫型3例,溃疡型4例,息肉型1例。电子结肠镜检查结合病理组织活检诊断阳性率达87.5%。结论本病好发于盲肠,多为单发病灶。本组病例中内镜下病灶形态表现以溃疡型多见。结肠镜检查联合内镜下活检、免疫组织化学检查有助于提高对大肠NHL内镜诊断阳性率。     

A case of rectal mucosa-associated lymphoid tissue lymphoma diagnosed by endoscopic unroofing technique

Mucosa-associated lymphoid tissue (MALT) lymphoma is a typical primary gastrointestinal lymphoma, particularly in the stomach. Although primary rectal lymphoma is rare, it may present as a subepithelial tumor. Several techniques have been proposed for a tissue diagnosis in subepithelial tumor, including endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA), EUS-guided trucut biopsy (EUS-TCB), and tacked biopsy. However the diagnostic efficacy of these techniques appears to be limited. The unroofing technique involves removal of the overlying mucosa, thereby exposing the subepithelial lesion. It was originally reported as a method for endoscopic treatment of colorectal lymphangioma. In this case, a subepithelial tumor of the rectum was diagnosed using the endoscopic unroofing technique. This is a useful modality for the diagnosis of subepithelial tumor, because it provides histologic results in a safe and rapid manner.     

Colorectal endoscopic submucosal dissection: present status and future perspective,including its differentiation from endoscopic mucosal resection

Endoscopic submucosal dissection (ESD) allows en bloc resection of a lesion, irrespective of the size of the lesion. ESD has been established as a standard method for the endoscopic ablation of malignant tumors in the upper gastrointestinal (GI) tract in Japan. Although the use of ESD for colorectal lesions has been studied via clinical research, ESD is not yet established as a standard therapeutic method for colorectal lesions because colorectal carcinoma has unique pathological, organ specific characteristics that differ radically from those of the esophagus and stomach, and scope handling and control is more difficult in the colorectum than in the upper GI tract. Depending on the efficacy of endoscopic mucosal resection (EMR) and the clinicopathological characteristics of the colorectal tumor, the proposed indications for colorectal ESD are as follows: (1) lesions difficult to remove en bloc with a snare EMR, such as nongranular laterally spreading tumors (particularly the pseudo depressed type), lesions showing a type VI: pit pattern, and large lesions of the protruded type suspected to be carcinoma; (2) lesions with fibrosis due to biopsy or peristasis; (3) sporadic localized lesions in chronic inflammation such as ulcerative colitis; and (4) local residual carcinoma after EMR. Colorectal ESD is currently in the development stage, and a standard protocol will be available in the near future. We hope that colorectal tumors will be efficiently treated by a treatment method appropriately selected from among EMR, ESD, and surgical resection after precise preoperative diagnosis based on techniques such as magnifying colonoscopy.     

色素内镜联合内镜黏膜切除术诊治结直肠侧向发育型肿瘤的临床研究

背景:结直肠侧向发育型肿瘤(LST)与结直肠癌关系密切。目的:探讨色素内镜联合内镜黏膜切除术(EMR)对结直肠LST的临床诊疗价值。方法:纳入2009年7月～2012年2月于达县人民医院行结肠镜检查发现可疑病灶的患者2200例,对病灶内镜下喷洒0.4%靛胭脂行黏膜染色。对染色发现的LST,观察病灶大小并进行形态分型。对LST病灶行EMR或内镜分片黏膜切除术(EPMR),未能行EMR或EPMR者行内镜下活检。结果:黏膜染色后发现结直肠LST患者28例,共30个LST病灶。30个LST病灶中颗粒均一型14个(46.7%),结节混合型8个(26.7%),平坦隆起型5个(16.7%),假凹陷型3个(10.0%);行EMR19个(63.3%),行EPMR6个(20.0%),行内镜下活检5个(16.7%)。病理学检查示早期结直肠癌4个(13.3%),进展期结直肠癌3个(10.0%),腺瘤23个(76.7%)。结论:色素内镜可有效发现结直肠LST病灶。色素内镜联合EMR或EPMR根除LST病灶对早期结直肠癌的防治具有积极意义。     

Early gastric cancer: diagnosis, treatment techniques and outcomes

The detection of early gastric cancer is performed by endoscopic study with or without the dye-spraying method, which is useful in detecting small lesions or surface lesions. For the diagnosis of early gastric malignancy, magnification endoscopy, narrow-band imaging and optical coherence tomography are used for histological diagnosis and research. On the other hand, endoscopic ultrasonography is used to discuss the depth of carcinoma invasion, but cannot be used to detect the malignant lesions except for the rare cases of scirrhus-type gastric carcinoma, the histological results of which are sometimes difficult to obtain by biopsy study. The role of endoscopic ultrasonography diagnosis is to assist in making a decision of therapeutic strategy. Curative endoscopic treatment of early gastric cancer is common according to the development of various endoscopic techniques and accessories. Curative treatment is feasible using these techniques.     

结直肠高级别上皮内瘤变的临床分析38例

目的:研究结直肠高级别上皮内瘤变的临床病理特征,探讨临床合理治疗决策.方法:回顾性总结38例经内镜检查和病理初步诊断为结直肠高级别上皮内瘤变患者的,临床资料,分析其临床表现、内镜形态学、组织病理学特点、预后等,随访观察3-36 mo.结果:38例患者中,最终确诊17例为结直肠癌.21例仍为高级别上皮内瘤变.治疗前后诊断一致性较差(Kappa值为0.376).结直肠高级别上皮内瘤变合并癌的高危因素包括:肿瘤大小、内镜形态特点、症状严重、绒毛状腺瘤合并高级别上皮内瘤变、CEA或CA19-9增高等.结论:使用WHO新的诊断结直肠高级别上皮内瘤变需引起临床医生重视,特别是对于内镜下单纯活检病例.应当谨慎选择治疗方式和随访时间.     

经支气管镜治疗支气管肿瘤

经支气管镜治疗支气管肿瘤张保金，赵忠忱近十几年来经气管镜治疗的方法已有多种，技术亦日益提高，特别对气管支气管肿瘤的治疗更逐步普及，这是重新打开大气道的阻塞和狭窄，迅速缓解患者呼吸困难和濒临窒息的有效方法。一、适应症的选择：支气管肺癌开始均在支气管粘膜...     

A case of gastric syphilis with neurosyphilis presented as epigastric pain

Gastric syphilis has non-specific symptoms and various endoscopic and radiographic findings. Spirochetes are seen infrequently in biopsy specimens and the pathological findings are often non-specific. So it is very difficult to make a definitive diagnosis of gastric syphilis based on clinical symptoms and biopsy findings. We report the case of a gastric syphilis with neurosyphilis presented with epigastric pain. This case reminds us that gastric syphilis is one possibility in ulcerative gastric lesions.     

Primary esophageal mucosa‐associated lymphoid tissue lymphoma diagnosed by using stacked forceps biopsy

Non‐Hodgkin lymphoma involving the esophagus is very rare. Only a few cases have been reported in the English literature to date, and it accounts for less than 1% of all cases of gastrointestinal lymphoma. As this malignancy manifests as a submucosal tumor, pathological diagnosis by using a simple endoscopic biopsy alone is difficult. Therefore, surgical biopsy, endoscopic mucosal resection, and endoscopic ultrasound‐guided fine‐needle aspiration have been used in most cases. Herein, we report a case of esophageal mucosa‐associated lymphoid tissue lymphoma in a 49‐year‐old man, which involved the use of a stacked forceps biopsy to obtain adequate samples for pathological analysis; the use of the stacked forceps biopsy method is unlike those used in previous cases. The patient received cyclophosphamide, vincristine, and prednisolone chemotherapy; he achieved a complete response. In addition, we review the literature relevant to this case.