上消化道黏膜下肿瘤的诊断与治疗

目的探讨上消化道黏膜下肿瘤的诊断与治疗方法。方法对82例胃镜检查中提示黏膜下肿瘤者进一步行内镜超声检查,确定肿瘤的性质及起源部位,对起源于黏膜肌层及固有肌层、直径0.5~1.5cm的良性间质瘤采用皮圈套扎术治疗。结果82例患者内镜超声检查发现胃黏膜下肿物34例,食管黏膜下肿物43例,十二指肠肿物5例;起源于黏膜肌层66例,固有肌层12例,黏膜下层4例;内镜超声下判定良性间质瘤71例,恶性间质瘤7例,异位胰腺3例,脂肪瘤1例。42例行皮圈套扎术治疗的良性间质瘤患者中41例肿物完全脱落,脱落率为97.6%。无穿孔、出血等并发症发生。结论在内镜超声指导下对上消化道黏膜下肿瘤进行内镜下皮圈套扎治疗是一种安全有效的方法。     

超声内镜对上消化道黏膜下隆起性病变的诊断价值

目的:探讨超声内镜对上消化道黏膜下隆起性病变的诊断价值,并对误诊的病例进行分析,以期提高超声内镜对上消化道黏膜下隆起性病变的诊断准确率。方法:对内镜检查发现的1 364例上消化道黏膜下隆起性病变进行超声内镜检查,超声结果与术后病理结果进行比较,对误诊较多的病例回顾分析其超声图像特征,探讨误诊原因。结果:病理与超声结果符合的病例有106例,与超声结果不符合的有35例,诊断准确率达75.18%(106/141),明显高于胃镜的诊断准确率33.33%(47/141),两者比较差异有统计学意义(P<0.01);超声下,回声不均匀、起源于肌层的黏膜下肿瘤,间质瘤的可能性比平滑肌瘤的可能性大(P<0.01);对病灶位于胃窦尤其是胃窦大弯,并且超声图像示回声不均匀、边界欠清楚、形状不规则、起源于肌层的胃黏膜隆起性病变,除考虑胃间质瘤外还要排除是否存在胃异位胰腺的可能。结论:超声内镜对上消化道黏膜下隆起性病变具有良好的诊断价值,但对平滑肌瘤与间质瘤的鉴别较困难;对起源于肌层的形态不典型的胃异位胰腺,有时与胃间质瘤难以鉴别。     

内镜超声诊断上消化道黏膜下低回声病变的价值及病理性质探讨

目的:探讨上消化道黏膜下低回声病变的病理性质及内镜超声的诊断价值。方法:超声内镜诊断为上消化道黏膜下低回声病变94例,通过内镜下微创治疗、外科手术治疗、超声内镜引导下细针穿刺活检术等手段获取病理组织并经常规病理、细胞学与免疫组织化学检查(SMA、CD117、CD34、S-100等),并分析内镜超声图像(包括大小、层次、回声、有否液性暗区及分叶、边缘的声晕等)。结果:94例消化道黏膜下低回声病变,36例食管病变:平滑肌瘤26例,平滑肌肉瘤2例,间质瘤8例(其中2例为恶性);58例胃部病变:间质瘤52例,平滑肌瘤6例。结论:消化道黏膜下低回声病变,在食管以平滑肌瘤多见;在胃以间质瘤多见。内镜超声能准确诊断胃肠道间叶源性肿瘤,对良恶性鉴别有一定的价值,但很难区别间质瘤和平滑肌瘤,结合EUS引导下细针穿刺活检术是未来的诊断选择。     

食管间质瘤的临床特点及内镜下治疗效果评价

目的 探讨食管间质瘤的临床特点,评价内镜下治疗的效果和安全性.方法 回顾性分析24例内镜下治疗后病理学确诊的食管间质瘤患者的临床资料,其中18例行内镜黏膜下剥离术(ESD),6例行内镜黏膜下隧道肿瘤切除术(STER),分析患者的基本情况、病变部位、超声内镜表现、组织学特征、治疗情况以及术后随访结果.结果 24例患者中,年龄＞ 50岁者占70.83％,男性占70.83％;病变多位于食管下段,多起源于固有肌层;食管间质瘤伴平滑肌分化率高.18例行ESD患者中,肿瘤起源于黏膜肌层和固有肌层各9例,均一次性完整剥离,但1例固有肌层肿瘤剥离后发生0.3 cm穿孔.6例行STER患者的肿瘤起源于固有肌层,均一次性完整剥离.术后随访3～ 42个月未发现肿瘤残留和复发.结论 内镜下治疗食管间质瘤安全、有效,对起源于固有肌层的食管间质瘤STER治疗优于ESD.     

46例胃间质瘤的临床分析

目的 探讨胃间质瘤的临床及内镜特征.方法 回顾性分析46例经手术病理证实的胃间质瘤患者的临床及内镜资料.结果 胃间质瘤主要临床表现为腹痛腹胀及上消化道出血.胃镜检查肿瘤发生于胃底胃体多见,多呈半球形隆起;超声内镜多为固有肌层低回声肿物;其中仅有5例内镜下活检证实为胃间质瘤.结论 胃间质瘤的临床表现无特异性,内镜下活检阳性率低,超声内镜对胃间质瘤诊断有帮助,确诊主要依靠手术病理及CD117、CD34的联合检测.     

超声内镜对上消化道黏膜隆起性病变的诊断价值

目的 探讨超声内镜(EUS)对上消化道隆起性病变诊断和鉴别诊断的价值.方法 分析176例上消化道隆起性病变EUS检查结果.结果 176例上消化道隆起性病变中,按病变部位分为食管49例(28%),贲门6例(3%),胃96例(55%),十二指肠25例(14%).按病变类型分为间质瘤67例,外压35例,黏膜下囊肿25例,息肉...     

微探头超声内镜在胃平滑肌瘤诊断中的应用价值

目的探讨微探头超声内镜（miniprobe endoscopic ultrasonography MEUS）在胃平滑肌瘤诊断中的应用价值。方法对125例胃黏膜下隆起性病变行微探头超声内镜检查,在MEUS检查前均经胃镜检查并发现胃内有隆起性病变,但诊断未能确定。对76例MEUS诊断为胃平滑肌瘤的病例均行内镜下治疗,术后标本送病理检查。将胃镜、MEUS及病理结果进行比较。结果超声内镜诊断胃平滑肌瘤76例,其中病变起源于黏膜肌层62例,给予内镜下黏膜下切除术治疗;起源于固有肌层14例,给予内镜下黏膜下剥离术治疗。病变位于胃底部14例,胃体部28例,胃窦部34例;直径〈2cm 64例,〉2cm 12例。76例患者均成功切除病变,7.5MHZ适合于显示病灶内部回声,12MHZ显示病灶起源较清楚。病理均提示为胃平滑肌瘤,其起源层次与超声内镜诊断结果一致,超声内镜检查准确率为100%。结论微探头超声内镜可清晰显示胃平滑肌瘤的病变层次结构,根据其诊断结果对胃平滑肌瘤行内镜下治疗是一种安全、有效、创伤小的治疗方法。     

超声微探头在诊治食管隆起病变中的价值

目的:探讨超声微探头(MPS)对食管隆起病变的诊断价值和选择治疗方式的意义。方法:对食管隆起病变进行内镜下超声微探头检查,根据超声检查资料进行诊断并选择治疗方法。结果:22例患者中,良性间质瘤8例,恶性间质瘤2例;脂肪瘤3例,囊肿3例,食管癌3例,食管静脉瘤2例,未见异常发现1例。其中MPS诊断位于黏膜下层以内的直径<2 cm的良性病变有9例采用内镜下治疗,无并发症发生。结论:MPS对食管隆起病变的大小、层次和性质能够明确,并有助于选择适当病例进行内镜下治疗。     

微探头超声结合ESD技术对消化道黏膜隆起性病变的诊疗价值

目的:评价内镜微探头超声(miniprobe ultrasonography,MPS)对消化道黏膜及黏膜下隆起性病变的诊断价值;探讨内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)在治疗消化道黏膜隆起性病变中的价值.方法:对我院内镜中心2008-01～2009-08间普通胃肠镜检查发现的消化道黏膜局限性隆起病变,进行MPS检查,对位于黏膜下层以上的隆起性病变借助于ESD技术行内镜治疗.比较术前MPS诊断与内镜治疗术后病理结果的一致性;评价应用ESD技术治疗黏膜下层以上的隆起性病的可行性及疗效;1mo后复查胃肠镜及MPS.结果:MPS诊断消化道黏膜及黏膜下隆起性病变34例,其中食管21例,胃11例,大肠2例.诊断平滑肌瘤20例,间质瘤8例,脂肪瘤1例,纤维瘤1例,早期癌1例,中重度不典型增生3例.分别来源于黏膜层、黏膜肌层和黏膜下层.选择ESD治疗,均完整切除病变,成功率100%,术中穿孔1例,经保守治疗痊愈,未发生大出血及其他并发症,并发症发生率2.94%.ESD术后病理诊断与ESD术前MPS诊断符合31例,诊断准确率91.18%.1mo后复查内镜及MPS,原病变处溃疡愈合,瘢痕形成,病变切除完全.结论:MPS对消化道粘膜及黏膜下隆起性病变诊断准确率高,应用ESD技术对于消化道黏膜及黏膜下隆起性病变治疗彻底、安全、可靠、创伤小、费用低、并发症少,具有广泛的临床应用价值.MPS和ESD联合应用,可提高病变诊断准确性及治疗安全性.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…