Peutz-Jeghers综合征的影像学诊断及临床分析——附两例报道及文献回顾

目的 提高Peutz-Jeghers综合征（PJS）的诊断及治疗水平。方法 回顾性分析两例Peutz-Jeghers综合征患者的人口学及临床、影像资料。结果 两例均为临床确诊的Peutz-Jeghers综合征,均有腹痛病史,均有小肠息肉继发肠套叠,形成肠梗阻病史;其中1例并有乳腺癌和子宫病变,影像学表现与临床症状相一致。结论 Peutz-Jeghers综合征以反复便血、腹痛、特定部位皮肤黏膜黑斑、消化道多发性错构瘤性息肉及家族遗传性为特征,且有息肉恶变及胃肠道恶性肿瘤的可能,其临床及影像学表现具有一定特征性。息肉的切除或者摘除是重要的治疗手段,需定期随访。     

Familial adenomatous polyposis and changes in the gut microbiota: New insights into colorectal cancer carcinogenesis

Patients with familial adenomatous polyposis (FAP), an autosomal dominant hereditary colorectal cancer syndrome, have a lifetime risk of developing cancer of nearly 100%. Recent studies have pointed out that the gut microbiota could play a crucial role in the development of colorectal adenomas and the consequent progression to colorectal cancer. Some gut bacteria, such as Fusobacterium nucleatum, Escherichia coli, Clostridium difficile, Peptostreptococcus, and enterotoxigenic Bacteroides fragilis, could be implicated in colorectal carcinogenesis through different mechanisms, including the maintenance of a chronic inflammatory state, production of bioactive tumorigenic metabolites, and DNA damage. Studies using the adenomatous polyposis coli^Min/+ mouse model, which resembles FAP in most respects, have shown that specific changes in the intestinal microbial community could influence a multistep progression, the intestinal “adenoma-carcinoma sequence”, which involves mucosal barrier injury, low-grade inflammation, activation of the Wnt pathway. Therefore, modulation of gut microbiota might represent a novel therapeutic target for patients with FAP. Administration of probiotics, prebiotics, antibiotics, and nonsteroidal anti-inflammatory drugs could potentially prevent the progression of the adenoma-carcinoma sequence in FAP. The aim of this review was to summarize the best available knowledge on the role of gut microbiota in colorectal carcinogenesis in patients with FAP.     

Diagnostic accuracy of the double-contrast enema for colonic polyps in patients with or without diverticular disease

The accuracy of the double-contrast enema for the diagnosis of polypoid lesions in the presence or absence of diverticula was evaluated by retrospectively reviewing the medical records of 202 patients subjected to examination and endoscopy. Analysis of the data on 215 polypoid lesions showed that (a) the diagnostic accuracy of the examination is not affected significantly by the presence of diverticula; (b) the sensitivity of the examination is highly dependent on the size of the polyps (smaller or larger than 0.5 cm) but not on the form (sessile or pedunculated); and (c) the positive predictive value is higher in patients without diverticula. The doublecontrast enema was confirmed to be a valid method for the diagnosis of polypoid lesions.     

氩离子凝固术治疗不同病理类型结直肠息肉的疗效观察

目的：氩离子凝固术（Argon-plasma coagulation，APC）可以有效地治疗结直肠息肉，对不同病理类型息肉的疗效是否存在差异，目前尚不清楚。本文比较APC治疗不同病理类型结直肠息肉的效果。方法：对62例结直肠息肉患者共112枚结肠息肉行APC治疗，其中17例亚蒂和74例扁平息肉仅用APC治疗；21例有蒂息肉电切治疗后用APC处理息肉残基，治疗结束后1个月进行结肠镜随访。结果：112枚结直肠息肉经一次APC治疗均成功清除，随访期间共有4例（6．5％）患者出现复发，均为直肠腺瘤性息肉，经再次APC治疗后彻底清除。单纯APC治疗组复发3枚（3．3％）；电切后用APC处理残端组术后复发1枚（4．7％），两组间复发率无显著差别（P〉0．05），腺瘤性息肉的复发率显著高于其他两种病理类型（P〈0．05）。1例直肠有蒂息肉经圈套器切除后APC处理残端时出现黏膜下气肿，3例患者出现了短暂的腹痛，未经处理缓解，其余患者无特殊并发症。结论：APC是一种安全有效的结直肠息肉治疗方法，但对腺瘤性息肉APC治疗后应加强随访，以确保治疗成功。     

Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice

AIM: To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale(BBPS) in clinical practice.METHODS: The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates(AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS: Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0(poor bowel prep, BBPS 0-3) n = 26(7.3%), Group-1(Suboptimal bowel prep, BBPS 4-6) n = 121(34%) and Group-2(Adequate bowel prep, BBPS 7-9) n = 209(58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2(3.8% vs 16.7%, P 0.05), Group 1 and 2(14.8% vs 16.7%, P 0.05) and Group 0 and 1(3.8% vs 14.8%, P 0.05). χ2 method was used to compute P value for determining statistical significance.CONCLUSION: Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.