食管胃底静脉曲张破裂出血的内镜治疗

食管胃底静脉曲张破裂出血的内镜治疗上海第二医科大学瑞金医院吴云林陈金联门脉高压食管胃底静脉曲张破裂出血是上消化道出血的常见原因。临床上需紧急止血及预防再出血。内外科有多种方法控制急性食管静脉曲张出血，气囊填塞治疗常可获得短暂止血，但早期再出血率及病死...     

单纯胃静脉曲张内镜漏诊4例分析

单纯胃静脉曲张内镜漏诊４例分析湖南省人民医院消化科（４１０００２）刘洪娟，刘玉英，苏邦彦１临床资料女２例，男２例；年龄２１～４１岁；均因反复发作呕血、黑便而分别接受１～４次内镜检；体查４例均有脾肿大（肋下３～５．５ｃｍ）。内镜检查前均疑及食道、胃底静...     

1 078例食管胃静脉曲张内镜下表现特点

目的对1 078例食管胃静脉曲张(GOV)患者的内镜下表现特点进行分析。方法随机抽取2011年11月~2012年6月解放军第302医院内窥镜中心诊断食管胃静脉曲张4 210例患者中1 078例常规检查患者进行分析。食管静脉曲张严重程度分为:轻度(EV1)、中度(EV2)和重度(EV3)。门脉高压性胃病(PHG)分为轻度和重度。对胃静脉曲张提出新的分型方法:GV1、GV2、GV3、GV4和IGV。等级资料采用秩和检验。结果 1 078例患者中,EV 333例(30.89%);EV伴GV 728例(67.53%):其中GV1占42.31%,GV2占14.42%,GV占19.78%,GV4占23.49%;IGV 17例(1.58%)。无PHG 542例(50.28%),轻度PHG 324例(30.06%),重度PHG 212例(19.66%)。PHG发生率与GOV的分型无明显关系(P>0.05)。PHG的发生率与EV的严重程度有关(P=0.0023)。结论 GOV的内镜表现主要为EV伴GV占大多数,其中食管静脉曲张延伸至胃小弯最为常见,而食管静脉曲张只延伸至贲门也为数不少,可作为胃静脉曲张的分型之一。门脉高压性胃病的发生率随食管静脉曲张严重程度的增加而升高。     

内镜下精准食管胃静脉曲张断流术的前瞻性研究（附180例报告）

目的前瞻性研究内镜下精准食管胃静脉曲张断流术的临床疗效及安全性。方法 180例肝硬化伴食管胃静脉曲张行内镜下治疗者纳入前瞻性分析,行内镜下精准食管胃静脉曲张断流术。采用改良的"三明治夹心法",聚桂醇-组织胶-生理盐水,行血管来源支精准断流治疗,观察治疗的显效率、有效率、改善率以及再出血率和并发症发生情况。结果术后1个月,静脉曲张显效率67.8%(122/180),有效率30.0%(54/180),无效率2.2%(4/180),改善率97.8%(176/180)。术后2周内,再出血率3.3%(6/180)。术后3个月内,再出血率7.2%(13/180)。所有患者均无严重并发症发生,总体并发症发生率37.8%(68/180)。结论内镜下精准食管胃静脉曲张断流术疗效及安全性较好,值得推广。     

食管癌内镜分型的临床意义

根据日本食管疾病学会制定的内镜分型标准，研究１７３例食管癌。检出６例浅表型（０型）癌，１６６例进展期癌。０型癌均经手术切除。在进展期癌中，Ｉ型３３例（１９．１％），Ⅱ型２０型（１１．６％），Ⅲ型６４例（３６．９％），Ⅳ型３５例（２０．２％），Ⅴ型１５例（８．７％）。活检阳性率和手术切除率分别为９０．１％和８０．９％，Ｉ型的活检阳性率和手术切除率明显高于Ⅳ型（Ｐ＜０．０５），表明新分型标准能客观反映     

内镜治疗食管静脉曲张破裂出血（附385例报告）

目的：探讨经内镜治疗食管静脉曲张破裂出血的最佳治疗方案,方法：自1988年2月－2000年5月收治肝硬化门脉高压食管静脉曲线破出血385例。临床随机分成3组：单纯硬化组（EVS）103例,内镜直视下向静脉内和静脉旁注射1％乙氧硬化醇,单纯结扎组（EVL）105例,分单次结扎和五连环连续结扎;联合治疗组（结扎加硬化治疗,EVL＋EVS）,经1－2次结扎后14天作硬化治疗,间隔1－3月对静脉曲张未消失者重复硬化治疗,结果：6个月内无出血者硬化组66％,结扎组83％,联合治疗组92％,3－6个月内随访,食管静脉曲张消失率硬化组86％,结扎组68％,联合治疗组91％,结论：联合结扎和硬化不同步良管静脉曲张破裂出血能增加止血效果,提高食管静脉曲张消失率,减内内镜治疗次数和硬化剂用量,为目前内镜治疗食管静脉曲线破裂出血较为安全有效的方法。     

食管胃底静脉曲张内镜注射治疗19例

目的：通过对食管胃底静脉曲张及合并出血的内镜下治疗观察,以探讨硬化剂联合组织粘合剂的临床疗效。方法：对19例食管胃底曲张静脉内镜下注射硬化剂和组织粘合剂。结果：7例急性出血者出血停止,18例曲张静脉消失或基本消失。结论：对于食管胃底静脉曲张出血内镜下注射硬化剂联合组织粘合剂是一种较好的急诊止血方法,有效延长了肝硬化患者生存期。     

21例胃底及食管静脉曲张病人的内镜下套扎治疗及护理

为了有效地防治胃底曲张静脉并发急性大出血，降低其病死率，我科对21例胃底静脉曲张的病人实施了内镜下曲张静脉套扎术，并通过术前细致的护理、合理的使用镇静剂，术后有效的卧位、合理的饮食、正确的加用质子泵抑制剂等，使手术收到良好的效果。     

92例内镜下食管胃底静脉曲张患者套扎止血的护理

内镜下食管胃底静脉曲张套扎术是目前治疗食管胃底静脉曲张破裂出血的主要方法,危险性小,成功率高,并具有操作简便,并发症少,可重复治疗等优点。我院消化科自2008年6月至2009年6月对92例食管胃底静脉曲张破裂出血的患者行内镜下套扎止血治疗,经过术前、术中、术后的精心护理,取得了满意的疗效。     

胃窦血管扩张症的内镜诊断和治疗

胃窦血管扩张症 (GastricAntralVascularEcta sia ,GAVE)在临床上常表现为因隐性失血而引起的继发性贫血。其特征是在内镜下可见胃窦部呈弥漫性或线型排列的 ,通常是出血性的红色斑块样病变 ,由于其典型的内镜下表现 ,临床上更多地称之为“西瓜胃”。约 30 %的GAVE患者伴有肝硬化或门脉高压症[1] ,这种情况下GAVE与门脉高压性胃病 (PortalHypertensiveGastropathy ,PHG )的鉴别较为困难 ,但却非常重要 ,因为GAVE对降低门脉高压的治疗并不敏感。由于国内对GAVE的研究和报道极少 ,本文就该病的发病情况、病理机制、与PHD的内镜…     

Biological and clinical implications of hsa_circ_0086720 in gastric cancer and its clinical application

BackgroundCircular RNAs (circRNAs) are thought to be vital participants in carcinogenesis and have the characteristics of being stable, specific, and well conserved. However, their clinical significance and application value in gastric cancer (GC) are still poorly understood. Hsa_circ_0086720 was found to be a dysregulated circRNA in GC by microarray screening and was further explored for its clinical significance and application.MethodsHsa_circ_0086720 was detected in GC cell lines, tissues, and plasma, and the clinicopathological correlations were investigated. The existence, stability, origin, and change in the plasma hsa_circ_0086720 level were verified in early GC patients. Moreover, receiver operating characteristic and Kaplan–Meier survival curves were constructed to analyze the diagnostic and prognostic values, and bioinformatics analysis was used to identify the potential functions. Finally, risk factors and nomogram predicting were established.ResultsHsa_circ_0086720 was found to be downregulated in gastric carcinogenesis, and tissue hsa_circ_0086720 was negatively associated with perineural invasion, Borrmann type, disease‐free survival, and overall survival. Hsa_circ_0086720 was stable in circulating plasma and was actively secreted by cells in gastric carcinogenesis. As a biomarker for early GC screening, plasma hsa_circ_0086720 had good sensitivity and specificity, and its stability met the clinical application requirements. Bioinformatics analysis suggested that dysregulated hsa_circ_0086720 has important functions in gastric carcinogenesis. Univariate Cox regression analysis identified factors associated with overall survival time and disease‐free survival time. The nomograms showed good accuracy of predicting survival time.ConclusionHsa_circ_0086720 is a novel biomarker for screening early GC and predicting the prognosis of advanced‐stage patients.     

Isolated gastric varices: Splenic vein obstruction or portal hypertension?

The presence of isolated gastric varices without esophageal varices is thought to be highly suggestive of splenic vein obstruction. A review of our radiologic files revealed 14 patients with isolated gastric varices on barium studies performed during the past 10 years. Eight of the 14 patients had adequate clinical and/or radiologic follow-up to suggest the pathophysiology of the varices. Seven had evidence of portal hypertension, and the remaining patient had evidence of splenic vein obstruction. Six patients had signs of upper gastrointestinal (GI) bleeding. Double-contrast upper GI examinations revealed thickened, tortuous fundal folds in 6 patients and a lobulated fundal mass in 2. Thus, most patients with isolated gastric varices have portal hypertension rather than splenic vein obstruction as the underlying cause.     

胃Dieulafoy病内镜下特点及临床诊治心得

目的探讨胃Dieulafoy病的内镜及临床诊治特点。方法搜集1998年1月至2009年1月我院1012例上消化道出血患者的临床资料,对确诊的20例胃Dieulafoy病患者临床资料进行回顾性分析。结果Dieulafoy病好发于男性,男：女为3．5：1,平均年龄41．3岁;本病以反复发作性上消化道出血为主要症状,出血前无明显腹部不适或疼痛;内镜检查及治疗为本病主要诊疗手段;镜下表现特点为t片状黏膜糜烂,中央有血管断端显露（3／11）,胃底见喷射样出血点（3／11）;胃体上部前壁见点状血痂（2／11）;胃体上部后壁见红疹样隆起（2／11）,胃体上部前壁有浅小溃疡（1／11）。内镜治疗以内镜下电凝止血为主（7／11）。病变部位局部楔形切除在基层医院也应受到重视。结论急诊科、消化科医师尤其是内镜医师应提高对本病的认识,对患者进行细致、反复的内镜检查以及及时有效的镜下治疗。     

Endoscopic ultrasonographic study of the azygos vein before and after endoscopic obliteration of esophagogastric varices by injection sclerotherapy

BACKGROUND AND STUDY AIMS: The azygos vein plays an important role as a drainage system for the superior portosystemic collateral circulation in portal hypertensive patients. Endoscopic ultrasonography (EUS) and Doppler EUS allow the performance of hemodynamic studies of the azygos vein. In this study, we observed the changes in the azygos vein which occur with variceal obliteration by endoscopic injection sclerotherapy (EIS). PATIENTS AND METHODS: We recruited patients with portal hypertension and bleeding varices who were not on portal pressure-lowering agents and who were scheduled for the EIS program. EUS was performed in these patients to study the azygos vein at the start of EIS. The azygos vein diameter, maximal velocity (Vmax), and blood flow volume index (BFVI) were measured. After variceal obliteration and within 1 week, another EUS study of the azygos vein was carried out. RESULTS: Out of 40 patients recruited into the study variceal obliteration and EUS assessment of the azygos vein, within 1 week of obliteration, was achieved in 33. We noticed a significant increase in azygos vein diameter (P<0.001) and BFVI (P=0.001) following variceal obliteration. No significant change was observed in Vmax (P>0.05). In one patient, marked caliber irregularities were observed in the azygos vein after variceal obliteration. CONCLUSIONS: Using EUS and Doppler EUS, hemodynamic studies of the azygos vein blood flow can be performed, allowing the monitoring of the effects of EIS and variceal obliteration on the superior portosystemic collateral circulation. The clinical significance of the observed changes in azygos blood flow that occur with variceal obliteration should be investigated in further studies and correlated with short-term and long-term outcome.     

十二指肠胃黏膜异位症的内镜表现及临床特点

目的十二指肠胃黏膜异位(HGM)是一种较少见的先天性胚胎残余病变,患者多表现为功能性消化不良(FD)或慢性胃炎症状,临床上容易漏诊。该实验通过对135例十二指肠球部胃黏膜异位症病例的分析,探讨其临床诊疗特点。方法有FD或慢性胃炎症状行胃镜检查患者,发现十二指肠HGM病变行内镜切除并作病理检查,分析幽门螺杆菌(Hp)感染情况,并采用Glasgow评分对治疗前后进行症状评分。结果 4 650例胃镜检查患者中,发现十二指肠HGM患者134例,胃镜检出率为2.9%。患者主要表现上腹隐痛不适、反酸或腹胀等症状。按罗马Ⅲ标准分类,其中符合餐后不适综合征(PDS)者92例(69.2%)、上腹痛综合征(EPS)43(31.8%)。内镜检查发现,十二指肠HGM主要位于十二指肠球部(93.3%),降段较为少见(6.7%)。形态上主要分为4种类型:以多发结节样隆起最为多见,占57%;其次为单发息肉或多发颗粒状隆起(34.1%)。少见的还有溃疡及肿块型,分别占6.7%和2.2%。这两型由于形态不典型,极易误诊为消化性溃疡或肿瘤。超声内镜(EUS)对不典型的十二指肠HGM病变的鉴别诊断有意义,表现为黏膜下层低回声光团,内有无回声区,但这些特征有时也易误诊为异位胰腺。内镜下切除十二指肠HGM对症状改善有帮助。结论十二指肠HGM是部分FD或慢性胃炎症状反复发作的原因,内镜下治疗HGM可有效改善患者的症状。