影像诊断与消化系疾病

影像诊断与消化系疾病巫协宁上海市第一人民医院消化科上海市第一人民医院中心实验室上海２０００８０消化科医生应熟知各种影像诊断方法的适应症和禁忌症、优点和不足，善于选用最恰当的检验手段，用于诊断消化系疾病。对青年医师来说不仅仅是阅读报告单，更重要的是要理...     

数理医学在消化系肿瘤中的研究现状及展望

数理医学作为医学交叉学科的重要分支已经在临床科研各个领域发挥了重要的作用.数理医学在消化系肿瘤的影像诊断、储存、传输方面,以及在肿瘤精准治疗的方案设计方面均发挥着巨大的优势.特别是在消化系肿瘤的微创治疗领域,恶性肿瘤消融三维数学模型的建立及导航,手术影像学模拟均提高了消化系肿瘤治疗的安全性及有效率.此外,在目前大数据时代,应用数理医学进行数据分析及提供个体化治疗方案,将是今后发展的重要趋势之一.也为临床医师提供了一个有效的肿瘤诊断及治疗手段.应用数理医学的方法和模式进行临床及科学研究,更加快捷地促进临床肿瘤诊治的研究及发展,为患者造福.     

书讯

<正>本刊讯池肇春教授等主编的《消化系统疾病鉴别诊断与治疗学》第2版现由山东科学技术出版社出版,在全国各地新华书店发行.第2版的特色突出在基础与实用上,主要介绍常见消化系疾病的鉴别诊断与治疗,包括方法、步骤、经验,还增添一些进展和新概念.全书分上、下两卷:上卷为总论,重点阐述消化系疾病的诊疗基础;下卷为各论,论述消化系疾病的鉴别诊断与治疗.全书150余万字,内容精简实用,可为消化科、普外科、肿瘤科、感染科、影像科、介入科医师工作中的参考用书.定价为148元/册,欲购者可直接从     

Myc诱导的核抗原Mina53与消化系肿瘤的关系

Myc诱导的核抗原mina53基因是近年新发现的c-myc下游直接靶基因之一。研究发现mina53基因在多种肿瘤组织,尤其是消化系肿瘤中高表达,有提示预后的作用,表明其在肿瘤的发生、发展过程中可能发挥重要作用。对mina53基因的深入研究有助于进一步揭示消化系肿瘤的本质,为辅助诊断和指导治疗提供新途径,以期改善肿瘤患者的预后。     

奥曲肽治疗消化系内分泌肿瘤

奥曲肽治疗消化系内分泌肿瘤南京南化（集团）公司医院消化科（２１００４８）王国品奥曲肽是一种八肽的生长抑素（ＳＳ）长效类似物，近年研究发现它对消化系内分泌肿瘤有治疗作用，本文就此作一概述。１奥曲肽的药理学１９８２年，Ｂａｎｅｒ等合成了一种八肽的ＳＳ长效...     

临床有奖病例讨论（五）--贲门糜烂

消化系疾病涉及范围广,疑难疾病多,尤其是消化系肿瘤的早期诊断和治疗技术方面,至今尚存在诸多难题。日本利用胃肠气钡双对比造影染色内镜、窄带内镜、激光共聚焦内镜等技术细致检查,使早期胃癌的手术率达到50％甚至更高;并对早期消化系肿瘤进行内镜下的黏膜切除术及黏膜下剥离术,大大提高了消化系早期肿瘤的治疗效果。     

胃巨大溃疡、腹部肿块

消化系疾病涉及范围广，疑难疾病多，尤其是消化系肿瘤的早期诊断和治疗技术方面，至今尚存诸多难题，日本利用胃肠气钡双对比造影染色内镜、窄带内镜、激光共聚焦内镜等技术细致检查，使早期胃癌的手术率达到50％甚至更高；并对早期消化系肿瘤进行内镜下的黏膜切除术及黏膜下剥离术，大大提高了消化系早期肿瘤的治疗效果。     

以循证医学为证据处理肠易激综合征

肠易激综合征（irritable bowel syndrome，IBS）是消化科门诊中常见的疾病之一，但并未像器质性疾病一样引起临床医师的足够重视。实际上，尽管IBS 不是器质性疾病，但是其对患者生命质量的影响与不少器质性疾病相同，甚至有研究发现 IBS 患者的生命质量低于消化科器质性疾病患者。消化科临床医师应该了解 IBS 的规范化诊断与治疗，依据循证医学证据指导临床的诊断与治疗。     

土耳其Afyon地区医师结核病诊断与治疗方法评价

目的:评价土耳其Afyon地区医师诊断及治疗结核病的方法。材料及方法:由208名医师(46名专科医师和162名全科执业医师)填写有关结核病的调查表。结果:医师中以细菌学检查为首选诊断方法者占75％(n=156)。对于新诊断的患者,64.4％的医师采用三药联用方案,30.8％采用四药联用。联合用药最常选用的是HRE(36.5％)。首选疗程为9个月(38.5％)和6个月(34.6％)。对于治疗失败患者的处理,20.2％的医师是在原有方案上增加一种新药, 而65.4％的医师则建议将患者转诊到结核病专科单位处理。对于儿童结核病的治疗,38.5％的医师认为两药方案就足够了。对于孕期结核病,9.7％的医师认为应该在产后治疗,而11.5％的医师则认为应该在终止妊娠后进行治疗。结论:医师关于结核病诊断和治疗的知识不足。为医师提供额外的教育资源可以为促进结核病控制工作做出贡献。     

肠道菌群在消化系肿瘤中的研究新进展

肠道菌群作为人类机体的一种复杂而微妙的微生态系统,因其在人类自身的健康与疾病中扮演着重要的角色而成为全球医学领域研究的焦点之一。特别是近些年以来,随着宏基因组学原理和通量测序分析的迅猛发展,越来越多的研究证明肠道菌群与人类宿主消化系肿瘤的发生、发展密切相关,肠道菌群代谢产物和各种肠道微生态制剂在诊治消化系肿瘤的潜在价值越来越受全球研究者的关注,有望通过对肠道菌群的深入研究为诊治消化系肿瘤提供新途径、新思路和新方案。鉴于此,本文重点概述肠道菌群在常见消化系肿瘤中的作用,从而使临床医师更好地认识肠道菌群在消化系肿瘤中的地位与作用。     

Management by specialists of patients with digestive cancers in the Department of C?te-d'Or

The relative frequency of consultation of the different specialists involved in the diagnosis and treatment of cancer is not well known in France. This study was completed with data collected by the Digestive Tract Cancer Registry in C?te d'Or. Among 3.192 digestive tract cancers diagnosed between 1976 and 1982, 64 p. 100 were treated by gastroenterologists or surgeons. Only 18% of the patients consulted an oncologist. The frequency of consultation of gastroenterologists in the care of digestive tract cancers was independent on the location of the cancer but varied with the place of residence, fluctuating from 69.7% for patients living in the town of Dijon, to 39.9% for patients living in a town with a regional hospital without gastroenterologist. The inverse phenomenon was observed for oncologists. They treated 63.2% of the patients with esophageal cancer and 31.2 p. 100 of patients with rectal cancer, but less than 10 p. 100 of the patients with gastric, colonic, liver, biliary tract or pancreatic cancer. The number of surgeons consulted depended essentially on the operability of the cancer. Between 1976 and 1982 consultation with gastroenterologists and surgeons by patients with digestive tract cancer increased by 4.4 p. 100 (p less than 0.05) and 2.1 p. 100 per year (p less than 0.01), respectively. The frequency of consultation of oncologists remained stable: +0.3 p. 100 per year. These results confirm the importance of a training policy oriented towards specialists who are not oncologists. They must take note of their importance in the diagnosis and the organization of the fight against digestive tract cancers.     

上消化道肿瘤的预防和内镜下早期癌的发现与治疗

世界范围内,上消化道肿瘤具有高患病率和高死亡率的特点,由此产生的医疗费用也相当惊人,尤其是在高发病率的亚洲地区。因此上消化道肿瘤的预防以及内镜下早期癌的发现和治疗就显得非常重要,受到许多国家胃肠病学专家的关注。本文摘录了第六届上海国际胃肠病学会议期间欧美和亚太地区胃肠病学专家在这些方面的专题报告,分为致癌原、化学预防、癌前疾病、内镜下早期癌的发现和治疗等几方面进行介绍。     

免疫介导消化系统疾病在我国的诊治现状以及今后发展方向

随着我国经济的发展和国民生活习惯的改变,免疫介导消化系统疾病的发病率呈上升趋势,由于其临床表现具有复杂性、多样性、多变性,个体差异大,常可累及多个器官,并反复发作,迁延不愈,已越来越受到医学界的重视。我们在充分认识免疫介导消化系统疾病诊治现状的同时,需要多学科的共同努力,提高其诊治水平。     

腹腔镜在消化系统疾病诊治中的应用进展

腹腔镜具有创伤小、康复快的优势,已成为外科医师的有力工具。随着腹腔镜器械不断改善、操作技巧的积累,以及对内镜操作技术的娴熟,消化内科医师已尝试将腹腔镜运用于消化系统疾病的诊治中,尤其双镜结合治疗取得了一定的成功。本文就腹腔镜在消化系统疾病诊治中的应用进展作一综述。     

Endoscopist's view of the future role of the gastroenterologist in digestive oncology

Improvement in digestive oncology will require the creation of multidisciplinary teams. Expert gastroenterologists who are super‐specializing in digestive oncology (onco‐gastroenterologists) should be in the center of such highly qualified teams. To fulfill this role the onco‐gastroenterologist will need adequate training in all aspects of diagnostic and therapeutic endoscopic activities related to digestive cancer. This article reflects the spectrum of expertise that will be necessary to guarantee optimal service.     

Systemic chemotherapy for pancreatic cancer

Surgical resection offers the only curative strategy for pancreatic cancer. Yet, because early detection of pancreatic cancer is so difficult and diagnosis is delayed, pancreatic cancer in most patients is surgically unresectable. Even in patients with resectable disease, the long-term outcome remains unsatisfactory due to early recurrence after resection. Early appearance of distant metastasis suggests that systemic treatment, such as chemotherapy, should play a major role in improving patient survival. Although the recently developed gemcitabine has renewed interest in clinical research for pancreatic cancer, other currently available chemotherapeutic agents have little impact on survival. Studies to identify more effective agents or treatment regimens must have the highest priority. The expanding understanding of molecular and genetic biology should facilitate research to develop novel molecule-targeted agents and to establish individualized therapy regimens for this disease.     

New drugs and new approaches in metastatic bladder cancer

The median survival of patients with metastatic cancer of the urothelium who receive best supportive care only in 4-6 months. With the introduction of combination chemotherapy regimens including cisplatin and methotrexate for the management of metastatic urothelial cancer, median overall survival has doubled. Nevertheless, death due to cancer ultimately occurs in more than 80% of these patients, thus more effective therapy is required. The new available treatment modalities range from new combinations of conventional chemotherapeutic agents to combinations incorporating novel drugs like gemcitabine and the taxanes. These new combinations incorporate the new active agents in two, three or multiple drug combinations, administered either in one regimen or sequentially in various combinations and schedules intended to improve the outcome of bladder cancer patients. Ongoing phase III studies will help to define the role of these new combinations in the treatment of advanced bladder cancer. The improved understanding of the molecular biology of urothelial malignancies is helping to define the role of new prognostic indices that can direct the most appropriate choice of treatment for advanced disease. In addition, advances in the molecular biology of urothelial malignancies may allow identification of specific genetic lesions and biochemical pathways upon which future therapeutic approaches can be focused. The integration of newer biologic agents, probably to supplement rather than to supplant chemotherapeutic drugs, should be a primary direction of research with the objective to interfere with multiple aspects of bladder cancer progression.     

Papel del digestólogo en el manejo del paciente obeso

Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.     

结直肠癌定义和早期病变中的若干问题

结直肠癌是我国常见的恶性肿瘤，随着人们生活水平的提高，我国结直肠癌的发病率也逐年提高。早期诊断、早期干预和治疗对结直肠癌预后至关重要。目前消化科临床医师和病理医师对早期病变的特征、分类和生物学性质的认识尚有分歧。本文对结直肠癌早期病变的相关问题作一阐述，希望对共识的形成有促进作用。     

Gastroenterologists and interventional radiologists: Friends or foes? A multidisciplinary approach for solving gastrointestinal problems

While endoscopy used to have more therapeutic abilities than radiology, interventional radiology is now racing to lead the minimally invasive diagnostic and therapeutic techniques in medicine as well as surgery. Expecting the new epidemic of hepatocellular carcinoma, radiologists and gastroenterologists are on the run competing in many procedures that are needed. While some radiologists worry about non-radiologists who “intervene” in radiology, many gastroenterologists defend their specialty. Both gastroenterologists and radiologists are invited to collaborate in diagnosing and treating many diseases.Treatment of upper gastrointestinal bleeds should be multidisciplinary involving a team of gastroenterologists, radiologists and surgeons. The role of the interventional radiologist and surgeon arises only after the failure of the endoscopic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) is the preferred treatment for variceal bleeding after failed endoscopy. As the entire field of gastroenterology continues towards less invasive, safer and more effective means of diagnosing and treating diseases, digestive endoscopy will continue to expand the ways in which this unique and minimally invasive technology can be applied to the benefit of patients. In line with this trend, there will be a decline in simple diagnostic standard endoscopies.Development of new techniques, such as CT colonography and capsule endoscopy will actually increase the demand for digestive endoscopy. The trend of future digestive endoscopy will continue to move from diagnostic to therapeutic modalities.Future gastroenterologists will be trained and expected to become micro-surgeons of the gastrointestinal tract working in multispecialty teams along with their colleagues: surgeons and radiologists.