经口服超声造影剂联合彩色多普勒超声在胃疾病诊断中的应用价值

目的 探讨经口服超声造影剂联合彩色多普勒超声在胃疾病诊断中的应用价值.方法 对132例胃疾病患者口服＂胃窗声学造影剂＂后进行彩色多普勒超声仪检测,以80例健康人作为对照,检测其胃壁超声声像及胃壁厚度.并将病例组超声检测结果与病理诊断、胃镜诊断结果进行比较分析.结果 超声结果显示病例组较正常组胃壁有不同程度的增厚,超声诊断出胃溃疡、胃癌、食道贲门癌、胃腺瘤、胃平滑肌瘤、胃间质瘤和胃淋巴瘤患者共129例,诊断符合率达97.73%,与胃镜诊断结果相比,无显著差异（P〉0.05）.结论 经口服超声造影剂联合彩色多普勒超声诊断胃部疾病灵活简便,无痛苦无创伤,值得临床推广应用.     

Ultrasonic examination of the wall of the fluid-filled stomach

The ultrasonographic examination of the fluid-filled stomach in five standardized positions permits the transabdominal visualization of the gastric wall in all sections of the organ. In a prospective study, 107 patients were examined--68 with a pathological change in the wall of the stomach and 39 with no gastric disease. In 56 patients (82.4%) the lesion was correctly identified. In addition to wall-infiltrating processes and stenoses, circumscribed space-occupying lesions were also detected; for example, localized carcinomas, leiomyosarcomas, lymphomas, leiomyomas, polyps, giant folds, and impressions of the gastric wall. Thirty-seven patients (94.9%) with no gastric disease were considered normal at the ultrasonographic examination. The procedure suggests itself not only as a supplement to endoscopy and diagnostic X-rays, but also as a diagnostic alternative in selected patients who cannot be stressed by these methods. The exclusion of gastric disease by this technique is not possible.     

胃平滑肌肉瘤20例临床分析

目的：探讨胃平滑肌肉瘤临床特征,总结其诊断和治疗经验.方法：回顾性分析两医院1993年1月～2002年12月20例胃平滑肌肉瘤临床资料,从临床表现、诊断和治疗等总结其临床特征.结果：胃平滑肌肉瘤占同期胃恶性肿瘤的0.98%.临床表现为上消化道出血,腹痛,腹部包块,贫血及体重下降.肿瘤瘤体大,多位于胃的近侧部,以胃内、胃外型为主.转移方式以肝和瘤体附近淋巴结多见,肿瘤转移与其大小、生长部位、生长方式无关（P＞0.05）.胃镜下活检成功率较低,手术及病理检查是诊断和治疗的最佳方法.结论：胃平滑肌肉瘤临床表现缺乏特征性,肿瘤容易转移至肝和附近淋巴结,手术及病理检查是诊断和治疗的最佳方法.     

胃肠超声造影检查在胃部疾病诊断中的临床应用

目的:研究胃肠超声造影检查在胃部疾病诊断中的临床应用价值。方法:对我院在2018年1月-2019年6月期间收治的84例经胃肠超声造影检查和其他检查诊断为胃部疾病且有病理检查结果的患者进行回顾性分析,其中包括43例胃溃疡、41例胃肿瘤,均给予胃肠超声检查,对胃肠超声造影对胃部疾病检查结果及阳性检出率进行分析。结果:胃肠超声造影检测确诊胃溃疡真阳性37例,其中包括21例小弯侧、13例大弯侧、3例胃底;胃肿瘤真阳性检出35例,其中包括21例恶性肿瘤、14例良性肿瘤;胃肠超声造影检测胃溃疡阳性检出率为86.05%(37/43),胃肿瘤阳性检出率为85.37%(35/41)。结论:在胃部疾病诊断中应用胃肠超声造影检查效果显著,能够有效提高诊断准确率,进而为临床医师提供准确可靠的诊断和治疗依据,在临床上很具有应用价值。     

Roles of oxidative stress in stomach disorders

The stomach is a sensitive digestive organ that is susceptible and exposed to exogenous pathogens from the diet. In response to such pathogens, the stomach induces oxidative stress, which might be related to the development of gastric organic disorders such as gastritis, gastric ulcers, and gastric cancer, as well as functional disorders such as functional dyspepsia. In particular, the bacterium Helicobacter pylori plays a major role in eliciting and confronting oxidative stress in the stomach. The present paper summarizes the pathogenesis of oxidative stress in the stomach during the development of various stomach diseases.     

Gastric fundus impression caused by splenic vessels: detection by endoscopic ultrasound

When a submucosal impression of the stomach fundus is seen during upper GI endoscopy, a true submucosal tumor can reliably be differentiated from an extragastric impression by endoscopic ultrasound (EUS). We report on 15 patients in whom EUS identified splenic vessels near the splenic hilum causing an impression of the posterior wall of the gastric fundus. Neither by EUS nor conventional ultrasound, computed tomography or clinical follow-up, was a tumor in the stomach or upper abdomen that could have been the cause of the gastric wall impression, identified. Two of the 15 patients had portal hypertension with multiple intra-/paramural venous collateral vessels. Twenty patients examined for other reasons and 10 patients with portal hypertension but without fundic impressions, served as controls: In these cases the splenic vessels were shown by EUS to follow a course more distant to the gastric wall. Thus, normal vascular structures should be included in the differential diagnosis of gastric fundus impression detected by endoscopy.     

乙肝病毒与胃部病变及血清乙肝标记物的关系研究

目的：通过63例临床肝病病例的胃粘膜及血清乙肝标记物的分析，探讨胃粘膜病变与乙型肝炎之间的关系。方法：检测63例病人血清HBVM（HB sAg、HBcAg、HBV-DNA)。同时给63例病人做胃镜检查，取胃粘膜检测HBVM。结果：63例病人均有不同程度的胃十二指肠病变，好发部位依次为胃窦100％、十二指肠球部的20．6％、胃体9．15％、胃底约3．2％、幽门1．6％。胃粘膜HBsAg、HBcAg单项阳性率约为41％，双项同时阳性率约11．1％。结论：乙型肝炎与胃部疾病关系密切，血清HBVM与胃粘膜HBVM不是平行关系，胃粘膜HBVM的检测具有临床价值。     

磁共振弥散加权成像在胃癌诊断中的应用价值

目的探讨1.5T磁共振弥散加权成像在胃癌诊断中的应用价值。方法 36例胃部病变患者,其中胃癌分化好组11例,胃癌分化差组19例,良性病变组6例,同期健康成人志愿者10名为对照组,4组均行磁共振弥散加权成像,采用自旋回波/平面回波序列,测量胃壁在表观弥散系数(apparent diffusion coefficient,ADC)图上的ADC值,并进行比较。结果4组胃壁ADC值比较差异有统计学意义(F=26.76,P<0.05);根据ROC曲线,以ADC值<1.36×10-3 mm2/s为标准,磁共振弥散加权成像诊断胃癌的敏感性为87.5%,特异性为90.0%。结论磁共振弥散加权成像对进展期胃癌有较高敏感性和特异性,ADC值有助于病变的诊断和鉴别诊断。     

The sonographic appearances of gastric lymphoma

The sonographic images obtained from 17 patients with gastric lymphoma were reviewed. In 15/17 cases the tumor presented as an abdominal mass, either with a "target-like" pattern or with a solid, homogeneous structure; in the remaining two cases only thickening of portions of the gastric wall was seen. Two features that may help to differentiate lymphoma from other gastric diseases were observed in patients of this series. In eight cases thickened mucosal folds could be identified within the gastric mass, outlined by strong luminal echoes arranged like the spokes of a wheel. A hypoechoic appearance of hte infiltrated gastric wall was seen in 13/17 cases; it was less echogenic than the adjacent liver parenchyma and, often, it was almost echo-free. Sonography is often used as the first imaging method in cases of patients with abdominal complaints and clinically unsuspected tumors of the stomach may be visualized first by it. In such cases, identification of these features within a gastric mass may allow sonography to suggest the lymphomatous nature of the disease.     

胃部疾病仿真内镜与纤维胃镜的对比研究

目的　研究螺旋ＣＴ仿真内镜诊断胃组疾病的临床价值。方法　２７ 名可疑胃部疾病的患者在禁食禁水至少４ 小时,口服产气剂后立即进行上腹部螺旋ＣＴ扫描。在计算机工作站用预置的软件重建出仿真内镜图像。所有病人在ＣＴ扫描后１ 天之内进行了纤维胃镜检查;螺旋ＣＴ 仿真内镜的诊断结果与纤维胃镜的结果进行比较。结果　螺旋ＣＴ仿真内镜正确地诊断所有的正常胃（ｎ ＝ ６） 和胃息肉（ｎ ＝ ５） 的病例,１０ 个胃溃疡（１０／１２） 和３ 个胃癌（３／４） 的病人被ＣＴ 仿真内镜诊断,其所见与纤维胃镜检查相似;但是２ 个浅小息肉和１ 例胃底癌于ＣＴ 仿真内镜被漏诊。结论　螺旋ＣＴ仿真内镜是一种新的非创伤性检查技术,在采用合适的检查体位和胃部适度扩张的条件下可以成为胃部疾病的一种有效的检查方法。     

The gastric air-fluid sign: Aid in CT assessment of gastric wall thickening

The differentiation of apparent gastric wall thickening due to incomplete gastric distention from true pathologic wall thickening can be difficult on computed tomographic (CT) scanning. We have observed a transition in gastric wall thickening that is often present at or slightly above the gastric air-fluid or air-contrast level. The apparently thickened gastric wall in the dependent portion of the stomach undergoes an abrupt change to normal thickness at or above the air-fluid level.Review of CT scans in 259 patients without known or suspected gastric pathologic conditions revealed this finding, termed the gastric air-fluid sign, in 57 patients (22%). While not considered diagnostic, the presence of this sign may allow for a greater degree of confidence in the CT assessment of gastric wall thickening in an appropriate clinical setting.     

New additional operation for the prevention of the gastric stasis after selective gastric vagotomy with antrectomy

In order to prevent postoperative gastric stasis, we devised and tested the following improvements in the selective gastric vagotomy with antrectomy. (1) The gastroduodenostomy was made so as to have an acute angle to the longitudinal axis of the remnant stomach, and (2) the downward traction being exerted on the remnant stomach by the transverse colon was eliminated by dissecting the greater omentum, and then (3) the posterior wall of the corpus on the lesser curvature side was fixed to the stump of the hepatogastric ligament, and the posterior wall of the corpus on the greater curvature side was fixed to the retroperitoneum inferior to the pancreas. By these procedures, the corpus was maintained in a position superior to the anastomosis. These operative procedures resulted in preventing the gastric stasis after the start of oral feeding. The two patients on whom this operation was performed have been followed up for 3 to 4 months since the operation, and neither of them has had any complaint of gastric stasis, such as anorexia or a feeling of heaviness of the stomach.     

Food residue at endoscopy in patients who have previously undergone distal gastrectomy: risk factors and patient preparation

BACKGROUND AND STUDY AIMS: Food residue is often seen in the gastric remnant after partial gastrectomy, making it difficult to diagnose early cancer in the residual stomach. The aims of this study were to clarify the risk factors for the accumulation of food residue, and to study methods of preparation for endoscopy in patients who had undergone distal gastrectomy. PATIENTS AND METHODS: 374 endoscopic examinations of patients who had undergone distal gastrectomy for gastric cancer were compared with 2168 endoscopic examinations in patients without a history of gastrectomy. Relationships between the presence of food residue and a number of clinical factors, including patient preparation, were evaluated by univariate and multivariate analyses. RESULTS: Food residue in the gastric remnant was observed in 70 examinations (18.7 %), a significantly higher proportion than that found in control patients (0.3 %). From multivariate analysis, underlying diseases (endocrine, metabolic, or connective tissue disease), Billroth type I reconstruction, and postoperative gastric retention were found to be independent risk factors for the accumulation of food residue. Diet preparation (a liquid diet plus aclatonium napadisilate) significantly decreased the incidence of food residue. CONCLUSIONS: Our diet preparation method can be recommended as a preparation for upper gastrointestinal endoscopy in patients who have undergone distal gastrectomy, especially in patients with additional risk factors.     

Hydro-MRI for the visualization of gastric wall motility using RARE magnetic resonance imaging sequences

BACKGROUND: Although different imaging techniques such as conventional X-ray, ultrasonography, and hydro-computed tomography are available for the imaging of the stomach, none can depict this organ in full size without radiation. Therefore, the study of the entire gastric wall motility of the stomach is difficult and in principle only performable with rapid magnetic resonance imaging (MRI) techniques. T1-weighted imaging sequences have been used for the dynamic study of gastric wall motility. This technique was combined with the oral intake of para- or superparamagnetic contrast agents to achieve sufficient intraluminal contrast. The technique described in the present study is based on a different contrast mechanism. METHODS: The stomach was filled with 500 mL of 10% of aqueous dextrose solution, and a strongly T2-weighted fast rapid acquisition with relaxation enhancement (RARE) type imaging sequence was used for data acquisition. No other contrast agents were applied. An ultrafast RARE imaging sequence with an asymmetric phase-encoding scheme was developed to achieve a high temporal and spatial resolution. The scanning time per image was approximately 1 s. RESULTS: The stomach was imaged in full size. The concentric constrictor rings moved from the proximal part of the body toward the antrum. The mean duration for one contraction cycle was approximately 17.9 +/- 2.5 s, the mean contractile frequency was 3.4 +/- 0.5 s, and the mean spreading velocity was 65.5 +/- 3.6 cm/min. CONCLUSIONS: The purpose of this study was to demonstrate a new technical approach for a noninvasive dynamic study of gastric motor function with hydro-MRI. This robust method may have clinical application, e.g., in the diagnosis of gastroparesis, and may be extended to the rest of the gastrointestinal tract.     

胃微生物与人体共生关系的研究进展

近年来,共生功能体(holobionts)这一概念被越来越多的科研学者频繁提出。微生物与宿主在共同进化的过程中通过长期互作形成一个整体,其稳态的打破可诱发疾病。目前人们对胃部菌群方面的认识已经从H.pylori的致病作用转化为多种微生物共同存在和协同作用,研究也从单一致病菌的关联性研究转化为探讨宿主-微生物复杂且动态的共生关系,并对共生关系在胃部疾病的发生发展中的作用提出新观点。由于饮食、用药、环境、遗传等各方面都对菌群结构及丰度产生影响,因此对治疗方法也需要调整和提出新的思路。新的科研方法使人们对胃部菌群的认识更深刻更广泛,对H.pylori作用的重新认识与非H.pylori细菌在胃内作用的新发现出现很多争议,单一病因与整体微生态变化对疾病发生进展的作用以及菌群特征分析是否可以成为胃部疾病新的诊断方法成为热点话题。本文就胃微生物与人类共生关系的研究发展做一综述,以期在预防和治疗胃部疾病上提供新思路。     

A new ultrasonic probe for endosonographic imaging of the upper GI-tract. Preliminary observations

A new ultrasonic probe (7.5 MHz, diameter 3.7 mm) was used in vitro in 3 gastric resection specimens and in vivo in 12 patients in an attempt to visualize normal and pathological wall structure of the esophagus, stomach and duodenum via the working channel of a gastroscope, and of the biliary tract via the percutaneous approach. In 5 of these patients conventional endosonography was performed. The probe visualizes the normal layer structure and pathological lesions of the upper GI-tract wall, since it can be accurately positioned at the structure of interest under visual control; water is instilled into the hollow organs to improve transmission of the ultrasound beam. Intra- and transmural changes such as blood vessels in the wall of the esophagus and stomach in portal hypertension, or gastric and esophageal tumors were demonstrated. The important advantage of the probe is that it can be used in stenosed or narrowed hollow organs, where conventional endosonography fails. However, the depth of penetration of the ultrasonic beam (10-15 mm) and circumferential imaging of the gastric wall are still inferior to those of conventional endoscopic ultrasound. As the focus distance of the ultrasound probe to the biliary ducts is too small, visualization of the biliary system is incomplete. Technical improvements could make this new probe an irreplacable diagnostic tool in the future.     

Potentiating effect of sodium glutamate on gastric secretion and its possible use as a clinical test]

The authors report a potentiating effect of sodium glutamate on gastric secretion in subjects free of gastrointestinal diseases. Similar effect has been discovered in dogs. In subjects with gastric hyposecretion (chronic gastritis, functional regulatory disturbances) sodium glutamate combined with pentagastrin is a helpful tool in overall evaluation of gastric secretion. In achlorhydria is can be used for determination of a residual capacity of the stomach to secrete the hydrochloric acid in failure of humoral stimulators.     

Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) of early gastric cancer is a minimally invasive procedure. The incidence and characteristics of metachronous multiple gastric cancers were investigated in a retrospective study in patients with early gastric cancer after EMR treatment. PATIENTS AND METHODS: A total of 143 patients with early gastric cancer who had undergone EMR treatment were periodically followed up with endoscopic examinations for 24 months or longer. RESULTS: The median period of endoscopic follow-up was 57 months (range 24 - 157 months). None of the patients died of gastric cancer, and there were no treatment-related deaths. Five patients died of other diseases. Of 20 patients (14 %) with metachronous multiple gastric cancers, 15 were treated by EMR. One patient with differentiated submucosal cancer and four with undifferentiated cancers underwent surgery. Sixteen patients (11 %) had synchronous multiple early gastric cancer lesions within 1 year of the initial EMR. About half of the multiple lesions were located in the same third of the stomach as the primary lesion, and most lesions were similar in macroscopic type to the primary lesions. Most multiple lesions were of the differentiated type. CONCLUSIONS: Annual endoscopic examinations can preserve the whole stomach in most patients with early gastric cancer after successful EMR.     

胃壁厚度在超声筛查胃部病变中的价值

目的探讨口服造影剂胃超声检查在胃部病变筛查中的应用价值。 方法纳入2015年1月至2018年12月于中山大学附属第八医院体检行胃超声检查同时取得胃镜检查结果者3573例。超声观察胃腔、胃壁及胃周结构,并测量胃壁厚度。分析胃超声检查与胃镜诊断结果,绘制胃壁厚度评估胃病变的ROC曲线,并计算ROC曲线下面积、最佳截断值及诊断敏感度和特异度。采用线性加权Kappa检验对胃壁厚度评估胃部病变的结果与胃镜检查结果进行一致性分析。 结果所有纳入对象经术后病理证实胃癌20例。胃超声检查筛查出18例胃癌,均经手术病理证实为胃腺癌。超声检查漏诊2例,误诊2例。胃镜漏诊1例。以手术病理、胃镜活检病理结果及胃镜结合临床随访结果为诊断标准,绘制胃壁厚度评估正常胃壁与病变胃壁的ROC曲线。ROC曲线下面积为0.946（95%CI：0.930~0.962）,最佳截断值为5.5 mm,其诊断敏感度和特异度分别为97.5%和98.3%。绘制胃壁厚度评估肿块胃壁与非肿块胃壁的ROC曲线。ROC曲线下面积为0.829（95% CI：0.758~0.900）,最佳截断值为9.5 mm,其诊断敏感度和特异度分别为79.7%和75.9%。基于ROC曲线阈值分析结果,以胃壁厚度为依据诊断不同病变,胃壁厚度＜6 mm判定为正常或非糜烂性胃炎,6 mm≤胃壁厚度≤9 mm判定为糜烂性胃炎,胃壁厚度＞9 mm判定为肿块。对胃壁厚度评估结果与胃镜检查结果进行一致性分析,Kappa值为0.792（P＜0.001）。 结论胃壁厚度评估胃部病变与胃镜诊断结果一致性较好,胃超声检查作为一种简便、快捷的胃疾病筛查手段,对于胃癌的筛查及其他胃部疾病的初筛及随诊具有重要意义。     

So-called functional diseases and disorders of the stomach

While analyzing the data available in the literature and their own findings, the authors propose a classification of functional diseases and disturbances of the stomach by origin, nature of functional disorders, and clinical symptoms. They consider the features of gastric functional disturbances in chronic diseases of the gastrointestinal tract, abnormalities of other organs and systems, diseases of the nervous system, intoxications, arrhythmias, nitriture, etc. Among the patients admitted to the Clinic of Neuroses and Psychotherapy, individuals suffering from neurotic disorders or neurotic continuous mild abnormalities of the stomach, neurosis-like disorders complicating the course of chronic gastroenterologic diseases have been identified. Principles and patterns of management of patients with gastric functional diseases and disturbances have been developed.