日本血吸虫病流行区HBV与血吸虫感染相关性血清流行病学调查

目的 了解血吸虫病流行区HBsAg人群分布规律及其与血吸虫感染的相关性。方法 在安徽省一中度血吸虫病流行村，采用病原学方法（Kato-Katz法，二送六检）和血清学方法（ELISA法、IHA法串联筛检方案）进行血吸虫感染情况检测，同时平行检测HBsAg（ELISA法），并进行相关个案调查。结果 1）居民HBsAg阳性率11．21％（105／937），其中男性12．38％（50／404），女性10．32％（55／533），性别间差异无显著性（wald=1．545，P=0．214）；25-34岁及以上年龄组HBV感染的危险度（OR）是5～14岁组的8．852～10．5ll倍（P均d0．001）；2）血吸虫抗体阳性率与HBsAg携带率年龄性别分布曲线走向基本一致，有随年龄增大而上升趋势；≥25岁居民血吸虫抗体阳性率、粪检阳性率、HBsAg携带率分别在30％、3．13％和10％以上；3）慢性血吸虫病患者与非血吸虫病患者HBsAg携带率分别为7．69％和9．96％，HBsAg平均A值分别为0．180（一0．005，0．364）和0．234（0，141，0．327），差异无显著性（P均〉0．05）。血吸虫抗体阳性与阴性者HBsAg携带率分别为12．26％、10．66％，HBsAg平均A值分别为0，246（0，166，0．327）和0．241（O．182，0．301），差异无显著性（P均〉0．05）。结论 本研究未发现HBV与血吸虫感染有相关性，但≥25岁居民血吸虫合并HBV感染的潜在威胁不能忽视。     

胶体金CWSAg-DIPSTICK在检测日本血吸虫病中的应用

目的：研究胶体金CWSAg-DIPSTICK在检测日本血吸虫病中的应用。方法：以日本血吸虫可溶性虫卵抗原（SEAg)、尾蚴抗原（CeAg)为诊断抗原，采用胶体金CWSAg-DIPSTICK对325例血吸虫病人（其中急性血吸虫病28例，慢性血吸虫病297例），79例肝吸虫病人，157例囊虫病人，184例旋毛虫病人，165例肝炎病人，481例肺结核病人，876例普通就诊者以及518例正常人的临床应用与国内几种常用的血清学诊断方法比较试验。结果：胶体金CWSAg-DIPSTICK操作时间为2－5min，阳性检出率为（97．31％－100％）。其中慢性血吸虫病97．31％（289／297），急性血吸虫病100％（28／28）；交叉反应率为0．62％－4．89％，其中，肺吸虫病1．96％（3／153），肝吸虫病1．33％（1／75），囊虫病0．64％（3／153），旋毛虫病4．89％（9／184），肝炎1．21％（2／165），结核病0．62％（3／481）；假阳性率为0．19％－1．25％，其中，寄生虫病特检门诊普通就诊者1．25％（11／876）、正常人0．19％（1／518）。结论：胶体金日本血吸虫病快速诊断试纸具有特异性较强，操作简便，反应快速，敏感性较高，假阳性率低等优点，值得临床上推广应用。     

慢性萎缩性胃炎胃窦病理与内镜表现对照研究

目的探讨慢性萎缩性胃炎（CAG）病理学指标与内镜表现的关系。方法对46例CAG患者胃窦黏膜病理结果与内镜下各种表现、幽门螺杆菌（Hp）感染情况进行对照比较分析。结果发现46例CAG患者萎缩均伴不同程度的慢性炎症,其中萎缩伴肠上皮化生32例（69．57％）,萎缩伴肠上皮化生和上皮内瘤变10例（21．74％）,与之对应镜下表现形式多种。胃镜下单红相为主（花斑样改变）表现与病理学诊断萎缩符合率60．87％（28／46）,且以轻中度萎缩为主。传统胃镜下萎缩表现与病理诊断萎缩的符合率为21．74％（10／46）,其中白相为主,血管透见或显露与病理学诊断萎缩符合率13．04％（6／46）,两种及以上胃镜下的表现共存时符合率则更低。结论用传统胃镜下萎缩的表现诊断CAG不可靠,应多作黏膜活检病理才能正确诊断。     

超声微探头联合环扫超声内镜对食管黏膜下病变与纵隔病变鉴别诊断的应用价值

目的评价环扫超声内镜联合超声微探头对食管黏膜下病变与纵隔病变鉴别诊断的意义。方法回顾分析吉林大学中日联谊医院53例由于胃镜或CT等影像学检查发现不能明确来源的表现为食管隆起性病变患者,首先行超声微探头检查,明确大致起源后换用环扫超声内镜检查,综合两者结果做出诊断并与CT结果进行比较。结果超声内镜与CT诊断食管黏膜下病变的敏感度分别为90．9％（20／22）、50．0％（11／22）,特异度分别为93．5％（29／31）、83．9％（26／31）;诊断非侵袭性纵隔病变的敏感度分别为91．7％（22／24）、70．8％（17／24）,特异度分别为93．1％（27／29）、62．1％（18／29）;诊断侵袭性纵隔病变敏感度及特异度两者均为100．0％。结论超声微探头联合环扫超声内镜对食管黏膜下病变与纵隔病变的诊断与鉴别诊断有重要意义,尤其对食管黏膜下病变与非侵袭性纵隔病变其诊断的特异度与敏感度显著高于CT检查。     

山羊感染血吸虫病调查

为了解湖区山羊血吸虫感染状况，于1993年—1995年，对东至县部分散放于江、湖、河滩的山学进行了血吸虫感染的调查。采用塑料林顶管孵化法共检查山羊172只，发现阳性55只，阳性率为31．98％，3年感染率分别为24．62％（16／65）、41．79％（28／67）、27．5％（11／40）。本次调查发现山羊血吸虫感染率达到31.98％。并发现2只因重度感染而致死亡。说明山羊已成为该地IX受血吸中危害的主要对象之一。也是这类地区血吸虫病重要传染源之一。牧养山羊这一农村致富途径已越来越受到农民的欢迎，但在血吸虫病流行区，做好山羊血吸虫病的防治工作…     

克罗恩病的临床特征以及胶囊内镜在诊断中的价值

背景：近年我国克罗恩病（CD）的发病率和患病率呈上升趋势,然而其早期诊断率较低。目的：总结CD的临床特征,评价胶囊内镜在CD诊断中的价值。方法：回顾性分析浙江中医药大学附属第一医院2003年1月～2008年9月确诊为CD的69例住院患者的临床资料以及X线钡剂造影、结肠镜和胶囊内镜下特点。结果：69例CD患者中男35例,女34例,发病年龄17～73岁。临床表现主要有腹痛、腹泻、便血等,以及贫血、低蛋白血症、消瘦、发热,肠外表现以口腔溃疡、关节痛多见,部分出现肛门病变、肠梗阻等并发症。病变范围小肠型占47．8％,结肠型占14．5％,小肠结肠型占37．7％。X线钡剂造影诊断率为44．0％（22／50）,结肠镜检查诊断率为75．8％（50／66）。胶囊内镜检查诊断率为62．5％（10／16）,检出小肠病变10例,结肠病变2例,镜下主要表现为溃疡、黏膜充血水肿、糜烂、节段性病变、息肉样或鹅卵石样增生等。结论：CD病变以小肠累及率较高,其临床表现多样,常伴有多种肠外表现和并发症,可为临床诊断提供线索。胶囊内镜检查能发现CD的早期小肠黏膜病变,对CD具有较高的诊断价值。     

广东省消灭血吸虫病后监测结果分析

广东省于１９８５年消灭血吸虫病，１９８６～１９９５年开展监测巩固工作。１０年来，用各种方法查螺９７７６８４８８ｍ２，１９９２年仅在径口华侨农场曹寨村发现１残存螺点２０００ｍ２，钉螺最高密度为１２只／０．１１ｍ２，自然感染率为２．２９％（２１／９１８）。共复查历史病人５５１４３人，其中１例粪检血吸虫卵阳性，复治１５０２５人（２７．２５％）。新感染调查易感人群，皮试阳性率５．６１％（２９４９／５２５７５），粪检血吸虫卵阳性者２人（１９９２年曹寨村）。解剖野鼠１１６３０只，未发现血吸虫卵。大量监测结果显示，广东省消灭血吸虫病后，虽于１９９２年在曹寨村出现１个疫点，但经及时处理迅速扑灭，而其它地区均未发现残存钉螺及新感染病人，认为其消灭血吸虫病的成果巩固。     

29例胃十二指肠血吸虫病的内镜表现及病理特点分析

目的探讨胃、十二指肠血吸虫病的内镜和病理表现及预后。方法对29例胃、十二指肠血吸虫病患者的内镜下表现及病理表现进行分析，并根据随访资料进行预后分析。结果胃、十二指肠血吸虫病的内镜下表现缺乏特异性。29例中内镜下表现为溃疡17例，肿瘤样病变3例，浅表性胃炎2例，糜烂出血性胃炎1例，萎缩性胃炎6例。病理检查均在黏膜层、黏膜下层或坏死组织中发现有大量血吸虫卵沉积。29例中3例合并胃癌，另在最长11年的随访中发现癌变6例，癌变率达31％。结论胃、十二指肠血吸虫病内镜下表现缺乏特异性，诊断主要依靠病史和病理学检查，预后分析表明本病易产生癌前病变并易癌变，应定期随访以便早发现早治疗。     

胶囊内镜在消化道疾病诊断中的应用

目的了解胶囊内镜在消化道疾病，特别是对小肠疾病中的临床诊断应用价值。方法2004年2月至2006年2月间，应用GIVEN公司产M2A胶囊内镜检查74例，其中53例患者（分为不明原因消化道出血30例，反复发作腹痛、腹泻患者23例）经过胃镜和结肠镜检查，41例未发现可解释疾病的阳性结果，12例有胃黏膜的慢性炎症、息肉或结肠息肉；21例为健康体检者。结果0例不明原因出血的患者中，小肠病变诊断的阳性率为76．7％（23／30），其中小肠克罗恩病5例，小肠血管畸型6例，小肠黏膜糜烂11例和小肠息肉样隆起5例，其中3例经过手术证实为小肠肿瘤，1例为罕见的Cronkhite-Canada综合征，另有小肠憩室1例；持续腹痛、腹泻组的23例患者中，小肠病变诊断的阳性率为65．2％（15／23），其中小肠黏膜糜烂8例、回肠末端多发小溃疡7例，小肠多发息肉5例；21例健康查体者中有1例可见小肠多发细小的息肉样隆起，2例为小肠黏膜的炎症，8例为胃黏膜炎症，其余10例未见任何异常。疑诊小肠疾病的53例患者小肠病变的诊断阳性率为71．7％（38／53），胶囊内镜对出血组患者小肠黏膜病变诊断阳性率高于腹痛组，但差异无统计学意义；出血组患者胶囊在胃排空时间、小肠通过时间和排出体外时间均明显少于查体组。结论胶囊内镜对小肠疾病的诊断阳性率高，而且安全无痛苦，具有较好的临床应用价值，尤其适用于不明原因的消化道出血患者。     

窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值

目的探讨窄带成像放大内镜对胃良恶性溃疡的鉴别诊断价值。方法对常规内镜检查诊断为胃良性溃疡者186例再行窄带成像放大内镜检查,观察溃疡边缘胃小凹及黏膜微血管改变,并于相应部位取活检做病理学检查。结果常规内镜诊断为胃良性溃疡者186例,窄带成像放大内镜检查诊断为良性溃疡174例,恶性溃疡者12例;良性溃疡胃小凹形态规则,149例（85．63％,149／174）为D型,23例（13．22％,23／174）为C型,2例（1．15％,2／174）为E型;恶性溃疡患者胃小凹形态不规则、大小不一,胃小凹基本形态均为F型（100％,12／12）。良、恶性溃疡小凹形态比较差异有显著性（P〈0．01）;76例良性溃疡患者溃疡边缘未见黏膜微血管（43．67％,76／174）,98例可见规则的血管网（56．33％,98／174）。11例恶性溃疡患者溃疡边缘可见不规则的血管（91．67％,11／12）。良恶性溃疡微血管形态比较差异有显著性（P〈0．01）。结论窄带成像放大内镜对胃良恶性溃疡的鉴别诊断有重要的参考价值。     

电子结肠镜检查回盲部病变12328例分析

目的探讨皖南地区回盲部病变的发病情况及内镜下特点。方法回顾总结分析皖南医学院附属医院内窥镜中心近4年来肠镜检查中发现的回盲部病变发病情况及内镜下特点。结果 2009年9月至2013年6月共行电子结肠镜检查12 328例,发现回盲部病变225例。其中回盲部息肉76例,恶性肿瘤40例,慢性炎症37例,憩室20例,溃疡18例,外压隆起9例,阑尾病变5例,间质瘤4例,克罗恩病3例,肠结核2例,血管病变2例,血吸虫肠病2例,囊肿1例,脂肪瘤1例,未明确诊断的隆起灶5例。在肠镜检查中,回盲部发病率较低,发病率为1.83%,但回盲部病变的种类繁多,总体上以良性病变为主,良性病变占80.00%,恶性病变占17.78%,未明确的隆起病灶占2.22%。良性病变中主要以息肉为主,占良性病变的42.22%;恶性病变主要以腺癌为主,占恶性病变的77.50%。结论常规结肠镜加上病理组织学检查是诊断回盲部病变的主要手段,结合超声肠镜可提高诊断准确率。     

Colonoscopic and histologic features of colonic Crohn's disease in Chinese patients

OBJECTIVE: An attempt was made to provide a better insight into endoscopic and histological features and to enhance the understanding of the diagnostic value of colonoscopy combined with biopsy for colonic Crohn's disease. METHODS: As presented in our 27 cases of colonic Crohn's disease (Crohn's colitis), the endoscopic findings and histological changes of biopsy specimens were analyzed. As collated with correspondent results of biopsy and surgical specimens, the diagnostic accuracy of endoscopy was evaluated. RESULTS: Of these patients, 26 involvements of the colon (often combined with other sites of the bowel) were observed (96.3%). However, involvements limited to the colon alone were seen in only four cases (14.8%). Endoscopically, diverse patterns of multi‐staged‐segmental distributed and multi‐sited inflammatory lesions, both destructive and proliferative/regenerative changes were observed in the bowel of the same patient. The diaganostic accuracy of colonoscopy, as confirmed by the histological examination of biopsy and resected specimens, was 66.7%. The major characteristic features of mucosal biopsy were the focal distribution of inflammatory infiltration and lymphoid aggregate. Otherwise, it may include edematous and widened submucosa, deep fissuring ulcers and hyperplasia, fibrosis and granulomas (detected in 30% of the group), among others. CONCLUSION: The colonic involvement of Crohn's disease was common. Colonoscopy may be valuable in establishing a diagnosis and in assessing the extent and severity of such colonic involvement. Biopsy is helpful to confirm a diagnosis conducted by colonoscopy. Colonoscopy combined with biopsy may replace radiology as the initial test of choice in many clinical situations.     

Endoscopic Surveillance for Cancer in Chronic Ulcerative Colitis

Severe epithelial dysplasia in multiple colonoscopic biopsy specimens may help identify those patients with chronic ulcerating colitis (CUC) at highest risk for developing colonic cancer. This retrospective analysis of 75 patients with longstanding CUC studied by colonoscopy and biopsy disclosed 11 patients with cancer. Four of these cancers were detected by surveillance colonoscopy and seven were detected by diagnostic colonoscopy. There was a high correlation between the presence of dysplasia and cancer in the patients. Cancer was found in five of seven patients who underwent operation after colonoscopic biopsies showed severe dysplasia. No cancers were found at operation in 15 patients whose colonoscopic biopsy specimens were free of dysplasia. Dysplasia can be consistently identified. A reviewing pathologist agreed with the initial biopsy diagnosis in 59 of 64 cases (92%) and with the colectomy diagnosis in 18 of 21 (86%). Colonoscopy with multiple biopsy specimens is a valuable surveillance technic. Patients without dysplasia on biopsy should have continued surveillance.     

The value of fiber gastroscopy and targeted gastrobiopsy in the diagnosis of stomach ulcers and tumors

In 2,000 patients the fiber-gastroscopic and bioptic findings were tested with the help of control examinations, results of operations and course observations. Here the fibergastroscopic diagnosis tumour was confirmed in 89.4%. 13 times a wrong diagnosis of tumour was made. Here different substrates were in question (ventricular ulcers, polypous hyperblastic mucous membrane and others). 11 carcinomas were gastroscopically not recognized as tumour. In 25 cases (20%) of the histological investigation of bioptically taken tissue did not result in a confirmation of the fiber-gastroscopic diagnosis of tumour. But 19 times of them the histology was falsely negative. The supplementation of the gastroscopy by biopsy resulted in a right diagnosis in 93.6%. By control examinations a further increase of the accuracy to 96.8% could be reached.     

纤维结肠镜临床应用10年体会

本文统计了我院１０年间３７２１例纤维结肠镜（下称内镜）检查。于初期采用＂无ｘ线引导内镜检查术＂，近年来对部分病人采用＂单人操作内镜检查＂，其进至盲肠的成功率为９７．４３％。内镜观察并取材活检，提示１８种大肠病变，其诊断率为９９．６８％。对大肠隆起性病变，内镜检查并取材活检可明确诊断。对大肠血管性病变和肝病并门静脉高压所致大肠粘膜充血性改变的诊断为影象学检查所不及。本组１９８例大肠息肉于内镜下高频电凝切除，３８例微波烧灼，均治愈。     

Comparison between stool examination, serology and large bowel biopsy in diagnosing Schistosoma mansoni

This report evaluates the diagnostic method in 167 patients with colonic schistosomiasis. These patients formed a part of a large number of patients who had sigmoidoscopy or colonoscopy for various gastrointestinal problems. During sigmoidoscopy or colonoscopy examination, typical intestinal Schistosomia lesions could be seen and at the same time several biopsies could be taken. Stool examination showed Schistosoma mansoni ova in only 19 patients (11.37%) of the 167 patients whose colonic biopsies were positive for Schistosoma mansoni. Serological tests were carried out in 115 of these patients and 88 patients (52.69%) had a titre of 64 or more. This study shows that endoscopic colonic biopsy is a better method than stool examination and serological tests in the diagnosis of intestinal or hepatosplenic schistosomiasis.     

胃镜普查及随访对老年人胃癌的诊断价值

目的 通过老年人进行胃镜普及及随访,提高老年人胃癌的防治水平。方法 结合每年查体对3048例60－93岁老年人进行胃镜普查,胃镜随访2034例,随访率为66．7％。结果 共检出胃癌92例,检出率为3．0％,其中早期胃癌58例,占63．0％;胃镜随访中检出早期胃癌39例,占随访检出胃癌49例的79．6％。胃癌、早期胃癌的手术切除率为88．9％及100．0％,5年生存率分别为91．9％和96．3％。胃镜检查并发症的发生率为0．097％。结论 开展胃镜普查及随访是提高老年人早期胃癌诊断率及胃癌术后5年生存率的安全可靠方法。     

单克隆抗体74D_(11)、SJA_(111)检测慢性日本血吸虫病循环抗原的研究

本研究用双抗夹心ＥＬＩＳＡ法检测慢性日本血吸虫病人血清循环抗原，观察血吸虫感染家兔血清循环抗原的动态变化。该方法采用兔抗ＡＷＡ－ＩｇＧ作包被抗体，抗日本血吸虫成虫和虫卵单抗ＳＪＡ１１１和７４Ｄ１１组合作Ⅱ抗，１７２例经粪孵毛蚴确诊的血吸虫病人中，１３６例循环抗原阳性（７９．１％），其中轻度（毛蚴数＜５只／２０克粪）、中度（６－２０）、重度（大于２０）感染者循环抗原阳性率分别为７３．４％、８７．７％、９２．８％，检测６５例健康献血员，２０例肺吸虫病人，１２例华支睾吸虫病人，１０倒包虫病人，交叉反应率依次为１．５％、５％、０％、０％，４２例经吡喹酮治疗后的血吸虫病人用该方法复查，治后３月和６月随访粪孵毛蚴阴转者中，循环抗原阴转率分别为７８．０％和９２．１％，考核疗效明显优于检测循环抗体。用单抗ＳＪＡ１１１检测感染家兔循环抗原动态变化，循环抗原于感染后３—４周可检出，７周达高峰，以后逐渐消退，而循环抗体（ＩｇＧ）推迟１周出现，８－９周达高峰。实验结果表明，血吸虫病血清ＣＡｇ阳性率与感染度有关，可在早期检出，检测方法具有较高敏感性和特异性，可用于早期诊断和疗效考核。     

Evaluation of gastric ulcerations

All gastric ulcers diagnosed during the period November, 1969–May, 1974, were prospectively evaluated by roentgenography, fiberoptic gastroscopy, directed biopsy, and brush cytology. Gastroscopy was performed routinely in patients with radiologic diagnosis of gastric ulcer or questionable findings, and in symptomatic individuals with negative roentgenograms. A total of 123/142 ulcers, 109 benign, 14 malignant, were available for complete follow-up. Gastroscopy was correct in 106 of 109 benign ulcers visualized. Roentgenoscopy demonstrated 91 of 109, of which 7 were incorrectly called carcinoma. Gross diagnosis was correct by gastroscopy in 11 of 14 malignant ulcers. Radiology visualized 6 of 14; gross diagnosis was correct in 1 of 6 (5 called benign). Directed gastroscopic biopsy was negative for malignant changes in all 109 benign and 3 of 14 malignant ulcers. Total complete gastroscopic diagnostic failures were 4 of 123, for an overall accuracy of 96.7%. Overall roentgenographic accuracy was 70.8%.     

Comparison of non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer

AIM: To compare the clinicopathological features of patients with non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer.METHODS: All the patients with rectosigmoid carcinoma who underwent laparoscopic radical surgical resection in the Shanghai Minimally Invasive Surgical Center at Ruijin Hospital affiliated to Shanghai Jiao-Tong University between October 2009 and October 2013 were included in this study. Twenty-six cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected. Symptoms, endoscopic findings and clinicopathological characteristics were evaluated retrospectively.RESULTS: There were no significant differences between patients with and without schistosomiasis in gender, age, CEA, CA19-9, preoperative biopsy findings or postoperative pathology. Patients with rectosigmoid schistosomiasis had a significantly higher CA-125 level and a larger proportion of these patients were at an early tumor stage (P = 0.003). Various morphological characteristics of schistosomiasis combined with rectosigmoid cancer could be found by colonoscopic examination: 46% were fungating mass polyps, 23% were congestive and ulcerative polyps, 23% were cauliflower-like masses, 8% were annular masses. Only 27% of the patients were diagnosed with rectal carcinoma preoperatively after the biopsy. Computed tomography (CT) scans showed thickened intestinal walls combined with linear and tram-track calcifications in 26 patients.CONCLUSION: Rectosigmoid carcinoma combined with schistosomiasis is associated with higher CA-125 values and early tumor stages. CA-125 and CT scans have a reasonable sensitivity for the accurate diagnosis.