结肠镜及病理学检查对回盲部病变的鉴别诊断价值

目的探讨结肠镜和病理学检查对回盲部病变的鉴别诊断价值。方法所有患者均进行肠镜检查,采用Olympus CF XQ240型电子肠镜,均检查至回肠末端10～20cm,结合病理检查、临床表现、内镜表现对回盲部病变进行鉴别诊断。结果3127例肠镜检查中,发现回盲部病变253例,占8.1,明确诊断241例,诊断不明者12例,确诊的病例中,主要病变有炎症98例,息肉38例,溃疡性结肠炎37例(多为全结肠累及回盲部),其次为憩室22例和肿瘤22例,结核及Crohn病少见。结论结肠镜及病理学检查对回盲部病变的鉴别诊断具有重要价值,可显著提高其确诊率。     

双气囊推进式电子小肠镜对小肠疾病的诊断应用

目的 评价双气囊推进式小肠镜对小肠疾病的诊断价值。方法 对2003年7月至2004年3月间38例有消化道症状，但是经胃镜、结肠镜、全消化道钡餐、腹部血管造影等检查为阴性者，进行双气囊推进式电子小肠镜检查。根据患者病情决定从上消化道或下消化道插镜，其中8例经上消化道插镜未能到达回盲部者改从下消化道插镜。结果 双气囊推进式小肠镜检查发现有小肠病变33例(检出率86．8％)，其中空回肠克罗恩病7例，空回肠多发溃疡5例，空肠血管畸形并出血4例，空肠多发憩室4例，空回肠静脉显露3例，小肠恶性间质瘤2例，非特异性回肠炎2例，回肠中分化腺癌1例，空肠钩虫病1例，回肠蛔虫病1例，嗜酸细胞性小肠炎1例，吻合口狭窄1例，回肠结核1例。检查过程中未见明显并发症，除2例因腹痛不能耐受而中途放弃外，其余患者均可完成检查。结论 双气囊推进式小肠镜可直视检查全小肠腔内病变，病变检出率高，安全性好，是诊断和治疗小肠疾病的有利工具，但操作难度较高。     

回盲部非特异性溃疡87例回顾性分析

临床上无回盲部非特异性溃疡的诊断,是一种原因不明的以回盲部局限性溃疡为特征的慢性疾病,随着近年来结肠镜及病理检查的推广应用,回盲部非特异性溃疡的检出率得到明显提高。肠镜检查时常发现有个别患者全结肠为正常内镜表现,仅在末端回肠或回盲瓣存在局限性溃疡,从外观看溃疡小,形态较规则,周边黏膜正常或充血水肿,病变肠段蠕动良好,触之质软,镜下为良性溃疡改变,     

回肠末端病变140例临床分析

回肠末端是空回肠病变的好发部位。胶囊内镜及双气囊内镜的临床应用，使小肠疾病诊断水平有了显著提高，但由于检查费时且价昂，普及率低，目前大多数基层医院仍然以结肠镜逆行检查回肠末端，作为诊断回肠末端病变主要手段。我们近几年来通过结肠镜检查回肠末端9326例，发现病变140例，报告如下。     

双气囊内镜和胶囊内镜诊断小肠出血的临床评价

目的评价双气囊内镜和胶囊内镜对小肠出血的临床诊断价值。方法比较双气囊内镜、胶囊内镜及全消化道造影对小肠出血病灶的总体检出率;通过自身对照,比较双气囊内镜和胶囊内镜对小肠出血诊断率;分析胶囊内镜对1次双气囊内镜检查明确诊断率的影响。结果105例小肠出血患者中,双气囊内镜检出克罗恩病24例,腺癌15例,慢性非特异性炎症12例,不明原因小肠溃疡10例,小肠间质肿瘤8例,小肠息肉8例,小肠血管畸形出血6例,钩虫病5例,麦克尔憩室及多发憩室5例,小肠淋巴瘤3例,无明显异常9例,阳性率91．4％（96／105）。其中40例进行胶囊内镜检查,病变检出率75．0％（30／40）;75例患者全消化道造影检查,病变检出率33．3％（25／75）。根据胶囊内镜结果1次双气囊内镜检查明确诊断率90．0％（36／40）,而根据临床特征及消化道造影结果1次双气囊内镜检查明确诊断率69．2％（45／65）。结论小肠疾病的主要病因是小肠良性溃疡（包括克罗恩病）、肿瘤、慢性炎症,其次是息肉、血管畸形、寄生虫感染、麦克尔憩室及淋巴瘤等。双气囊内镜对小肠出血诊断率高于胶囊内镜,胶囊内镜能提高1次双气囊内镜明确诊断率。     

推进式双气囊电子小肠镜对不明原因小肠出血的病因诊断

目的通过对不明原因消化道出血患者行双气囊电子小肠镜检查，评价双气囊电子小肠镜对小肠出血的诊断价值。方法2003年4月至11月，对34例疑为小肠出血患者行推进式双气囊电子小肠镜检查，结合手术和病理做出病因诊断。结果在34例患者中30例发现病灶，检查总体阳性率为88．2％。4例阴性患者中，1例内镜抵达空肠中段，3例抵达回肠中下段。30例阳性患者中，血管病变7例(占20．6％，位于空肠1例，空回肠3例，回肠3例)；小肠肿瘤11例(占32．4％，均经手术及病理证实，位于十二指肠2例，空肠5例，回肠4例。肿瘤性质分别为：间质肿瘤3例，脂肪瘤1例，平滑肌瘤2例，血管瘤2例，嗜铬细胞瘤1例，Kaposi型血管内皮瘤1例，腺癌1例)；克罗恩病4例(占11．8％，位于空回肠部)；其他8例。结论小肠血管病变、小肠肿瘤及小肠克罗恩病为不明原因小肠出血最常见病因；推进式双气囊电子小肠镜是一项安全、直观、可靠、有效的检查手段，对不明原因小肠出血具有较高临床诊断价值。     

胶囊内镜与双气囊内镜诊断小肠疾病的比较

目的比较胶囊内镜和双气囊内镜对小肠疾病的检出率和诊断准确性，探讨其联合应用的临床意义。方法对116例不明原因消化道出血和102例不明原因腹痛或腹泻患者，共218例进行内镜检查。其中165例首选胶囊内镜，53例首选双气囊内镜。对胶囊内镜检查阴性或可疑病变者建议双气囊内镜检查，反之亦然。比较两种检查方法对小肠疾病的检出率、诊断率以及患者依从性、不良反应发生率等。结果1例胶囊内镜和2例双气囊内镜操作失败。51例患者行64次双气囊内镜检查，其中34例经口、4例经肛检查，13例分别接受经口和经肛检查。胶囊内镜对小肠病变的总检出率及对不明原因消化道出血的小肠疾病检出率（72．0％和88．0％），均明显高于双气囊内镜（41．2％和60．0％），诊断率也高于后者（51．8％和39．2％）。5例胶囊内镜检查阴性再经双气囊内镜检查者中，1例发现病灶；15例胶囊内镜检查怀疑小肠病变者中，12例经双气囊内镜结合活检病理确诊。而3例双气囊内镜未发现异常者再经胶囊内镜检查发现小肠病变。所有患者均未发生严重不良反应。结论胶囊内镜对小肠疾病检出率高，可作为怀疑小肠疾病，尤其是不明原因消化道出血的首选检查方法；双气囊内镜在胶囊内镜检查阴性者中仍可发现部分病灶，并能明确多数胶囊内镜下可疑病变，可作为胶囊内镜检查后的补充检测手段。     

回肠末端溃疡性病变临床特点分析

回肠末端指回盲瓣至回肠肛侧约30 cm的部分,它是小肠病变多发部位,随着结肠镜插镜技术的提高以及双气囊小肠镜的应用,其病变检出率不断提高.发生在回肠末端的溃疡性病变,如克罗恩病、肠结核、淋巴瘤等,其内镜下表现及临床特点相似,容易误诊.本文对55例回肠末端溃疡患者的临床特点、内镜下表现及诊治情况进行总结分析.     

小肠腔内超声在小肠疾病诊断中的初步应用研究

目的 研究小肠腔内超声(ISIU)对小肠正常组织的影像学表现及对小肠病变的诊断价值.方法 对2011年12月至2012年12月经胶囊内镜、胃镜、结肠镜及双气囊小肠镜检查中筛选出的50例患者,行小肠腔内超声检查,观察其正常组织结构及病变小肠的超声内镜学表现.发现小肠病变者加行经腹超声(US)及螺旋CT(SCT)检查,研究ISIU对小肠正常组织及部分病变的临床诊断价值.结果 50例入选患者中,完成ISIU检查共47例,其中发现小肠病变10例.所发现病变中,ISIU诊断出全部病例,US、SCT分别诊断出1例和3例.经ISIU观察正常小肠肠壁图像可分6层,但空肠与回肠在ISIU下表现不完全相同,各有其特点.结论 ISIU可提供高分辨率的正常小肠壁结构的各层次图像,并可对病变的来源及内部回声进行清晰的观察,从而有助于提高小肠疾病的诊断率.     

结肠镜常规检查回肠1340例

目的:评价经结肠镜常规检查回肠的临床价值,提高对回肠疾病的诊断与治疗水平. 方法:结肠镜到达回盲部后采用直接进入法、钩拉进入法、导丝引导进入法插镜至回肠20-70 cm,观察回肠黏膜病变. 结果:1 340例患者1 240例成功插入回肠,成功率为925%, 244例发现了病变,总阳性率为19.7%. 结论:在小肠镜还未推广使用的情况下,结肠镜常规深插对发现回肠末端疾病很有意义.     

Cecal intubation rate with the double-balloon endoscope after incomplete conventional colonoscopy: A study in 45 patients

Background and Aim:  Conventional colonoscopy is the gold standard for colorectal cancer screening. However, a failure rate to complete conventional colonoscopy of more than 10% is reported in the literature. We evaluated whether the therapeutic Fujinon double-balloon endoscope EN-450T5/20 is a valuable tool to intubate the cecum and to carry out all conventional endoscopic procedures after incomplete conventional colonoscopy.
Methods:  Forty-five consecutive patients with prior incomplete conventional colonoscopy were prospectively enrolled. All but three procedures were carried out under conscious sedation with the patient in the left lateral decubitus position without fluoroscopic guidance.
Results:  The cecum was reached in 42 of 45 patients (93%) and in 62% additional therapeutic interventions were carried out. Double-balloon colonoscopy required less conscious sedation compared to conventional colonoscopy. No external abdominal compression nor fluoroscopic control was used. The insertion depth of the double-balloon endoscope did not exceed the working length of a conventional colonoscope.
Conclusions:  The present study illustrates that the concept of double-balloon endoscopy is a valuable alternative to reach the cecum after prior incomplete conventional colonoscopy, especially due to redundant colon and colonic loop formation. The procedure requires less conscious sedation and no fluoroscopic control, but allows all conventional endoscopic interventions.     

Outcomes of endoscopy in patients with iron deficiency anemia after Billroth II partial gastrectomy

GOALS: To determine the frequency of gastrointestinal lesions detected by upper endoscopy and colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. STUDY: The authors reviewed the medical records of 116 consecutive patients with a Billroth II partial gastrectomy and 232 age- and gender-matched controls without gastric surgery who were referred for endoscopy to evaluate iron deficiency anemia over a 5-year period. RESULTS: Clinically important lesions were detected in 22.4% of the patients with gastric surgery and in 59.5% of those with intact stomachs (p < 0.001). In the gastric surgery group, clinically important lesions were found more often in the upper gastrointestinal tract than in the colon (19.0% vs. 3.4%, p < 0.001). In the nonsurgical group, the diagnostic yields of upper endoscopy and colonoscopy were not significantly different (38.4% vs. 32.8%, p = 0.24). Synchronous lesions in the upper and lower gastrointestinal tract were significantly less common in the group of patients with gastric surgery compared with those without gastric surgery (0.0% vs. 11.6%, p < 0.001). Small bowel biopsies and small bowel follow-through did not identify any additional lesions. In the gastric surgery group, multivariate analysis identified abdominal symptoms (OR = 11.2, 95% CI 3.2-39.2, p < 0.001), a positive result on fecal occult blood testing (OR = 6.4, 95% CI 2.0-20.3, p = 0.002), and Billroth II surgery at least 10 years before evaluation (OR = 5.4, 95% CI 1.7-16.7, p = 0.004) as independent predictors of identifying a clinically important lesion by endoscopy. CONCLUSIONS: Upper endoscopy had a significantly higher diagnostic yield than colonoscopy in patients who developed iron deficiency anemia after Billroth II surgery. Prospective studies are necessary to determine the role and cost-effectiveness of colonoscopy in the evaluation of iron deficiency anemia in this patient population.     

Initial experiences using endoscopic papillotomy and bile duct drainage in patients with Billroth II gastrectomy

First results of endoscopic papillotomy and biliary drainage in patients with Billroth II gastrectomy are presented. For endoscopic papillotomy and removal of gall stones a home-made papillotomy and a side viewing endoscopy were used. The technique for biliary drainage in patients with Billroth II gastrectomy and normal stomach is identical.     

晚期壶腹周围癌的胆胰管双支架治疗

目的探讨晚期壶腹周围癌患者胆管和胰管双支架治疗的临床价值。方法36例经病理学和（或）临床诊断为晚期壶腹周围癌患者,影像学表现为胰管和胆管均有狭窄,经内镜先在胰管内置入Teflon塑料支架,然后胆道内置可膨胀式金属支架,不成功者改经皮经肝胆管内置入金属支架进行引流。观察支架置放前后患者的血清肝生化指标、胰酶水平和临床表现。结果36例置入胰管塑料支架均顺利,29例内镜置人金属胆道支架成功,7例（2例Billroth1I术后）因导丝插入胆管困难改为经皮经肝胆管内支架置入。支架置放后肝ALT、AST、ALP、r-谷氨酰转肽酶以及总胆红素、直接胆红素均有明显的下降;15例出现血淀粉酶和血脂肪酶的升高,但经过治疗后均恢复正常;腹痛缓解率82．4％（28／34）,腹泻改善有效率达88．2％（15／17）。结论胆、胰管联合支架可以解除壶腹周围癌患者的胆、胰管恶性狭窄与梗阻,安全有效。     

双通道直视胃镜治疗毕Ⅱ式胃大部切除术后低位胆道梗阻的疗效评价

目的探讨双通道直视胃镜诊治毕Ⅱ式胃大部切除术后低位胆道梗阻的疗效及安全性。方法对18例毕Ⅱ式胃大部切除术后低位胆道梗阻患者行双通道直视胃镜下检查和治疗,记录手术过程和治疗结局,并评价疗效和安全性。结果13例经双通道直视胃镜成功造影并经十二指肠镜成功取石或置入支架,成功率达72％（13／18）;失败5例,改行外科手术或经皮经肝胆道引流。内镜术后出现迟发性出血1例、胰腺炎2例,经对症治疗后均好转。结论对于毕Ⅱ式胃大部切除术后的低位胆道梗阻,双通道胃镜直视下治疗安全有效。     

Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)in patients with Billroth Ⅱ gastrectomy has been considered a challenging procedure due to the surgically altered gastrointestinal anatomy.However,there has been a paucity of comparative studies regarding ERCP in Billroth Ⅱ gastrectomy cases because of procedure-related morbidity and mortality and practical and ethical limitations.This systematic and comprehensive review was performed to obtain a recent perspective on ERCP in Billroth Ⅱ gastrectomy patients.AIM To systematically review the literature regarding ERCP in Billroth Ⅱ gastrectomy patients.METHODS A systematic review was performed on the literature published between May 1975 and January 2019.The following electronic databases were searched:PubMed,EMBASE,and Cochrane Library.The outcomes of successful afferent loop intubation and successful selective cannulation and occurrence of adverse events were assessed.RESULTS A total of 43 studies involving 2669 patients were included.The study designs were 36(83.7%)retrospective cohort studies,4(9.3%)retrospective comparative studies,2(4.7%)prospective comparative studies,and 1(2.3%)prospective cohort study.Of a total of 2669 patients,there were 1432 cases(55.6%)of sideviewing endoscopy,664(25.8%)cases of forward-viewing endoscopy,171(6.6%)cases of balloon-assisted enteroscopy,169(6.6%)cases of anterior obliqueviewing endoscopy,64(2.5%)cases of dual-lumen endoscopy,31(1.2%)cases of colonoscopy,and 14(0.5%)cases of multiple bending endoscopy.The overall success rate of afferent loop intubation was 91.3%(2437/2669),and the overall success rate of selective cannulation was 87.9%(2346/2437).A total of 195 cases(7.3%)of adverse events occurred.The success rates of afferent loop intubation and the selective cannulation rate for each type of endoscopy were as follows:side-viewing endoscopy 98.2%and 95.3%;forward-viewing endoscopy 97.4%and 95.2%;balloon-assisted enteroscopy 95.4%and 97.5%;oblique-viewing endoscopy 94.1%and 97.5%;and dual-lumen endoscopy 82.8%and 100%,respectively.The rate of bowel perforation was slightly higher in side-viewing endoscopy(3.6%)and balloon-assisted enteroscopy(4.1%)compared with forward-viewing endoscopy(1.7%)and anterior oblique-viewing endoscopy(1.2%).Mortality only occurred in side-viewing endoscopy(n=9,0.6%).CONCLUSION The performance of ERCP in the Billroth Ⅱ gastrectomy population has been improving with choice of various type of endoscope and sphincter management.More comparative studies are needed to determine the optimal strategy to perform safe and effective ERCP in Billroth Ⅱ gastrectomy patients.     

Billroth Ⅱ式胃切除术后患者ERCP诊治

目的 总结BillrothⅡ式胃切除术后患者进行ERCP诊治的经验,对其手术操作的成功率、安全性和有效性进行评估.方法 回顾性分析2007年1月至2009年11月间,75例BillrothⅡ式术后因胆道疾患接受ERCP诊治患者的临床资料.结果 75例患者中,顺利进入空肠输入襻69例（92%）,其中选择性胆道插管成功68例,3例行诊断性胆道造影检查,65例为治疗性操作.后者中16例行EST＋取石＋鼻胆管引流术,19例行塑料支架胆管引流术,18例金属支架胆管引流术,12例内镜下球囊扩张术＋取石＋鼻胆管引流术.1例患者因空肠输入襻穿孔（1.3%）急诊行手术治疗,2例（2.6%）并发术后急性胰腺炎,经保守治疗痊愈,无出血相关并发症.结论 对于BillrothⅡ式术后患有胆道疾病的患者,进行ERCP诊治是安全、可行的.     

Utility of single and double balloon endoscopy in patients with difficult colonoscopy: A randomized controlled trial

AIM: To compare the utility of single-balloon colonoscopy (SBC) or double-balloon colonoscopy (DBC) for difficult colonoscopies. METHODS: Between August 2008 and June 2010, patients in whom total colonoscopy failed within 30 min of insertion were assigned randomly to undergo either SBC or DBC. No sedatives were used. After the endoscopy, all patients were asked to evaluate pain during the procedure on a 10-point analog scale (1 = no pain; 10 = worst imaginable pain) with a questionnaire. The study outcomes were the cecal intubation rate and time, endoscopic findings, complications, and pain score. RESULTS: The SBC and DBC groups included 11 and 10 patients, respectively. All but one SBC patient achieved total colonoscopy successfully. The cecal intubation times were 18 min (range: 10-85 min) and 12.8 min (range: 9.5-42 min) in the SBC and DBC groups, respectively (P= 0.17). No difference was observed in the prevalence of colon polyps between the SBC and DBC groups (45% vs 30%, P = 0.66). SBC showed advanced colon cancer in the ascending colon, which was inaccessible using conventional colonoscopy. The respective pain scores were 5 (1-10) [median (range)] and 5 (1-6) in the SBC and DBC groups (P = 0.64). No complications were noted in any patient. CONCLUSION: The utility of singleand double-balloon endoscopy for colonoscopy seems comparable in patients with incomplete colonoscopy using a conventional colonoscope.     

Postprandial Plasma Cholecystokinin Response in Patients after Gastrectomy and Pancreatoduodenectomy

Endogenous cholecystokinin release after a test meal was measured in the controls, patients with Billroth I and II anastomosis after subtotal gastrectomy, patients with a Roux-en-Y anastomosis after total gastrectomy, and patients with a modified Child's reconstruction after pancreatoduodenectomy 2 months after surgery. The postprandial plasma level in patients with Billroth I and II anastomosis was close to that in the controls. In a Roux-en-Y anastomosis, this level was slightly higher than in the controls and patients with a Billroth anastomosis. Differences in integrated cholecystokinin secretion at 120 min in different groups were insignificant. After a modified Child's reconstruction, the postprandial level was significantly lower than in the controls and in patients with a Billroth II anastomosis. One patient with a modified Child's reconstruction was examined 8 yr after surgery, and she had a normal response. We suggest that either the duodenum or jejunum used for gastrointestinal anastomosis can release cholecystokinin normally, and pancreatoduodenectomy may decrease cholecystokinin release 2 months after surgery.