染色放大内镜下大肠黏膜表面微细结构改变及其临床病理意义

目的通过染色放大内镜观察不同大肠黏膜病变的Pitpattern形态,探讨其在早期大肠癌诊断中的应用价值。方法应用染色放大内镜对146例患者的大肠黏膜进行细微结构形态学观察,并与观察部位活检所得的病理组织学改变进行比较分析。结果 146例患者中放大内镜检出息肉172枚,经0.2%的靛胭脂染色放大后又发现0.1～0.5cm大小的息肉84枚,共计息肉样病变256枚。染色放大内镜可明显提高息肉病变的检出率。各种腺管开口分型的病理诊断结果构成差异有显著性,Ⅰ～Ⅴ分型与病变严重程度之间呈明显正相关。染色放大内镜对大肠肿瘤性病变诊断符合率89.5%、敏感性82.2%、特异性92.3%,放大内镜诊断符合率71.5%、敏感性61.8%、特异性77.9%,染色放大内镜对大肠肿瘤性疾病诊断与放大内镜相比差异具有统计学意义（P〈0.01）。结论染色放大内镜对大肠肿瘤的诊断优于放大内镜,能够提高大肠癌的早期诊断率,从而为大肠癌及其癌前病变的内镜下正确处理提供快速而准确的依据。     

胶囊内镜和CT仿真内镜诊断小肠疾病的对照研究

目的评价胶囊内镜和cT仿真内镜（CTVE）在小肠病变诊断方面的临床应用价值。方法回顾性总结3l例临床怀疑小肠疾病行胶囊内镜和CTVE检查患者的临床资料,参照最终诊断结果（手术病例以病理诊断为金标准,非手术病例依据后续检查及随访结果给出最终诊断）统计胶囊内镜、CTVE以及二者联合的诊断阳性率并行对比分析。结果最终诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例,阴性5例。胶囊内镜诊断阳性24例,包括小肠肿瘤性病变14例（其中2例定位不准确,7例不能定性）和非肿瘤性病变10例;CTVE诊断阳性17例,包括小肠肿瘤性病变14例（其中1例定位不准确,4例不能定性）和非肿瘤性病变3例;胶囊内镜联合CTVE诊断阳性26例,包括小肠肿瘤性病变16例、非肿瘤性病变10例。对于小肠肿瘤性病变,胶囊内镜和CTVE诊断阳性率相同,均为87．5％（14／16）;而在总体诊断阳性率方面,胶囊内镜为77．4％（24／31）,CTVE为54．8％（17／31）,胶囊内镜联合CT仿真内镜为83．9％（26／31）,二者联合总体诊断阳性率明显高于CTVE（P=0．004）,但与胶囊内镜比较差异无统计学意义（P〉0．05）,胶囊内镜与CTVE比较差异也无统计学意义（P=0．065）。结论胶囊内镜和CTVE均有助于小肠疾病的诊断,胶囊内镜在诊断小肠非肿瘤性病变方面更有优势,而CTVE在判断小肠肿瘤性病变的位置和结构方面优于胶囊内镜,二者联合使用可进一步提高检出小肠疾病的能力。     

64层螺旋CT仿真内镜对老年大肠癌的诊断价值

目的 评价64层螺旋CT仿真内镜(CTVE)在老年人大肠癌诊断中的临床应用价值.方法 对纤维结肠镜和钡灌肠诊断为大肠癌的患者行CTVE检查,评价CTVE对老年人大肠癌的检出情况及患者的耐受性.结果 CTVE成功检出56例患者的大肠癌,准确性100%,并且有助于对肿瘤的浸润情况和肠外转移进行全面评估.患者对CTVE的耐受性明显高于纤维结肠镜和钡灌肠检查.56例行CTVE、纤维结肠镜和钡灌肠检查的患者耐受性分别为89.3%、62.5%和56.7%.结论 CTVE技术在老年大肠癌的诊断中是安全有效,是纤维结肠镜的重要补充手段.     

双气囊内镜对小肠疾病的诊断及治疗

目的 评价双气囊内镜(DBE)对小肠疾病的诊断和治疗价值及其检查的安全性.方法 2005年12月～2007年7月,我院对37例疑诊小肠疾病的患者行DBE检查,其中不明原因消化道出血25例.结果 37例患者发现病灶29例,病灶包括小肠肿瘤、炎症性肠病、小肠血管畸形、小肠憩室和小肠重复畸形等.其中24例经病检、手术或治疗效果确诊,准确性为95.8%.1例并发急性胰腺炎.结论 DBE对小肠疾病的检出率高,并可开展内镜下治疗,具有较高的临床应用价值.     

超声内镜与CT仿真内镜对上消化道隆起样病变的诊断价值

目的 研究超声内镜(EUS)与CT仿真内镜(CTVE)对上消化道隆起样病变的诊断价值。方法 48例经胃镜检查发现有上消化道隆起样病变的患者(食管癌、胃癌、息肉等病例除外)，行CTVE和EUS检查，除9例检查发现为正常脏器外压、2例食管静脉瘤而密切随访观察外，其余均经手术或活检获取病理确诊。将以上三种方法诊断结果与病理结果进行比较。结果 胃镜、EUS、CTVE对上消化道隆起样病变的诊断准确率分别为16．7％、89．6％、66．7％，EUS、CTVE与胃镜检查结果差异有显著性(P＜0．001)；EUS、CTVE两者之间比较差异有显著性(P＜0．05)，EUS优于CTVE；EUS、CTVE对上述疾病的诊断的敏感性、特异性分别为89．7％、88．9％和66．7％、66.7％。结论 EUS和CTVE作为新兴的检查手段在对上消化道隆起样病变的诊断中有较高的临床实用价值，且两者有较强的互补性，可作为胃镜较难诊断的上消化道隆起样病变的确诊方法之一。     

内镜下氩等离子凝固术治疗肠癌前病变的临床研究

目的 评价内镜下氩等离子凝固术(APC)治疗肠癌前病变-肠息肉及腺瘤的价值及安全性.方法 2004年4月～2007年12月.对17例肠息肉和腺瘤的患者先行内镜检查和病理组织学检查.之后予以内镜下氩等离子凝固术治疗.所有病例治疗六月后进行临床随访、内镜及病理组织学复查.结果 16例(94%)患者临床症状消失,复查内镜病灶消失,复查病理组织学检查示正常黏膜.1例(6%)患者临床症状减轻,复查内镜仍见腺瘤残留,再次行APC治疗后病灶明显缩小.结论 APC为经内镜非接触性治疗肠癌前病变的新方法,治疗肠癌前病变方便、快捷、安全、疗效可.     

CT仿真内镜对小肠病变的诊断价值

目的 探讨小肠CT仿真内镜(CTVE)对小肠病变的诊断价值.方法 应用GE Lightspeed pro 16或V64型螺旋CT扫描机对全腹行薄层容积扫描,并同时进行螺旋CT增强扫描,应用GE公司的图像分析软件中的Navigator软件包进行影像后处理,形成小肠三维重建图像,结合轴位、冠状位及矢状位图像,做出诊断.共对46例疑有小肠疾病的患者进行CTVE检查.结果 46例患者中CTVE检出小肠病变27例,其中间质瘤10例,恶性间质瘤1例,血管病变1例,血管脂肪瘤3例,结石2例,淋巴瘤1例,黏膜水肿、糜烂1例,肠腔狭窄1例,假性梗阻1例,憩室2例,息肉3例,克罗恩病1例;检查结果为正常小肠7例,以上均经手术或双气囊内镜检查证实;另有12例病变CTVE未能检出.CTVE的诊断正确率73.9%(34/46),对占位性病变的诊断正确率为90.9%(20/22).结论 小肠CTVE是安全、无创性检查小肠病变的有效方法,可适用于那些不能耐受小肠镜的患者,有较好的应用前景.     

OMOM胶囊内镜在胃肠道疾病诊治中的应用

目的评价胶囊内镜对胃肠道疾病的诊断价值。方法对24例诊断不明的胃肠道疾病患者进行胶囊内镜检查。结果24例患者检查过程中均无任何不适。共检出病变19例，包括糜烂性胃炎2例，十二指肠炎2例，克罗恩病5例，小肠血管畸形7例，小肠息肉1例，小肠黏膜下占位1例（手术及病理证实为小肠肿瘤），升结肠憩室1例。余未见异常。阳性检出率79．2％。结论胶囊内镜检查操作简单、安全、有效，对消化道疾病尤其是小肠疾病有较高的诊断价值。     

内镜超声诊断胃肠道黏膜及黏膜下隆起性病变432例

目的:探讨内镜超声(EUS)对胃肠道黏膜及黏膜下隆起性病变诊断的价值,分析胃肠道黏膜及黏膜下隆起性病变与术后临床病理诊断符合率.方法:回顾性分析胃肠道黏膜及黏膜下隆起性病变的临床资料.3100例患者术前行EUS检查,其中432例进行内镜下活检、息肉摘除术、EMR或ESD等治疗,术后将切除标本送病理.再将病理结果与术前内...     

大肠腺癌内镜与病理检查对照分析

目的探讨大肠腺癌的临床、病理学特征及内镜对大肠腺癌的诊断意义。方法回顾分析182例经内镜检查诊断为大肠腺癌的临床资料及其病理诊断结果,分析内镜征象的病理基础。结果病理回报腺癌118例,黏液腺癌20例,印戒细胞癌15例,鳞癌17例,类癌6例,息肉6例。内镜对大肠腺癌诊断符合率为100%;镜下腺癌的主要征象对病理的诊断敏感性86.8%。结论内镜下腺癌的典型性征象对大肠腺癌的诊断敏感性较高。     

Endoscopic and biopsy diagnoses of superficial,nonampullary, duodenal adenocarcinomas

AIM: To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors(NADETs).METHODS:Clinicopathological data were reviewed for84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September2002 and August 2014 at a single prefectural cancer center.Superficial NADETs were defined as lesions confined to the mucosa or submucosa.Demographic and clinicopathological data were retrieved from charts,endoscopic and pathologic reports.Endoscopic reports included endoscopic diagnosis,location,gross type,diameter,color,and presence or absence of biopsy.Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained.Endoscopic images were obtained using routine,front-view,high-resolution video endoscopy,and chromoendoscopy with indigocarmine was performed for all lesions.Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma.Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens.Sensitivity,specificity,and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis.RESULTS:The majority(81%)of the lesions were located in the second portion of the duodenum.The median lesion diameter was 14.5 mm according to final histology.Surgery was performed for 49 lesions from 39 patients,and 35 lesions from 35 patients were endoscopically resected.Final histology confirmed 65carcinomas,15 adenomas,and 3 hyperplasias.A finaldiagnosis of duodenal carcinoma was made for 91%(52/57)of the lesions diagnosed as carcinoma by endoscopy and 93%(42/45)of the lesions diagnosed as carcinoma by biopsy.The sensitivity,specificity,and accuracy of endoscopic diagnoses were 80%,72%,and 78%,respectively,whereas those of biopsy diagnoses were 72%,80%,and 74%,respectively.Preoperative diagnoses of carcinomas were made in88%(57/65)of the carcinoma lesions via endoscopy or biopsy.Endoscopic findings associated with carcinoma were red color,depression,and mixed-type morphology.CONCLUSION:Preoperative endoscopy and biopsy showed similar accuracies in the diagnosis of carcinoma in patients with superficial NADETs.     

Perioperative endoscopy of the whole small bowel in Crohn's disease.

The aim of this study was to search for small bowel lesions by means of a perioperative endoscopy in 20 patients operated on for Crohn's disease. Seven women and 13 men (mean age 29 years) had a total retrograde exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endoscopic exploration was completed, through an enterotomy, from the surgical area to the angle of Treitz. Periendoscopic biopsy samples were taken on macroscopic lesions and every 20 cm systematically. In 13 of 20 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulcerations (seven patients), mucosal oedema (three patients), non-ulcerative stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenosis (one patient). In seven patients none of the lesions detected at perioperative endoscopy had been recognised by preoperative evaluation or surgical inspection of the serosal surface. A typical granuloma was found at biopsy of lesions identified by endoscopy in three cases and at biopsy of an apparently healthy area in one case. Thus 65% of patients operated on for Crohn's disease had lesions of the small intestine detected by endoscopy, which were unrecognised before surgery in more than half of the cases.     

Intraoperative endoscopy to identify lesions

Intraoperative endoscopy is an important adjunct to surgical therapeutics. Endoscopy can improve the efficiency of operative interventions by localizing lesions and defining the extent of pathology. Different techniques can be employed to facilitate intraoperative endoscopy including sterile scope and nonsterile scope methods. Lesion marking can be accomplished using endoscopic or endoscopically guided surgical means. Air insufflation can often be utilized for easily accessible regions of the gastrointestinal tract (esophagus, stomach, rectum, and distal sigmoid colon). Carbon dioxide insufflation is most useful for extended procedures and accessing more difficult locations of the gastrointestinal tract. Commonly lesions identified endoscopically for surgical resection include gastric ulcers and tumors, small bowel lesions, and colon pathology.     

放大内镜在胃部疾病诊断中的应用

放大内镜在消化道疾病尤其胃癌及癌前病变的诊断方面有着独特优势,并能指导活检,避免不必要的活检创伤,有着普通内镜所不能比拟的优势.本文对近年来放大内镜在胃部疾患的应用进展作一综述,同时结合临床操作体会,总结放大内镜的操作要领.     

Gastrointestinal endoscopy in octagenarians

Seventy-five patients, 80-90 years old, each having approximately three associated diseases, underwent a total of 104 gastrointestinal endoscopies. Of these, 73 were upper (29 emergencies) and 31 lower endoscopies (21 were rigid sigmoidoscopies). There were two very mild short-lived complications; vomiting and bleeding. We found 16 gastric ulcers, 16 duodenal or pyloric ulcers, and 11 cases of esophagitis. Bleeding duodenal (8) or gastric (4) ulcers and polyps or malignant tumors (7) were seen less often. In 34 of 68 lesions the endoscopic and x-ray findings were the same. In the other 34 there were 10 endoscopic failures to identify colonic diverticula, hiatus hernia, and gastroesophageal reflux that were seen radiologically. In 24 patients, diagnoses were not made radiologically, but were recognized at endoscopy. The safety and accuracy of endoscopy in the old and sick does not differ from that in younger patients.     

Miniprobe sonography in the evaluation of 169 patients with gastrointestinal disease

OBJECTIVE : It is still difficult to precisely differentiate elevated lesions of the gastrointestinal mucosa or estimate the depth of malignant lesions by using conventional endoscopy and biopsy. The aim of the present study was to assess the clinical value of miniprobe sonography (MPS). METHODS : A total of 169 patients (including 83 patients who underwent endoscopic treatment or surgery) with gastrointestinal disease were examined by using MPS in conjunction with endoscopic examination. The diagnosis according to MPS was compared with macroscopic findings, endoscopic biopsy and surgical results. RESULTS : In the case of elevated lesions of the gastrointestinal mucosa with negative biopsies, compared with surgical findings, the diagnostic accuracy of MPS was 98.3% (115/117). In the case of malignant lesions, MPS findings with regard to the lesion depth were 100% in agreement with those from surgical biopsy (31/31). CONCLUSION : The MPS technique is significantly superior to conventional endoscopy with pathological biopsy in the differentiation of elevated lesions of the gastrointestinal mucosa and thus has important clinical value. But in the case of malignant lesions, only the depth of infiltration into the gastrointestinal wall can be correctly assessed by MPS, so its value is limited in the identification of lymph nodes and distal metastases.     

Age is not a discriminating factor for outcomes of therapeutic upper gastrointestinal endoscopy

BACKGROUND/AIMS: To compare the efficacy and complications of therapeutic endoscopy for acute nonvariceal upper gastrointestinal bleeding between the geriatric (aged 65 and older) and non-geriatric patients. METHODOLOGY: A total of 134 out of 259 hospitalized patients in the year 2005 had high-risk endoscopic lesions in UGI endoscopy and received therapeutic endoscopy. Seventy-six out of 134 patients were aged 65 and older (44 men), while 58 patients were aged 64 and younger (51 men). We compared clinical presentations, co-morbidities, endoscopic therapeutic procedures, endoscopic treatment failure, hospitalization days, blood transfusion, post-endoscopy complications (fever, acute coronary syndrome, aspiration pneumonia), and in-hospital mortality after therapeutic endoscopy. RESULTS: Geriatric patients had lower hemoglobin on arrival (9.19 +/- 2.7 vs. 10.64 +/- 2.46 g/dL, p = 0.002) and larger gastric ulcers (7.3 +/- 6.9 vs. 4.0 +/- 3.6 mm, p = 0.008). Failure of therapeutic endoscopy, defined as salvage endoscopy or surgery within 48 hours after first endoscopy, showed no difference (14% vs. 14%, p = 0.98). Hospitalization stay (mean 7.47 vs. 5.97 days, p = 0.2), blood transfusion more than 4 units (47% vs. 34%, p = 0.13), post-endoscopic complications, in-hospital mortality were all comparable between geriatrics and non-geriatrics. CONCLUSIONS: Our results serve a scientific basis that age is not a discriminating factor for outcomes in current therapeutic endoscopy.     

胶囊内镜对消化道疾病的诊断价值

目的探讨胶囊内镜对消化道疾病,特别是小肠疾病的诊断价值。方法 2007年6月至2010年4月间,对180例患者(其中不明原因消化道出血58例,慢性腹痛88例,慢性腹胀27例,慢性腹泻7例)行OMOM胶囊内镜检查,并对其结果进行回顾性分析。结果所有病人检查无不适感,180例患者中177例(98.3%)完成胶囊内镜检查,139例(77.2%)发现阳性病变;58例不明原因消化道出血者中42例(72.4%)为小肠病变;88例慢性腹痛者中43例(48.9%)为单纯小肠病变,6例(6.8%)为单纯食管或胃部病变,1例(1.1%)为单纯结肠病变,18例(20.5%)同时存在小肠病变和胃部病变,1例(1.1%)同时存在胃部病变和结肠病变;27例腹胀者中3例(11.1%)为单纯小肠病变,18例(66.7%)为单纯食管或胃部病变,2例(7.4%)同时存在小肠病变和胃部病变,2例(7.4%)同时存在胃部病变和结肠病变;7例慢性腹泻者中3例(42.9%)为小肠病变。3例(1.7%)发生胶囊滞留。结论胶囊内镜在消化道疾病尤其是小肠疾病的诊断中有较高价值,临床安全性好。