内镜下氩离子凝固术联合埃索美拉唑治疗Barrett食管疗效分析

目的:探讨内镜下氩离子凝固术(APC)联合埃索美拉唑治疗对Barrett食管(BE)的临床疗效.方法:选择经内镜及病理证实的52例BE患者,在内镜下行APC损毁化生黏膜治疗,再给予埃索美拉唑抑酸40 mg/d口服8周.术后进行内镜、病理随访12个月.结果:52例均完成治疗,其中需要1次治疗者40例,2次者10例,3次者2例.49例达到完全的鳞状上皮再生(94.2%),3例再生的鳞状上皮间混有岛状的柱状上皮(5.8%).12个月后共有5例出现内镜下可见的复发.结论:内镜下APC联合埃索美拉唑治疗BE简单、安全、有效,但有一定比例的残留和复发.     

氩离子凝固术治疗Barrett食管67例临床分析

目的 评价内镜下氩离子凝固术(APC)对Barrett食管(BE)的疗效及安全性.方法 内镜下对67例BE施行APC治疗,通常全周型以间隔1周分2～3次治疗,舌型以1次或间隔1周分2次治疗,岛型1次治疗.术后口服质子泵抑制剂奥美拉唑片,治疗时间最少2个月或至反流症状消失.观察疗效及并发症.末次APC治疗后1个月行内镜检查,其后每隔3个月进行一次内镜随访,随访时间持续1年.结果 末次治疗后1个月行内镜检查61例患者BE完全消除(91.0%),无严重并发症发生.随访1年,11例再次发现柱状上皮.结论 APC对BE的治疗安全有效,其长期效果需要大样本试验观察.     

内镜下氩离子凝固术治疗食管上段胃粘膜异位的护理

食管上段胃粘膜异位（heterotopic gastric mucosa in upper esophagus，HGMUE）是胚胎发育时期鳞状上皮不完全取代柱状上皮形成的先天性残余病变。患者多无临床症状，但也可以出现胸骨后烧灼感、吞咽困难或疼痛、咽部不适等症状，可导致溃疡、穿孔、瘘管等并发症。2005年1月至2008年8月，我科对25例内科治疗效果差的食管上段胃粘膜异位患者进行内镜下氩离子凝固术（argon plasma coagulation，APC）治疗，取得了良好效果，现将护理体会报告如下。     

氩离子凝固术治疗上消化道出血的护理

上消化道出血是消化内科常见的急症之一,病死率高,紧急止血是治疗的关键。氩离子凝固术（argon plasma coagulation,APC）经离子化气体将高频能量传送至靶组织,使该组织表层获得有效凝固效应,从而起到破坏组织作用。近年来,国内外报道APC用于多种原因所致的消化道出血,具有安全、有效、易操作的优势。我院自2005年开展APC技术以来治疗89例上消化道出血病例,本文将APC治疗上消化道出血的护理报告如下。     

内镜下氩离子凝固术与高频电凝切除术治疗结肠息肉的疗效研究

目的对比内镜下氩离子凝固术和高频电凝切除术治疗结肠息肉的疗效。方法收集我院治疗的肠息肉患者186例（息肉322枚）,根据治疗方法不同随机分为高频电凝切除组93例（息肉168枚）,氩离子凝固组93例（息肉154枚）,术后随访2个月,比较两组穿孔、出血并发症比例和治愈率。结果高频电凝切除组并发出血10例（10.8%）高于氩离子凝固组3例（3.2%）,P〈0.05,且高频电凝切除组出现穿孔1例。高频电凝切除组治愈率为94.5%,低于氩离子凝固组为100%,P〈0.05。结论与传统高频电凝切除术相比,氩离子凝固术治疗结肠息肉出血并发症少,治愈率高,值得临床推广。     

雷贝拉唑联合西沙比利治疗胃食管反流病的疗效观察

目的观察雷贝拉唑联合西比利治疗胃食管反流病（GERD）的临床疗效。方法选取90例胃食管反流病患者作为研究对象随机分为观察组和对照组,各45例,观察组采用雷贝拉唑联合西沙比利治疗,对照组采用雷尼春替丁联合西沙比利治疗,治疗8w后比较两组的治疗效果。结果观察组联合用药临床改善总有效率为95.6%,胃镜下胃食管炎愈合情况总有效率为97.8%;对照组的临床改善总有效率为82.2%,胃镜下食管炎愈合总有效率为75.6%,观察组明显高于对照组,差异具有统计学意义（P<0.05）。结论：雷贝拉唑联合西沙比利治疗胃食管反流病效果满意,值得临床推广使用。     

雷贝拉唑和莫沙比利联合治疗胃食管反流病的疗效观察

目的雷贝拉唑和莫沙比利联合治疗胃食管反流痛的疗效。方法把90例门诊病人随机分成3组．雷贝拉唑和莫沙比利联合组．以厦雷贝拉唑组和莫沙比利组。治疗前及治疗8周后进行症状对比。结果联合用药组缓解率（93．3％）明显高于雷贝拉唑组（80％）及莫沙比利组（73.3％）。结论雷贝拉唑联合莫沙比利治疗GERD明显优于单个用药。     

内镜下套扎术与硬化剂注射术治疗食管胃底静脉曲张出血的Meta分析

目的:系统性评价内镜下套扎术(EVL)与内镜下硬化剂注射术(EIS)治疗食管胃底静脉曲张出血的安全性及有效性。方法:系统检索Pubmed、The Cochrane Library (2022年第2期)、CNKI、万方、CBM及VIP数据库，查找所有比较EVL与EIS治疗食管胃底静脉曲张出血的临床试验，检索时限为建库至2022-02-01。按照纳入及排除标准筛选文献，并采用RevMan 5.4软件进行Meta分析。结果:最终纳入46篇研究(中文20篇，英文26篇),EVL组2 187例，EIS组3 152例。Meta分析结果示：(1)有效性：两组患者的有效率(OR=1.07, 95%CI:0.83-1.38,P=0.620)及根治率(OR=1.23, 95%CI:0.97-1.54,P=0.080)差异均无统计学意义；但EVL组根治时间更短(MD=-12.44, 95%CI:-21.57--3.30,P=0.008),且复发率低(OR=1.27, 95%CI:1.03-1.56,P=0.020)。(2)安全性：两组患者的失败率(OR=0.93, 95%CI:0.53-1.64,P=0.8...     

内镜下套扎术联合药物治疗食管静脉曲张出血的近期疗效观察

目的探讨内镜下食管静脉曲张套扎术联合药物治疗肝硬化上消化道出血的近期疗效。方法回顾性分析2007年3月至2009年12月143例肝硬化患者行食管静脉曲张套扎术治疗的资料。结果食管静脉曲张套扎术术后联合普奈洛尔、抑酸剂、生长抑素等药物治疗,明显降低早期再出血、食管溃疡、门脉高压性胃病等发生率;肝功能C级患者再出血率明显高于A级及B级患者;肝硬化有脾切除加断流术史者与无脾切除加断流术患者比较,食管静脉曲张复发率低。结论食管静脉曲张套扎术术后联合药物治疗可降低食管静脉曲张复发、食管静脉曲张出血早期再发率,减少食管溃疡、门脉高压性胃病发生率。食管静脉曲张套扎术是治疗食管静脉曲张出血安全有效的方法,疗效确切,提高了患者生存率。     

An endoscopic training and assessment model for argon plasma coagulation

PurposeArgon plasma coagulation (APC) is a standard modality for the treatment of gastrointestinal bleeding. However, there are no metrics to assess technical proficiency. We aimed to determine if a Quick APC Training Test (QAPCTT) can improve performance and assess proficiency with this modality.Materials and methodsEndoscopy trainees at various levels of training were asked to perform the QAPCTT with an in vivo model before and after an APC curriculum with didactic lectures and additional hands-on experience. As trainees performed the test, endoscopic supervisors recorded the time required to complete each task as well as the number of inadvertent mucosal touchdowns. Each partipant was assigned a technical proficiency score by supervising endoscopists.ResultsFourteen adult gastroenterology fellows participated in the course. 100% of fellows were comfortable with generator settings and APC equipment after the course compared to only 21% (p < 0.001) on the pre-test questionnaire. Those deemed technically proficient on the post-course QAPCTT required significantly less time for the task of making a square (100 s vs. 215 s; p = 0.006) and had significantly fewer inadvertent mucosal touchdowns (5 vs. 19; p = 0.0017).ConclusionsDedicated APC training is required to achieve competence with this modality. A structured curriculum improves knowledge about the technique and hands-on training is important for achieving technical proficiency. The QAPCTT appears improve APC technique and may readily identify trainees in need of additional APC experience to gain proficiency.     

Differential expression of pepsinogen isozymogens in a patient with Barrett esophagus

The pepsinogen A (PGA) isozymogens in the gastric mucosa and Barrett epithelium of a female patient with Barrett esophagus were studied on different occasions during a 3-year period by electrophoretic analysis of in vivo steady-state pepsinogen in biopsies by activity staining in combination with variant specific monoclonal antibodies and of de novo synthesized pepsinogen by autoradiography. In Barrett epithelium only one (Pg3) or two (Pg3 and Pg5) primary PGA gene products were detected, whereas in gastric mucosal biopsies three (Pg3, Pg4 and Pg5) primary gene products were demonstrated on all occasions. These differences strongly suggest differential expression/activation of individual gene numbers in the PGA gene cluster in Barrett esophagus and are in line with the preneoplastic nature of this condition. The mechanism behind this deregulation is currently under investigation by cell biology and molecular genetic techniques.     

雷贝拉唑三联法治疗幽门螺旋杆菌阳性消化性溃疡的临床疗效观察

目的观察雷贝拉唑、克拉霉素及阿莫西林三联法治疗幽门螺旋杆菌阳性消化性溃疡的临床效果。方法将150例消化性溃疡患者随机分成治疗组和对照组,治疗组75例接受雷贝拉唑三联法,对照组75例接受奥美拉唑、克拉霉素及阿莫西林三联法;用药均为7 d,疗程结束4周及半年后复查内镜及快速尿素酶实验检查,观察幽门螺旋杆菌根除率、溃疡治愈率和复发率。结果经过治疗后两组幽门螺旋杆菌根除率分别为84.0%和81.3%,差异无统计学意义（P〉0.05）;总有效率分别为94.7%和81.3%,复发率分别为为7.7%和16.1%,差异有统计学意义（P〈0.05）。结论采用雷贝拉唑三联法和传统的奥美拉唑三联疗法治疗Hp阳性消化性溃疡均能快速缓解临床症状,但雷贝拉唑三联疗法疗效更显著,幽门螺旋杆菌根除率、溃疡治愈率更高,而复发率较低。     

Role of brush cytology in the diagnosis of Barrett's esophagus: an analysis of eight cases

Although debatable, role of cytology in diagnosing Barrett's esophagus has been stressed by some authors. Our brief report analyses the role of brush cytology (BC) in its diagnosis. Eight patients who presented with upper gastrointestinal (GI) manifestations and subsequently diagnosed to have Barrett's esophagus with or without adenocarcinoma on brush cytology (BC) or, endoscopic biopsy (EB) or, a combination of both the techniques were included in the study. In all the cases routine cytologic smears and histologic sections with relevant special stains (when essential) were studied. On cytology, the diagnosis of "Barrett's esophagus" was made when the esophageal brushings obtained from a region beyond 3 cm from the gastroesophageal junction showed closely intermingled clusters of squamous and columnar cells, or when there was evidence of intestinal metaplasia. Adenocarcinoma in Barrett's esophagus was diagnosed by the usual criteria for malignancy with features of adenocarcinoma. Cytologic diagnoses were correlated with the histologic diagnoses. Of the eight cases, seven had histopathologic correlation of which six had evidence of BE on BC; four had cytohistologic concordance, of which three cases revealed adenocarcinoma arising in BE. Two endoscopic biopsies were nonrepresentative. In one case, cytology missed Barrett's esophagus. For two cases in which cytology detected Barrett's mucosa, biopsies were nonrepresentative. Our study showed brush cytology (BC) to be a fairly reliable test for detecting Barrett's esophagus. Owing to its inherent advantage of sampling a wider and circumferential area, a technically well performed brushing procedure is likely to be more representative and superior than multiple endoscopic biopsies.     

Preparation of heparin-like surfaces by introducing sulfate and carboxylate groups on poly(ethylene) using an argon plasma treatment

Carboxylate and sulfate groups were introduced at the surface of poly(ethylene) (PE) samples. This was accomplished by coating and immobilizing sodium 10-undecenoate (C11(:)) and 10-undecene sulfate (S11(:)) on the polymer by means of an argon plasma treatment. The composition of the coated surfactant layer was proportional to the composition of the coating solution. The thickness of the surfactant layer on the surface of PE samples, which were precoated from an aqueous solution with a total surfactant concentration of 0.30 M, was about 55 A°. The presence of carboxylate and sulfate groups after plasma treatment of the precoated surfaces was confirmed by X-ray photoelectron spectroscopy (XPS). About 20% of the initial amount of functional groups of the coated surfactants was retained at the PE surface. The ratio of carboxylate/ sulfate groups at the plasma treated surfaces was dependent on the composition of the precoated surfaces. The minimum surface density of these groups on the resulting samples was about one group per 40 A°².     

Molecular evaluation of ablative therapy of Barrett's oesophagus

Barrett's oesophagus is a major risk factor for developing oesophageal adenocarcinoma. Ablation by argon plasma coagulation (APC) and photodynamic therapy (PDT) is currently under investigation for the removal of metaplastic and dysplastic Barrett's oesophagus. This study examined the effect of ablative therapy on Barrett's oesophagus at cell-cycle and genetic levels. The premalignant potential of residual or recurring Barrett's oesophagus was assessed by p53 immunohistochemistry, Ki67-related proliferative capacity, and DNA ploidy status (ie an abnormal chromosome 1 number) as measured by interphase in situ hybridization. Twenty-nine patients with Barrett's oesophagus (23 male and 6 female, mean age 58 years, mean length of Barrett's oesophagus 4 cm) were treated with APC or PDT. Intestinal metaplasia without dysplasia was present in 16 patients, low-grade dysplasia in five, and high-grade dysplasia in eight patients. Biopsy samples were obtained at regular intervals (mean follow-up 20 months, range 6-36 months). One month after the first ablation, Barrett's oesophagus was no longer identified, either endoscopically or histologically, in nine patients (32%). At this time point, significant down-grading was achieved for abnormal chromosome 1 numbers (p = 0.020) and Ki67-defined proliferation (p = 0.002). Patients with residual Barrett's oesophagus were additionally treated with APC, resulting in the elimination of Barrett's oesophagus in 76% of all patients. However, at the last follow-up endoscopy, metaplasia without dysplasia was still present in five patients, and low- and high-grade dysplasia were each present in one patient. An abnormal chromosome 1 number and p53 protein overexpression were detected only in the high-grade dysplastic lesion, but increased proliferation was still present in the majority of these persisting cases. Although endoscopic removal of Barrett's oesophagus by ablative therapies is possible in the majority of patients, histologically complete elimination cannot be achieved in all cases. Persistent Barrett's oesophagus may still harbour molecular aberrations and must therefore be considered still to be at risk of progression to adenocarcinoma.     

Ultrasound-guided fine-needle aspiration diagnosis of adenocarcinoma of esophagus with signet-ring cell features arising in Barrett's esophagus: A case report

We report a rarely documented case of adenocarcinoma of esophagus with signet-ring cell features arising in a Barrett's esophagus. This was diagnosed by employing combined endosonography and fine-needle aspiration cytology. The patient had progressive dysphagia and a poorly circumscribed mass involving the distal esophagus and gastroesophageal junction. An incisional biopsy was performed which showed Barrett's esophagus with highly atypical glands suspicious for adenocarcinoma. Following that, an ultrasound-guided endoscopic fine-needle aspiration revealed a cellular specimen with multiple groups and singly dispersed atypical glandular cells with a predominance of signet-ring features. These findings represented an adenocarcinoma with signet-ring cell features arising in Barrett's esophagus. Diagn. Cytopathol. 1998;19:51–54. © 1998 Wiley-Liss, Inc.     

支架植入联合放疗治疗中晚期食管癌的疗效分析

目的探讨支架植入联合放疗对中晚期食管癌患者的疗效。方法支架植入联合放疗患者72例为联合组,单纯支架植入患者32例为支架组,单纯放疗患者46例为放疗组。比较各组患者吞咽困难情况、生存率及并发症情况。结果联合组1、2、3年生存率分别为65.3%、41.7%、27.8%,高于支架组（21.9%、6.3%、3.1%）,两组比较差显著（P〈0.05）;高于放疗组（60.9%、39.1%、26.1%）,但两组比较无显著性差异（P〉0.05）。各组治疗后分别与治疗前比较相差异显著（P〈0.05）,联合组和支架组吞咽困难评分均较放疗组显著降低（P〈0.05）。各组治疗后并发症情况无显著差异。结论支架植入联合放疗可以缓解吞咽困难,改善生存率,是中晚期食管癌患者的安全可行的姑息性治疗手段。