单人操作结肠镜下治疗大肠腺瘤36例分析

目的 探讨单人操作结肠镜下治疗大肠腺瘤的方法、可靠性及安全性.方法 对经电子结肠镜诊断为大肠腺瘤,并经病理证实未恶变患者采用高频电圈套、热活检钳凝切法、氩离子凝固灼除法等切除.结果 36例42枚大肠腺瘤经一次治疗33例,经两次以上治疗3例,2例出现出血,经止血夹及氩离子凝固治疗后好转.结论 单人操作结肠镜下治疗大肠腺瘤...     

内镜下高频电凝切除消化道息肉68例体会

目的：探讨内镜下高频电切术对消化道息肉的治疗价值。方法：内镜下对68例108颗。不同大小，有蒂或无蒂，单发或多发息肉，给予高频电切治疗。结果：全部病例均治愈，未发生并发症，其中1例腺瘤息肉癌变，电切后随访2年，无复发，结论：内镜下高频最切治疗消化道息肉，方法切实可行，安全可靠，经济、适合基层医院推广。     

腺瘤性胃息肉内镜治疗及随访

目的 :观察内镜治疗腺瘤性胃息肉的疗效。方法 :对 90例腺瘤性胃息肉患者 ,分别采用高频电凝电切、微波或活检钳直接钳除等方法治疗。结果 :所有息肉均成功摘除 ,无发生出血及穿孔 ,随访 1～ 5年 ,发现 11例( 12 2 % )复发 ,1例 ( 1 1% )癌变。结论 :内镜治疗息肉方法简便 ,安全可靠。积极内镜复查 ,可了解息肉复发及癌变发生情况。     

高频电切及热活检灼除治疗胃黏膜脱垂症

目的观察内镜下高频电切及热活检灼除治疗胃黏膜脱垂症的效果。方法胃镜确诊的398例胃黏膜脱垂症患者随机分为高频电切组（161例）、热活检灼除组（185例）和对照组（52例）。治疗组术后和对照组每人每日口服奥美拉唑20mg，连续3周。1个月后行临床症状随访和胃镜复查。结果高频电切组、热活检灼除组和对照组症状随访率分别为96．89％、92．97％和88．46％；随访症状缓解总有效率为85．26％、86．05％和36．96％。治疗组与对照组相比，差异有显著性（P〈0.01）；两治疗组比较差异无显著性（P〉0.05）。高频电切组、热活捡灼除组和对照组胃镜复查率分别为74．53％、73．51％和82。69％；胃镜复查总有效率分别为97．5％、98．53％和13．95％。治疗组与对照组相比．差异有显著性（P〈0.01），两治疗组相比差异无显著性（P〉0.05），但热活检灼除组（92．65％）的显效比例高于高频电切除组（87．5％）（P〈0.01）。结论内镜下热活检灼除法治疗胃黏膜脱垂症易于操作，疗效确切，安全性高。     

儿童大肠息肉的内镜下介入治疗结果分析

近年来儿童大肠息肉的检出率不断提高，内镜下高频电凝切方法也日益成熟，应用最为普及，因能回收标本，故成为息肉治疗首选，我院自2005年1月-2009年共对20例儿童大肠息肉行成人结肠镜下圈套电凝切术和活检钳除，取得较好效果，现报告如下：     

可旋转重复开闭软组织钛夹联合高频电圈套电凝切除治疗大肠粗长蒂息肉的临床安全性观察

目的探讨可旋转重复开闭软组织钛夹(和谐夹)内镜下联合高频电治疗大肠粗长蒂息肉的疗效及安全性。方法对2014年1月-2015年12月该院消化内科内镜室的21例大肠粗长蒂息肉(直径≥2.0 cm)患者采用电子结肠镜下先予使用可旋转重复开闭软组织钛夹(和谐夹)1或2枚夹闭大肠粗长蒂息肉的根部,再予高频电圈套电凝电切除。随访观察术后出血、穿孔情况。结果该组21例共24枚粗亚蒂或长蒂大肠息肉均成功切除,残端渗血1例,给予热活检钳处理局部创面后行Olympus EZ Clip HX-610-135L钛夹夹闭。所有患者均未出现迟发性出血、穿孔等并发症。术后3~6个月复查结肠镜,原息肉切除部位均未见息肉复发。结论可旋转重复开闭软组织钛夹(和谐夹)内镜下联合高频电治疗大肠粗长蒂息肉未见出血、穿孔,安全有效。     

内镜高频电切治疗大肠息肉的配合及护理658例

内镜高频电切治疗大肠息肉,因可通过电视荧屏显示出病变的大小、位置、形态及活动情况,给术者及配合者提供了极大的方便。1995年7月～2 0 0 3年5月我院利用高频电切治疗大肠息肉6 5 8例,效果较好,现将护理及配合体会总结如下。1　临床资料1.1　一般资料。6 5 8例患者中年龄5～78岁。男35 1例,女30 7例。息肉0 .2～3.0cm。病理组织学检查,腺瘤性息肉占5 8% ,增生性息肉占19% ,炎性息肉占2 3%。1.2　方法。将连接于高频电发生器的圈套器或热活检钳通过电子结肠镜的活检孔道送达肠腔内的病变部位,对息肉进行圈套或钳夹,然后通电利用高频电流通…     

大肠息肉946例临床分析

目的:分析大肠息肉的临床特点,着重讨论各种病理类型应采用的处理术式及随访注意事项。方法:回顾性分析946例大肠息肉病例的临床资料。结果:本组男女之比为1.60∶1;平均年龄49.12岁;大肠息肉内镜检出率为14.62%;多发性息肉占22.73%。病检结果:增生性息肉占32.24%,炎症性息肉占26.74%。经内镜下行电切摘除术259例。结论:大肠息肉好发于直肠,多见于男性,随年龄增长发病增高。病理类型以增生性息肉为主,单发多见。诊断主要依靠内镜检查和病理活检。经内镜热活检钳凝除和高频电切除是主要治疗方法。     

内镜下黏膜切除术在治疗大肠隆起病灶中的应用

目的：探讨内镜下黏膜切除术对各型大肠隆起病灶的切除效果及其安全性，和对各类良性大肠息肉和早期癌的治疗价值。方法：于病灶基底部黏膜下层注射高渗钠—立止血液，病灶举起后。用透明帽吸引法使之形成假蒂，于假蒂处圈套收紧并高频电凝切除，收集标本行全瘤病理检查，对患者的临床资料、组织学结果、切除结果和随访结果进行分析。结果：共切除52例59个病灶(半球状和扁平状隆起病灶占38个)，57个被完全切除，完全切除率达96．61％(57／59)，且无穿孔及明显出血并发症发生。对8例早期癌和29例腺瘤患者进行3个月～36个月随访，无1例复发。结论：内镜下黏膜切除术具有完全切除率高、穿孔和明显出血并发症更低的优点。就隆起病灶形态而言，能有效切除球状至扁平状病灶；就隆起病灶性质而言，能有效治疗各类良性大肠息肉和黏膜层早期大肠癌。     

高频电灼治疗慢性泪囊炎的疗效分析

目的：探讨高频电灼治疗慢性泪囊炎所致鼻泪管阻塞的治疗效果。方法：临床治疗46例51只眼慢性泪囊炎病人。随访完整资料36例40只眼。结果：高频电灼法近期(两周)有效率97．5％，长期有效率为(三个月)为77．3％。结论：高频电灼治疗慢性泪囊炎是一种简便可靠，疗效满意的方法。     

单鼻孔蝶窦入路显微手术治疗垂体腺瘤56例护理体会

目的:探讨单鼻孔经蝶入路显微手术治疗垂体腺瘤的护理方法.方法:对2000年9月～2006年9月收治的56例垂体腺瘤患者,术前均行冠状TC、MRI扫描,并行内分泌学检查,肿瘤全切47例,次全切7例,部分切除2例,均行单鼻孔蝶窦入路显微手术治疗.并给予精心护理,采用综合医院焦虑/抑郁(HAD)情绪测定量表评估护理前后患者的心理状态.术后随访6～36个月.结果:术后症状及内分泌检查改善54例,5例出现鼻中隔穿孔、鼻黏膜感染、脑脊液漏等并发症.经积极有效护理,患者心理状态得到改善.2例1年后复发.结论:经蝶窦入路显微手术治疗垂体腺瘤,并给予积极精心护理可取得满意效果,降低住院费用,促进患者心理健康.     

Two cases of colonic adenomatous polyps accompanied by a migrated surgical suture

A 56-year-old man and a 70-year-old woman, with histories of left colectomy and appendectomy respectively, were admitted to our hospital. In both cases, colonoscopy showed a pedunculated colonic polyp in the ascending colon, and a silk suture became visible in the stalk during polypectomy. The histological diagnosis was adenoma. These two cases constitute the first report of colonic adenomatous polyps accompanied by suture migration.     

Endoscopic therapy of benign tumors of the papilla of Vater

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate the technical feasibility and safety of endoscopic treatment in 16 patients with benign adenomas of the papilla of Vater. PATIENTS AND METHODS: This study involved 16 patients with confirmed adenoma of the papilla of Vater. Diagnosis of adenoma was made by endoscopic findings, benign histologic findings at forceps and snare biopsy, and endoscopic ultrasonography (EUS). The size of the tumor ranged from 2 to 7 cm. Papillectomy by diathermy snare consisted of excision of the adenoma together with the papilla of Vater. In three patients, residual tissue that could not be removed with the snare was removed using argon coagulation. RESULTS: Postpapillectomy complications included bleeding in two patients. Two patients had acute pancreatitis. No procedure-related death occurred. Follow-up duodenoscopy was performed at 6 and 12 months after papillectomy and yearly thereafter. Three patients had recurrences (benign adenoma in all cases). Two patients were treated endoscopically. One patient with extension of tumor into the distal common bile duct was referred to surgery. CONCLUSIONS: Endoscopic resection of adenomas of the papilla of Vater appears to be a viable alternative to surgical therapy, particularly in patients for whom surgery is a high-risk approach.     

老年大肠肿瘤患者的内镜下黏膜切除治疗

目的 探讨内镜下黏膜切除术（EMR）对老年大肠扁平及广基肿瘤治疗的有效性及安全性。方法 60例老年患者，年龄平均71岁，通过结肠镜检查，非抬举征（non-lifting sign）阳性入选为EMR适应证。46例病变〈2cm行一次性切除；14例病变〉2cm行分次切除（EPMR），创面用夹子缝合，回收后做连续病理切片，证明肿瘤全部切除。结果 60例病变病理学检查结果：腺瘤55例，早期大肠癌5例均为黏膜层癌（m1-m3）。腺瘤55例中，管状腺瘤33例、腺管绒毛腺瘤14、绒毛腺瘤8例。结论 EMR作为内镜下治疗老年人大肠肿瘤是一个令人满意的治疗手段，特别适合高龄、不愿或不宜行外科手术的患者。     

多层(四层)螺旋CT结肠仿真内窥镜的临床应用

目的：研究多层螺旋CT仿真结肠镜(MSCTVC)检查的临床应用价值。材料与方法：应用MSCTVC和电子结肠镜(EC)对30例病人进行检查对照。其中17例还作了病理学检查。结果：MSCTVC与EC诊断符盒，结肠癌15例，息肉9例(其中1例息肉直径6mm)，囊肿1例。MSCTVC与EC不符合5例，其中1例EC未插入升结肠，MSCTVC发现升结肠癌；l例EC发现多发性息肉，MSCTVC发现结肠癌；1例EC发现乙状结肠息肉，MSCTVC加SSD发现横结肠冗长；1例EC插不进，MSCTVC发现回盲部癌；1例EC发现左半结肠1个息肉，右半结肠插不进。MSCTVC发现升结肠、肝曲、脾曲各有1个息肉。17例作病理学检查，MSCTVC和EC诊断为结肠癌者病理诊断为腺癌9例。良恶性不能明确者2例，MSCTWC和EC诊断为息肉者，病理学诊断为腺瘤5例，慢性炎症1例。30例中，3例EC诊断为结肠炎症，MSCTVC诊断为正常。4例EC失败，MSCTVC完成检查，诊断正常。结论:MSCTVC对结肠隆起性病变是一种有效的检查方法。     

胃镜热极止血的动物实验和临床应用

目的：观察评价经内镜热极治疗胃出血的可能性、疗效和操作方法。方法：对狗胃实验性出血灶和胃出血患者采用热极热凝治疗，并观察其效果。结果：拘胃所有实验性出血灶经热极止血全部成功；在临床应用中，内镜下热极止血的成功率为95.5％（64／67），且均未出现明显并发症。结论：内镜下热极治疗胃出血是一种有效而又简便、安全的方法。     

Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study

BACKGROUND AND STUDY AIMS: The aim of this study was to evaluate prospectively the long-term outcomes of using argon plasma coagulation (APC) as an adjunct to piecemeal polypectomy of large sessile colorectal adenomas. PATIENTS AND METHODS: A total of 77 patients with 82 sessile colorectal adenomas (median size 2.9 cm, range 1.5 - 8.0 cm) underwent snare piecemeal polypectomy. Patients in whom polypectomy was complete received no further treatment (polypectomy group; n = 14). When polypectomy was incomplete, additional treatment with APC was started either immediately or 1 - 3 months after the last polypectomy session (polypectomy + APC group; n = 63). Patients were followed (by endoscopy and biopsy) at regular intervals. RESULTS: Histologically proven adenoma eradication was achieved in 100 % of patients (14/14) in the polypectomy group and in 90 % of patients (57/63) in the polypectomy + APC group (two patients died of unrelated causes before adenoma was eradicated, two underwent operation because cancer was detected in the polyp treated, and two underwent operation because of endoscopic treatment failure). The adenoma recurrence rate was 14 % in both the polypectomy and polypectomy + APC groups. All recurrences except one occurred during the first year of follow-up and all were successfully re-treated endoscopically. A total of 69 patients in whom long-term follow-up data are available are free from adenoma at a median follow-up of 37 months (range 12 - 80). No major complications of endoscopic treatment occurred. In seven cases (9 %) the polyp was eventually shown to be malignant; in two of these patients the diagnosis of cancer was delayed as a result of unsuccessful endoscopic treatment. CONCLUSIONS: APC used in combination with piecemeal polypectomy of large colorectal adenomas is an effective and safe method of therapy, provided patient selection is careful and follow-up close.     

结直肠腺瘤及癌变组织PTEN和COX-2的表达及意义

目的探讨结直肠腺瘤及癌变组织抑癌基因人第10号染色体缺失的磷酸酶及张力蛋白同源基因(PTEN)和环氧化酶-2(COX-2)的表达差异。方法采用免疫组织化学SP法分别检测30例正常肠黏膜组织、30例非腺瘤性息肉、60例腺瘤性息肉及30例肠癌组织中PTEN、COX-2蛋白的表达,分析其与临床病理特征的关系及二者表达相关性。结果 PTEN在正常肠黏膜、非腺瘤性息肉、腺瘤性息肉及肠癌组织中的阳性表达率逐渐降低,腺瘤性息肉和肠癌组织阳性率显著低于正常肠黏膜和非腺瘤性息肉组织,差异有统计学意义(P0.05);COX-2在正常肠黏膜、非腺瘤性息肉、腺瘤性息肉及肠癌组织中的阳性表达率逐渐升高,腺瘤性息肉和肠癌组织COX-2阳性表达率显著高于正常肠黏膜组织,肠癌组织COX-2阳性表达率显著高于非腺瘤性息肉组织,差异均有统计学意义(P0.05);腺瘤性息肉中直径≥1 cm者PTEN阳性率低于直径1 cm者,绒毛状腺瘤PTEN阳性率低于管状腺瘤,腺瘤伴高级别上皮内瘤变及癌变的组织PTEN阳性率低于早期腺瘤,差异均有统计学意义(P0.05);腺瘤性息肉中直径≥1 cm者COX-2阳性率高于直径1 cm者,绒毛状腺瘤COX-2阳性率高于管状腺瘤,腺瘤伴高级别上皮内瘤变及癌变的组织COX-2阳性率高于早期腺瘤,差异均有统计学意义(P0.05);腺瘤性息肉和肠癌组织PTEN和COX-2表达呈负相关(P0.05)。结论 PTEN和COX-2可能共同参与结直肠腺瘤癌变,并起重要负协同作用;联合检测或可预测腺瘤癌变,对腺瘤癌变早期诊断、治疗及预后评估有一定参考价值。     

An evaluation of colorectal endoscopic mucosal resection using high-magnification chromoscopic colonoscopy: a prospective study of 1000 colonoscopies

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection provides an alternative to surgery for resection of sessile and flat colorectal lesions. High-magnification chromoscopic colonoscopy may allow early detection and anticipate histological diagnosis by identifying colonic crypt patterns. The aim of the present study was to assess the efficacy and safety of en-bloc endoscopic mucosal resection with high-magnification chromoendoscopy in the management of sessile and flat colorectal lesions 相似文献   

Biopsy of colorectal polyps is not adequate for grading of neoplasia

BACKGROUND AND STUDY AIM: Valid tissue sampling of colorectal adenomas is crucial for their management in terms of treatment and follow-up. The aim of this study was to assess the validity of a cold biopsy sample as representative for the whole polypectomy specimen, with regard to histopathological features. PATIENTS AND METHODS: As part of the Norwegian Colorectal Cancer Prevention trial, 442 participants (60% men) who fulfilled the criterion of colonoscopic recovery of adenoma that had been biopsied at flexible sigmoidoscopy, had their adenomas subsequently removed by polypectomy (snare resection) at colonoscopy. Logistic regression analysis was used to determine which variables contributed to the histopathological discrepancy between cold biopsy and polypectomy specimens. RESULTS: Among the 532 colorectal adenomas biopsied at flexible sigmoidoscopy and removed by colonoscopy, the assessment of intraepithelial neoplasia (dysplasia) status was changed in 51 adenomas (10%), and 38 (7%) of them had been underestimated at biopsy compared with polypectomy. Likewise, the assessment of villousness was changed in 45 adenomas (9%), being upgraded in 26 (6%) at polypectomy compared with biopsy. In a multivariate model, the diameter of neoplasia at polypectomy was positively associated with increased risk of the underestimation of intraepithelial neoplasia and/or villousness influencing a diagnosis of advanced colorectal neoplasia, when cold biopsy and polypectomy specimens were compared ( Ptrend=0.01). Among 56 cases of advanced neoplasia, 35 (63%) showed only low-grade intraepithelial neoplasia on biopsy. CONCLUSIONS: Biopsy-based diagnosis underestimated histopathological diagnosis in about 10% of colorectal adenomas detected by flexible sigmoidoscopy screening, but advanced neoplasia was underestimated in more than 60%. Efforts must be made to obtain polypectomy specimens to secure precise diagnosis.