三种影像学检查对华支睾吸虫所致胆胰疾病诊断的对比研究

目的探讨内镜下逆行胰胆管造影（ERCP）与B超和计算机断层成像（Cr）对华支睾吸虫感染所致胆胰疾病的诊断价值。方法将65例粪便中找到华支睾吸虫卵或胆汁中找到华支睾吸虫成虫或虫卵的梗阻性黄疸患者作为研究对象，对其B超、Cr和ERCP检查结果进行对比研究。结果B超最为简单、方便，主要表现为肝内胆管均匀扩张和肝内胆管壁增厚，回声增强并呈等号状为特征。Cr表现为近肝包膜处有均匀扩张的胆管，呈囊状扩张、胆管壁增厚。十二指肠镜下见约32．3％（21／65）的患者表现为乳头形态异常，开口尖细，黏膜外翻，内陷及僵硬感，插管困难。ERCP胆道造影表现为细丝形或椭圆形充盈缺损，末稍胆管呈囊状扩张是最有特征性的表现。合并症以胆管结石最多占40％（26／65），胆管癌及十二指肠乳头癌占9．8％（6／65），胰腺炎占1．5％（1／65）。结论对华支睾吸虫感染所致的胆道疾病，三种检查方法的共同特征为弥漫性肝内胆管末端囊性扩张，ERCP优于体表超声和CT。内镜下十二指肠乳头括约肌切开术和（或）内镜下鼻胆管引流术结合术后驱虫是该病的首选治疗方法。     

肝癌合并华支睾吸虫病的术中诊断及处理

目的总结肝癌合并华支睾吸虫病的术中诊断及处理方法。方法对78例肝癌合并华支睾吸虫病患者的术中所见及处理方法作回顾性分析。结果本组术中均于肝切面上或切除后胆管中肉眼见华支睾吸虫成虫,行肝癌切除术同时行胆总管切开探查,胆管冲洗取虫、T管引流,术后抗吸虫药物治疗。术后发生胆瘘10例,经处理治愈7例,死于胆瘘感染3例;死于肝功能衰竭2例。余患者1个月后复查肝功能恢复正常,大便检查无虫卵。结论华支睾吸虫疫区的肝癌患者术中应注意吸虫病后诊断;肝癌切除后胆管冲洗取虫、T管引流及术后抗吸虫治疗为有效方法。     

合并肝吸虫的梗阻性黄疸患者血清细胞因子变化及临床意义

正肝吸虫病是一种人畜共患的寄生虫疾病。研究指出,肝吸虫感染和胆管上皮癌及肝细胞癌的发生发展密切相关。本文主要是通过观察血清细胞因子在合并华支睾吸虫感染的梗阻性黄疸患者中变化,探讨其在肝吸虫病致病机制中的作用及临床意义。1资料与方法1.1一般资料选择2013年5月至2015年7月在本院诊治的60例合并华支睾吸虫感染的梗阻性黄疸患者为实验组,均有食用生鱼史,华支睾吸虫卵阳性,     

华支睾吸虫病合并胆结石胆囊炎1例分析

目的了解1例患者出现华支睾吸虫病、胆结石、胆囊炎三联症的有关发病原因与临床表现,分析有关发病因素。方法直接涂片法检查患者T型管引流液中华支睾吸虫卵,kato-katz法检查粪便中华支睾吸虫卵,吡喹酮驱虫药物治疗。结果无论肉眼或镜下对患者T型管引流液中排出的虫体经鉴定结果一致,均为华支睾吸虫成虫。对患者采用吡喹酮总量120 mg/kg体重,3 d分服9次服完的驱虫治疗与对症处理的治疗方案,经治疗半月、1月、3月复查与回访,临床症状与体征消失,治后半月、1月及3月的粪便均未再检获华支睾吸虫卵。结论该患者出现的华支睾吸虫病、胆结石、胆囊炎三联症为有华支睾吸虫病的流行或有发病的地区所少见。     

华支睾吸虫病诊断研究进展

本文就八十年代以来有关华支睾吸虫病诊断研究的进展情况作一综述。病原学诊断从粪便或十二指肠抽取物中检出华支睾吸虫卵，或从剖腹术中找到华支睾吸虫成虫是确诊华支睾吸虫感染的可靠方法。十二指肠抽取物的检出率很高，但其操作方法复杂，并不易为一般患者所接受。不同...     

华支睾吸虫病患者粪便虫卵核糖体DNA内转录间隔区序列分析

目的 通过PCR方法扩增华支睾吸虫病患者粪便虫卵核糖体DNA （ribosomal DNA,rDNA）内转录间隔区（internal transcribed spacer,ITS）序列进行分析,探讨其用于华支睾吸虫感染检测的价值. 方法 提取2例华支睾吸虫患者粪便中的虫卵DNA作模板,以rDNA ITS基因片段为目的片段进行PCR扩增,对扩增片段进行测序分析. 结果 从2例患者粪便虫卵样本中均扩增出1 123 bp的条带,经序列比对确定患者粪便中的虫卵为华支睾吸虫卵.测序分析发现本研究的两个样本与中国黑龙江分离株（KF740425）相似性为100％. 结论 本研究从2例华支睾吸虫病患者粪便虫卵中成功扩增出rDNA ITS基因,为从分子生物学角度检测华支睾吸虫病提供了资料.     

广州珠三角地区家猫自然感染华支睾吸虫的调查及豚鼠模型的构建北大核心CSCD

目的了解广州珠三角地区家猫自然感染华支睾吸虫状况,观察豚鼠感染华支睾吸虫后肝组织病理变化。方法解剖当地家猫,取肝脏,检查华支睾吸虫感染情况,阳性肝脏收集成虫,并取肝组织制作切片;采集阳性鱼,分离华支睾吸虫囊蚴,经口感染豚鼠,60个囊蚴/只,60d后解剖豚鼠,检查肝脏,收集成虫,取病变肝组织制作切片,作病理检查。实验设未感染对照组。结果当地猫华支睾吸虫自然感染率为41.47%(214/516);感染豚鼠华支睾吸虫成虫回收率50.83%(305/600)。与对照组比较,实验组豚鼠肝脏肿大,边缘呈球状隆起,部分肝叶表面可见水泡状凸起病变,水泡内液清亮;病变组织横切面可见胆管管壁增厚,管腔内有华支睾吸虫成虫寄生;镜下可见华支睾吸虫虫卵切面,周围大量炎症细胞浸润,胆管管壁增厚,管周纤维组织增生伴胆管扩张,肝小叶结构破坏。结论广州珠三角地区家猫华支睾吸虫感染率较高。豚鼠是华支睾吸虫合适的终末宿主,且肝脏病变明显。     

江西省信丰县华支睾吸虫病和防治相关知识知晓情况调查

目的 了解江西省信丰县华支睾吸虫病和防治相关知识知晓情况,为开展华支睾吸虫病防治工作提供科学依据。方法 以吃“鱼生”习惯为线索调查信丰县华支睾吸虫病潜在流行区,2016年开展人群粪检,并检测淡水鱼囊蚴及淡水贝类雷蚴、尾蚴,同时检查猫、犬和猪等保虫宿主粪便。对华支睾吸虫病防治知识知晓情况进行问卷调查。 结果 信丰县26个村的居民有生食淡水鱼习惯,吃“鱼生”者占调查人数的19.51%,其人群平均华支睾吸虫感染率为21.56%,纹沼螺华支睾吸虫感染率为0,淡水鱼华支睾吸虫感染率为8.24%,保虫宿主华支睾吸虫平均感染率为2.27%。人群华支睾吸虫感染率随年龄升高而呈现上升的趋势,吃“鱼生”与人群华支睾吸虫感染率呈正相关（r = 0.88,P < 0.01）。仅有11.46%的调查对象了解吃“鱼生”会感染华支睾吸虫,知道华支睾吸虫对身体有危害者仅占5.28%。 结论 信丰县5个乡（镇）26个村为华支睾吸虫病流行区;加强华支睾吸虫病危害和感染途径的健康教育、逐步改变居民吃“鱼生”的习惯是控制当地华支睾吸虫病流行的根本措施。     

四川省蓬溪县华支睾吸虫病流行病学调查

为了模清我县人群华支睾吸虫病的流行情况，我们采用改良加藤厚涂片法，对蓬溪县不同地势和经济状况的４个自然村２６０６名人进行粪检，定量检查华支睾吸虫虫卵。结果华支睾吸虫卵阳性者７１例，其感染率为２．７％，其中男、女人群的华支睾吸虫感染率分别为２．２％（２...     

华支睾吸虫病流行区胆石症患者胆囊结石类型及华支睾吸虫感染情况

目的探讨华支睾吸虫病流行区胆石症患者胆囊结石类型与华支睾吸虫感染的关系。方法选取2009年5月至2012年10月在广州市南沙区第六人民医院普外科实施内镜微创取石保胆手术的胆石症患者598例。胆石样品以红外光谱法分析结石成分,判断结石类型。胆石研碎后用光镜检查华支睾吸虫虫卵,计算不同类型结石的虫卵检出率。比较不同类型的结石患者,以及碳酸钙类结石患者中华支睾吸虫虫卵阳性和阴性患者的临床特点和生化特征。选取部分虫卵阳性的碳酸钙类结石行扫描电镜观察。结果 598例胆囊结石患者中,234例(39.1%)为胆固醇类结石,133例(22.2%)为胆色素类结石,112例(18.7%)为碳酸钙类结石,86例(14.4%)为混合类结石,33例(5.5%)为其他类结石。5类胆结石华支睾吸虫卵检出率分别为6.4%(15/234)、44.3%(59/133)、59.8%(67/112)、36.0%(31/86)和30.0%(10/33)。碳酸钙类结石的虫卵检出率最高,胆固醇类结石的虫卵检出率最低。碳酸钙类结石和混合类结石患者的血清CO2结合力高于胆固醇类结石患者(P0.05),碳酸钙类结石患者胆汁CO2结合力和p H值高于其他4组结石患者(P0.05)。碳酸钙类结石患者中华支睾吸虫虫卵阳性者的血清CO2结合力、胆汁CO2结合力和p H值均高于虫卵阴性者(P0.05)。光镜和扫描电镜观察均发现,碳酸钙类结石华支睾吸虫卵与碳酸钙结晶相互黏附。结论碳酸钙类胆囊结石患者的华支睾吸虫感染率高于其他结石类型的患者。     

Endoscopic mucosal resection and endoscopic submucosal dissection for early gastric cancer: Current and original devices

Compared with endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) is easier to perform and requires less time for treatment. However, EMR has been replaced by ESD, because achieving en bloc resection of specimens > 20 mm in diameter is difficult with EMR. The technique of ESD was introduced to resect large specimens of early gastric cancer in a single piece. ESD can provide precise histological diagnosis and can also reduce the rate of recurrence, but has a high level of technical difficulty, and is consequently associated with a high rate of complications, a need for advanced endoscopic techniques, and a lengthy procedure time. To overcome disadvantages in both EMR and ESD, various advances have been made in submucosal injections, knives, other accessories, and in electrocoagulation systems.     

超声内镜对食管静脉曲张结扎术前后侧枝循环变化的临床研究

目的 应用Fujinon SP-701小探头超声内镜观察食管静脉曲张结扎术(EVL)前后曲张静脉及侧枝循环的变化，分析影响疗效的原因。选择合理的治疗方法。方法 对60例单纯食管静脉曲张出血患者依超声检查结果分为3组：Ⅰ组为单纯食管静脉曲张(EV)；Ⅱ组为合并有食管旁静脉(PEV)，但无交通枝(PV)；Ⅲ组合并有食管旁静脉及交通枝。患者EVL术后4、8、12周行超声内镜检查，观察及测量EV、PEV、PV的变化情况，分析影响疗效的原因。结果 Ⅰ组显效率75％，复发率16％，疗效最佳；Ⅲ组显效率0％，复发率100％，疗效最差。Ⅰ组24例中出现PEV者12例；Ⅱ组20例PEV全部增宽，11例出现PV；Ⅲ组全部有PEV增宽、PV增多增宽表现。结论 超声内镜对食管静脉曲张出血治疗方法的选择有指导意义。单纯食管静脉曲张EVL可获得满意疗效，但是伴PEV及PV者不是EVL适应证，建议采用其他方法治疗。     

ERCP结合EPT对胆囊切除术后患者诊治价值的探讨

目的 回顾性研究逆行性胰胆管造影（ERCP）结合乳头肌切开术（EPT）对胆囊切除术后患者的诊治价值。方法 170例胆囊切除术后症状再发或反复发作患者，接受ERCP检查和EPT等治疗，诊断结果与B超作对照。同时动态观察内镜下介入诊治术后临床表现的改变。不良反应及血清淀粉酶的变化及高淀粉酶血症的分布情况。结果 经ERCP结合EPT等术后患者临床症状显著改善；与B超对照ERCP对胆囊切除术后胆总管残余结石的诊断率显著提高（P＜0．001），对胆总管扩张程度的诊断价值显著优于B超（P＜0．05），并能发现许多B超检查不能发现的胆胰病变；术后主要不良反应表现为出血、高淀粉酶血症，ERCP结合EPT等治疗组高淀粉酶的发生率显著高于单纯ERCP操作组（P＜0．01）。经积极地处理后短期内出血控制，血清淀粉酶多在3日内转为正常。结论 对胆囊切除术后患者，ECRP结合EPT不失为一项非常有价值、安全的诊治措施。     

Endoscopic Ultrasound-Guided Hepaticogastrostomy: Technical Review and Tips to Prevent Adverse Events

Most patients who require biliary drainage can be treated by endoscopic retrograde cholangiopancreatography (ERCP)-guided procedures. However, ERCP can be challenging in patients with complications, such as malignant duodenal obstruction, or a surgically-altered anatomy, such as a Roux-en-Y anastomosis, which prevent advancement of the duodenoscope into the ampulla of Vater. Recently, endoscopic ultrasound (EUS)-guided biliary drainage via transhepatic or transduodenal approaches has emerged as an alternative means of biliary drainage. Typically, EUS-guided gallbladder drainage or choledochoduodenostomy can be performed via both approaches, as can EUS-guided hepaticogastrostomy (HGS). EUS-HGS, because of its transgastric approach, can be performed in patients with malignant duodenal obstruction. Technical tips for EUS-HGS have reached maturity due to device and technical developments. Although the technical success rates of EUS-HGS are high, the rate of adverse events is not low, with stent migration still being reported despite many preventive efforts. In this review, we described technical tips for EUS-HGS related to bile duct puncture, guidewire insertion, fistula dilation, and stent deployment, along with a literature review. Additionally, we provided technical tips to improve the technical success of EUS-HGS.     

Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management

Endoscopic retrograde cholangiopancreatography (ERCP) has become an important therapeutic modality for biliary and pancreatic disorders. Perforation is one of the most feared complications of ERCP and endoscopic sphincterotomy. A MEDLINE search was performed from 2000-2014 using the keywords “perforation”, “ERCP” and “endoscopic sphincterotomy”. All articles including more than nine cases were reviewed. The incidence of ERCP-related perforations was low (0.39%, 95%CI: 0.34-0.69) with an associated mortality of 7.8% (95%CI: 3.80-13.07). Endoscopic sphincterotomy was responsible for 41% of perforations, insertion and manipulations of the endoscope for 26%, guidewires for 15%, dilation of strictures for 3%, other instruments for 4%, stent insertion or migration for 2% and in 7% of cases the etiology was unknown. The diagnosis was made during ERCP in 73% of cases. The mechanism, site and extent of injury, suggested by clinical and radiographic findings, should guide towards operative or non-operative management. In type I perforations early surgical repair is indicated, unless endoscopic closure can be achieved. Patients with type II perforations should be treated initially non-operatively. Non-operative treatment includes biliary stenting, fasting, intravenous fluid resuscitation, nasogastric drainage, broad spectrum antibiotics, percutaneous drainage of fluid collections. Non-operative treatment was successful in 79% of patients with type II injuries, with an overall mortality of 9.4%. Non-operative treatment was sufficient in all patients with type III injuries. Surgical technique depends on timing, site and size of defect and clinical condition of the patient. In conclusion, diagnosis is based on clinical suspicion and clinical and radiographic findings. Whilst surgery is usually indicated in patients with type I injuries, patients with type II or III injuries should be treated initially non-operatively. A minority of them will finally require surgical intervention.     

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

Gastric cancer accounts for a significant proportion of worldwide cancer-related morbidity and mortality. The well documented precancerous cascade provides an opportunity for clinicians to detect and treat gastric cancers at an endoscopically curable stage. In high prevalence regions such as Japan and Korea, this has led to the implementation of population screening programs. However, guidelines remain ambiguous in lower prevalence regions. In recent years, there have been many advances in the endoscopic diagnosis and treatment of early gastric cancer and precancerous lesions. More advanced endoscopic imaging has led to improved detection and characterization of gastric lesions as well as superior accuracy for delineation of margins prior to resection. In addition, promising early data on artificial intelligence in gastroscopy suggests a future role for this technology in maximizing the yield of advanced endoscopic imaging. Data on endoscopic resection (ER) are particularly robust in Japan and Korea, with high rates of curative ER and markedly reduced procedural morbidity. However, there is a shortage of data in other regions to support the applicability of protocols from these high prevalence countries. Future advances in endoscopic therapeutics will likely lead to further expansion of the current indications for ER, as both technology and proceduralist expertise continue to grow.     

Endoscopic ultrasound-guided biliary drainage-current status and future perspectives

Endoscopic retrograde cholangiopancreatography (ERCP) with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction. ERCP could fail in cases of duodenal obstruction, duodenal diverticulum, ampullary neoplastic infiltration or surgically altered anatomy. In these cases percutaneous biliary drainage (PTBD) is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices. A large amount of data is already collected that proves its efficacy, safety and ability to replace PTBD in cases of ERCP failure. It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future. Several EUS-BD techniques are developed EUS-guided transmural stenting, antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy. EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure. The lack of training, absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure, which is related to life-threatening adverse events. Developing training models, dedicated devices and guidelines hopefully will make EUS-BD easier, safer and well accepted in the future. This paper focuses on the technical aspects of the different EUS-BD procedures, available literature data, advantages, negative aspects and the future perspectives of these modalities.     

直肠类癌的内镜超声诊断和内镜黏膜下切除

目的 研究内镜超声对直肠类癌的诊断价值，探讨内镜下黏膜切除术治疗直肠类癌的应用价值。方法 应用微超声探头对结肠镜发现的黏膜正常的大肠隆起性病灶进行超声检查，对诊断直肠类癌病例应用套扎器对准病灶负压吸引进行圈套结扎，再在皮圈根部连皮圈电切病灶。比较内镜超声诊断和病理检查结果，观察切除标本基底有无肿瘤累及。结果 126例黏膜正常的大肠隆起性病灶经内镜超声诊断，25例直肠类癌全部得到病理证实。直肠类癌表现为黏膜下层的边界清晰、回声欠均匀的低回声肿块。全部类癌病例无固有肌层和血管浸润，行内镜黏膜下切除无一例出现出血和穿孔，切除标本边缘和基底无肿瘤累及。结论 内镜超声可以明确直肠类癌的肠壁来源、大小、内部回声性质、边界、有无肌层和周围血管浸润，内镜下黏膜切除术治疗直肠类癌疗效确切。