大肠息肉679例临床特征及内镜、病理学特点分析

 目的 研究大肠息肉患者的年龄,息肉的发生部位、大小、病理类型以及息肉癌变的相关规律.方法 对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜特点及病理资料进行总结和分析.结果 在3 680例肠镜检查者中,发现大肠息肉679例,其中男468例,女211例,检出率18.45%; 好发年龄以30～69岁为主,占80.41%;炎性、增生性、腺瘤性、错构瘤性、幼年性息肉分别占33.87%、32.11%、31.37%、1.77%、0.59%;息肉部位分别为直肠34.18%、乙状结肠23.12% 、降结肠14.96%、横结肠12.13%、升结肠11.49%、盲肠4.11%.679例大肠息肉患者中有30例发生癌变,癌变率为4.42%.管状腺瘤、混合性腺瘤、绒毛状腺瘤癌变率分别为5.88%、4.21 %、23.08%.息肉直径≤1.0 cm,无癌变发生;1.1～1.9 cm息肉,癌变率4.24%;≥2.0 c m息肉,癌变率21.37%.结论 30～69岁大肠息肉发病率较高,年龄大于50 岁为危险因素,男性较女性更容易患大肠息肉;息肉好发部位为左半结肠;病理类型以炎性息肉、增生性息肉和腺瘤性息肉常见;左半结肠、直径≥2.0 cm息肉、绒毛状腺瘤容易癌变 ;发现大肠息肉应尽可能切除,并应建立良好的随访机制,内镜下切除大肠息肉可预防息肉癌变.     

132例大肠息肉临床与病理分析

目的：探讨大肠息肉患者好发年龄、主要临床表现及息肉的发生部位、大小和病理类型及癌变规律。方法：对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜及病理资料进行分析总结。结果：检查患者1030例,检出大肠息肉132例,检出率12．8％,其中男性78例,女性54例;好发年龄50～69岁,占59．1％;腺瘤性、炎性、增生性、幼年性息肉各占63．8％、23．7％、8．9％和3．6％;息肉部位分别为盲肠4．0％、升结肠9．8％、横结肠6．7％、降结肠4．5％、乙状结肠33．9％、直肠41．1％。132例患者中,便血46例,21例息肉直径大于1．5cm者皆有便血;有4例发生癌变,癌变率3．0％,癌变息肉平均直径2.8cm。结论：50～69岁大肠息肉发病率较高;主要临床表现为便血,息肉直径较大及局灶癌变者易出血,男性较女性更易患大肠息肉;息肉好发部位为左半结肠;病理类型以腺瘤性息肉、炎性息肉较常见;左半结肠、直径≥2.0cm息肉容易癌变;内镜切除大肠息肉可预防息肉癌变。     

老年人结肠息肉的临床特点分析

目的 探讨老年结肠息肉的临床特点及其与癌变的关系.方法 对我院经结肠镜检出的498例结肠息肉患者的临床特点进行回顾性分析,比较老年组(60岁以上)与中青年组(60岁以下)结肠息肉的特点.结果 腺瘤性息肉的检出率老年组(69.7%)显著高于中青年组(37.6%)(P＜0.01);虽然结肠息肉以左半结肠为多,但在老年组腺瘤性息肉在结肠各部位的检出率并无显著性差异;绒毛状腺瘤不典型增生发生率和严重程度显著高于管状腺瘤.结论 老年人大肠息肉中的腺瘤性息肉患病率高,癌变机会大,老年人应尽量行全结肠检查,发现腺瘤性息肉,特别是绒毛状腺瘤不管大小应完整切除,减少癌变的机会.     

i-Scan染色联合内镜黏膜切除术治疗结直肠广基隆起性腺瘤性息肉疗效分析

目的探讨i-Scan染色联合内镜黏膜切除术(EMR)治疗结直肠广基隆起性腺瘤性息肉的临床疗效。方法回顾性分析解放军477医院自2011年5月至2013年7月收治的102例经病理确诊为腺瘤性息肉患者的临床资料。本组患者均行电子结肠镜检查,对息肉行i-Scan染色+放大内镜检查,行EMR治疗,留取完整标本送病理检查,创面均给予钛夹封闭。结果本组102例患者共检出150枚息肉,直径为0.8~2.0 cm,均为广基隆起性腺瘤性息肉。术后病理诊断:腺瘤性息肉148枚,术后1个月复查见病变部位黏膜光滑,未见息肉及病变黏膜残留;低级别上皮内瘤变2枚,未追加外科手术,随访3个月,未见肿瘤复发及他处转移。结论依据i-Scan染色预测息肉的组织学病理较确切,腺瘤性息肉系癌前病变,行EMR可完整切除息肉,减少息肉的复发,有助于发现早期癌变,改善患者预后。     

大肠息肉形态、部位、病理改变与恶变危险性关系分析

目的：分析大肠息肉形态、部位、病理改变等与恶变危险性的关系。方法对空军总医院2011年2月—2012年6月行结肠镜检查的537例患者的资料进行回顾性研究。结果内镜下发现大肠息肉158例，共282枚息肉，其中男121例，女37例，大肠息肉检出率为29.4%。腺瘤性息肉170枚，炎性息肉74枚，未做病理38枚；直径0.5 cm以下占55.3%；位于升结肠19.5%，横结肠20.2%，降结肠11.7%，乙状结肠30.1%，直肠18.4%；随访1年，4例复发，复发率为2.5%。结论大肠息肉以男性多见，腺瘤性为主，直径0.5 cm以下常见，好发部位为左半结肠；患病危险因素包括年龄、部位、息肉大小及病理类型，对所有息肉均应切除并做病理检查。     

550例大肠息肉的临床病理分析、内镜下治疗及随访

本文报道５５０ 例大肠息肉的临床及病理特点、内镜下治疗及１～２０ 年随访结果。大肠息肉的检出率为１４．０％ ，５０ 岁以上患者占 ４９．１％ ，单发性息肉 ４２０ 例，多发性息肉 １３０ 例，好发部位为乙状结肠和直肠（５０．５％ ）。病理诊断以腺瘤性息肉（４２．２％ ）和炎性息肉（４０．０４％ ）最多，息肉的异型增生发生率为１４．２％ ，腺瘤性息肉的癌变率为 １２．１％ ，结肠癌伴息肉的发生率为 ２．９％ 。对５４４ 例患者进行了内镜下息肉治疗，息肉的复发及再发率为５５．４％ ，平均复发时间为 ３２ 个月。随访检出４ 例息肉癌变，分别在术后第 ３、５、１０、２０ 年。     

结肠绒毛状腺瘤的双对比检查及其表现（附6例报告）

结肠绒毛状腺瘤是结肠腺瘤性息肉的一种类型，好发于直肠和乙状结肠，以发病年龄大，外观呈绒毛状，恶性程度高为特征，1861年，英国病理学家Holmes(1)首先报道两例并命名为绒毛状瘤（Villoustumor)，继后有不少病例报道，但国内有关X线形态分析的报道较少，现将我院经病理证实并有双对比结肠检查资料的6例报道如下。     

结肠息肉与代谢综合症相关性的临床研究

目的:通过比较结直肠息肉患者与结直肠检查未见异常者代谢综合征相关指标分析研究其与结直肠息肉的相关性.方法:根据纳入及排除标准入选225例结直肠息肉患者和153例同期住院肠镜检查未见异常患者血脂水平、血糖、体重指数.拟探讨与结直肠息肉的相关性.数据处理采用卡方检验或t检验.结果结直肠息肉组高脂血症发生率为50.6％(114/225),高于对照组的34.5％(53/153),(x2值=1.198,P＞0.05),其TG、TC、LDL-C、血糖、BMI的水平均高于对照组[(t=3.327、5.256、3.146、3.850、3.666,P=＜0.01).不同病理类型息肉组间患者血清TC、TG和LDL-C水平差异均无统计学意义(P均＞0.05).各病理类型结直肠息肉患者之间血脂水平比较,差异均无统计学意义(P均＞0.05).左半结肠、直肠高血脂发生率高于右半结肠,左右多发者高于上述二者,但差异无统计学意义.卡方值=1.469,P=0.480.男性血脂异常高于女性,但无显著差异(x2=0.40 P=0.523)在六个因素中甘油三脂和BMI与结直肠息肉有密切的关系,回归系数为1.006和0.122,甘油三脂和BMID的OR值分别为2.735,和1.129,P＜0.01.结论 代谢综合征相关指标与结直肠息肉相关,高TG血症和BMI与结直肠息内的发生密切相关.     

结肠绒毛状肿瘤的CT表现

目的 探讨结肠绒毛状肿瘤CT表现,以提高对该肿瘤的鉴别诊断水平.方法 回顾性分析经病理证实的8例结肠绒毛状肿瘤(包括绒毛状腺瘤和绒毛管状腺瘤)的CT表现.8例均为单发,其中男3例,女5例,8例均行CT平扫加增强检查.结果 8例中病变位于升结肠1例,乙状结肠2例,直肠5例.8例中有3例表现比较典型,增强后可见脑回状、树叶状表现,余5例病变呈息肉状.1例直肠腺瘤局部癌变,余7例为良性病变,其中4例合并不同程度不典型增生.结论 结肠绒毛状肿瘤CT表现形式多样,CT可以诊断典型的绒毛状肿瘤.     

直肠腺瘤性息肉癌变的MR多方位增强扫描表现

目的 探讨腺瘤性息肉癌变(APC)的MRI增强表现特点.方法 观察8例直肠腺瘤性息肉(AP)和APC共10枚病灶的MRI冠、矢、轴多方位增强扫描图像,并与病理诊断结果对照.结果 10枚直肠AP中,带蒂9枚,宽基底1枚;管状腺瘤1枚,绒毛-管状腺瘤4枚,绒毛-管状腺瘤伴局部癌变5枚.5枚AP增强扫描均呈“三环”状强化;5枚APC中4枚呈“煎蛋”样强化,1枚呈“铺路石”样强化.结论 直肠APC MRI增强扫描呈现“煎蛋”样强化,是否为APC的特征表现,值得关注.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.