胃窦粗大皱襞的临床表现、内镜形态及组织学改变

目的:探讨胃窦部粗大皱襞形成的原因、临床表现、内镜形态及组织学改变.方法:对胃镜检查中发现有胃窦部粗大皱襞患者,询问临床特点、内镜下检查形态、活组织病理检测其组织学改变,~(13)C尿素呼气试验测定其幽门螺杆菌感染率.结果:临床见有进食后上腹饱胀及上腹隐痛,伴有反酸、烧心、嗳气,胃动力药及助消化药物不能改善症状;内镜下形态以纵行条状粗大皱襞多见,弧形、类圆形次之.位于胃窦部小弯侧,1-4条,通向幽门,大部分脱入十二指肠,所有患者均有不同程度的胃炎.病理提示不同程度浅表性胃炎或不典型增生,伴糜烂者不典型增生比例较高.肠上皮化生、腺体数量减少也占一定比例.幽门螺杆菌阳性率为84.98%.结论:在胃窦部粗大皱襞中,幽门螺杆菌感染,不典型增生和肠上皮化生较一般浅表性胃炎高,可能与胃癌的发生有一定关系.     

高频电刀切除法治疗胃粘膜脱垂20例

高频电刀切除法治疗胃粘膜脱垂２０例陈邦杰胃粘膜脱垂（简称脱垂）发生主要原因是由于胃窦部粘膜下结缔组织异常松弛，每当炎症水肿、粘膜肌收缩时出现粗大皱襞呈“Ｖ”、“Ｓ”、“１”及槌状等形态，可持续存在或随蠕动变化而隐现，每当蠕动收缩时粗大皱襞向十二指肠延...     

小儿结肠息肉的内镜诊断及治疗

为探讨结肠镜检查对小儿下消化道出血的诊断及经内镜高频电凝切除术对小儿结肠息肉的治疗价值,23例下消化道出血的小儿接受了肠镜检查并应用内镜高频电凝切除术切除所有结肠息肉,结果显示:23例小儿下消化道出血的病因均为结肠息肉.本组病例中共发现并切除结肠息肉29个,其中直肠、乙状结肠息肉占72.4%(21/29);单发息肉占87.0%(20/23).病理学检查显示:幼年性息肉占69.2%(20/29);炎性息肉占20.7%(5/29);脉瘤性息肉占10.3%(3/29).所有病例均未发生出血、穿孔等严重并发症.作者认为:明确小儿下消化道出血的原因最好的方法是结肠镜检查,经内镜高频电凝切除术是治疗小儿结肠息肉安全有效的方法.     

弥漫浸润型胃癌误诊为胃黏膜相关淋巴组织淋巴瘤一例

患者女,63岁,因呕吐症状进行性加重,以"胃淋巴瘤可能,Menetrier病待排"收住入院.患者4个月前于外院胃镜检查提示:十二指肠球部溃疡并活动性出血,胃窦溃疡(A1期),胃黏膜粗大水肿性质待查,幽门螺杆菌(Hp)阳性;活检提示:胃黏膜呈炎症改变,伴有腺体萎缩,间质内有中等量淋巴细胞和浆细胞浸润,表层有少量嗜酸性粒细胞浸润;按消化性溃疡治疗及三联抗Hp治疗,症状改善不明显,渐出现呕吐,呕吐物为胃内容物.2个月前外院超声内镜检查提示:胃体、胃窦见粗大黏膜皱襞,增厚以黏膜层为主,考虑胃黏膜相关淋巴组织淋巴瘤可能;活检提示:黏膜慢性炎;予四联抗Hp治疗10 d,效果不明显.1个半月前于我院胃镜检查提示:胃体黏膜皱襞粗大呈脑回样,表面结节,僵硬,蠕动消失,Hp阴性;大块活检提示:炎性息肉(图1).     

老年人单发胃息肉的病例特点与内镜下治疗效果分析

目的探讨老年人单发胃息肉的病例特点,分析不同内镜下治疗方式的安全性及疗效。方法回顾性分析武汉大学人民医院2010年1月至2016年6月共计683例老年(60周岁以上)单发胃息肉患者的一般情况、内镜下表现及病理学特征,其中373例患者随访6~12个月,比较不同内镜下治疗方法的安全性及疗效。结果 683例老年单发胃息肉最常发生于胃窦部(51.1%),直径0.5 cm(54.03%),形态为山田Ⅱ型(60.18%),病理类型增生性息肉(45.97%)最为常见,炎性息肉(32.94%)次之。活检钳钳除术治疗369例(54.03%),高频电凝电切术治疗139例(20.35%),内镜下黏膜切除术175例(25.62%)。术后13例(1.90%)患者大便隐血阳性,215例(31.48%)患者诉腹部胀痛不适。对373例患者术后6~12个月进行内镜跟踪随访,7例患者复发,复发率为1.88%。结论老年人胃息肉多位于胃窦部,直径0.5 cm,山田Ⅱ型最为多见,病理类型以增生性息肉为主。内镜下治疗方法安全性高,但术后易发生腹部胀痛不适感。     

急诊内镜下消化道急性出血治疗37例

目的:本文在总结了近4a急诊内镜下止血的经验,探讨适合基层医院应用的简便、有效的治疗方法.方法:资料来自我室自1998-03/2002-02期间在12350例胃镜中正在出血37例本文研究资料.治疗方法:(1)局部注射治疗28例次,(2)高频电治疗仪局部高频电凝13例次;(3)电切时对电凝不彻底、息肉断端有出血和渗血者,再次电切9例次;(4)金属止血夹止血13例次;(5)出血创面喷洒凝血酶止血8例次;(6)内镜下以上方法联合治疗6例;结果:一次治疗显效24例(64.9%),有效例为34例(91.9%),本组经反复内镜下止血全部病例中仅1例因息肉电切后局部创面太大,无法止血,后转外科手术治疗外,其余病例经2次,甚至4次内镜下止血均有效止血.结论:内镜下注射盐水加副肾素和高频电凝反复应用是有效的的止血疗法.前者操作更为简单,安全,更适合基层医院应用.     

经结肠镜高频电圈套器联合尼龙绳套扎和/或钛夹钳夹治疗大肠宽蒂和大息肉156例

目的:评价结肠镜下高频电圈套器联合尼龙绳套扎和/或钛夹钳夹摘除大肠宽蒂、大息肉的疗效及安全性.方法:结肠镜下宽蒂息肉先予尼龙绳套扎其息肉根部,再予高频电圈套器凝切;大息肉(直径大于2.0cm者)先予钛夹2-3枚在息肉根部钳夹,然后再用高频电圈套器分块凝切.结果:结肠镜治疗大肠息肉788例、其中宽蒂、大息肉156例(宽蒂67例、大息肉89例),经予上述方法进行内镜下摘除,一次性切除息肉102枚(65.38%),分次切除54枚(34.62%),均获满意疗效,其中即刻出血2例(1.28%),立即给予内镜下血凝酶喷洒、电凝和/或钛夹,即时止血,无迟发出血.全部病例无1例穿孔.结论:经结肠镜高频电圈套器摘除消化系宽蒂、大息肉前给予尼龙绳套扎和/或钛夹钳夹息肉根部,明显减少了出血、穿孔等并发症,突破了以往内镜治疗息肉关于大小、宽蒂等禁区,避免了手术引起的创伤,安全可靠,值得推荐.     

Peutz-Jeghers综合征合并肿瘤分析26例

目的: 分析Peutz.Jegllers综合征及合并癌变的临床特征.总结其治疗和随访方案.方法: 回顾性分析荆楚理工学院附属第一、二临床医院1986.09/2006.08间收治的26例Peutz.Jeherts综合征患者的临床资料.结果: 10例患者(38.46%)家族史明确,临床以皮肤黏膜色素沉着、腹痛及便血为主要表现.并发肠梗阻14例(53.85%),消化道出血1O例(38.46%);发生恶变6例(23.08%),其中结肠癌3例,胃癌3例,平均确诊年龄31岁,恶变者的病理组织学分型均为低分化黏液腺癌.内镜下高频电凝息肉切除术、开腹肠道息肉切除及肠部分切除术为主要治疗手段.结论: Peutz.Jeghers综合征患者是恶性肿瘤的高发人群,肿瘤患者发病年龄轻,分化较差.定期复查内镜,以内镜高频电凝积极处理肠息肉,以及筛查肿瘤是提高Peutz-Jegllers综合征远期疗效的有效方法.     

上消化道肿瘤狭窄的内镜下治疗

目的探讨上消化道肿瘤狭窄的内镜下联合治疗方法和临床意义.方法对门诊及住院收治的20例上消化道中晚期肿瘤狭窄在消化内镜直视下用微波、高频电、探条联合扩张治疗.男16例,女4例,男女之比为41.年龄35岁～75岁.以进食和(或)饮水困难、呕吐为主诉.均已失去手术机会或不愿意手术.其中食管癌18例,胃体癌2例,狭窄部位食管上段3例,中段11例,下段4例,胃体高位浸润贲门口2例.病理诊断高分化鳞癌12例,中-低分化鳞癌6例,低分化腺癌1例,高分化腺癌1例.吞咽困难按Stooler标准分级,2级5例,3级13例,4级2例.我们先用微波天线经内镜活检孔插入肿瘤组织进行凝固,使其呈"漏斗型”,再用萨氏探条遵循从小到大顺序依次扩张,出血者用高频电凝止血,直至内镜顺利通过,再逆行对肿瘤组织微波凝固.治疗结果,患者的临床症状均有改善.结果20例中晚期肿瘤狭窄的患者经内镜下微波、高频电、探条联合治疗后,吞咽困难按Stooler标准分级改善2个级别,由4级升为2级以上,或由3级升为1级为显效,有14例,增加1个级别为有效,有6例,总有效率100%,改善吞咽困难18例占90.0%,治疗中胸痛13例占65.0%,术后发热3例占15.0%,无穿孔、大出血及死亡.结论上消化道中晚期肿瘤狭窄内镜下微波、高频电、探条扩张联合治疗,改善狭窄、梗阻及吞咽困难明显,联合治疗较单一治疗疗效好,附件简单,操作简便并发症低,安全、费用少等优点,为有效的姑息疗法,适合基层医院开展内镜治疗.     

康复新液在胃肠息肉电切术后的临床应用观察

[目的]探讨康复新液在胃肠息肉内镜下治疗后的应用疗效。[方法]搜集观察300例胃肠息肉患者,根据术后是否应用康复新液治疗分组:治疗组(150例)和对照组(150例)。对照组采用内镜下息肉电切后控制饮食、抑酸、预防出血、抗感染等综合治疗,治疗组在综合治疗基础上另予康复新液内服治疗。[结果]治疗组第1次复查内镜治愈132例(88%),有效16例(10.67%),无效者2例(1.33%),第2次复查内镜所有患者均好转;对照组第1次复查内镜治愈82例(54.67%),有效62例(41.33%),无效者6例(4%),第2次复查内镜共有137例完全治愈(91.33%),无效者0例,剩余13例在第3次复查时完全愈合形成瘢痕。对照组及治疗组第1次复查内镜,治愈率比较,差异有统计学意义(P0.05);2组第2次复查内镜,治愈率差异无统计学意义;2组首次及二次复查总有效率,差异均无统计学意义。术后3d治疗组患者腹痛缓解率93.33%,对照组腹痛缓解率80.0%,2组腹痛缓解率比较,差异有统计学意义(P0.05)。术后治疗组患者迟发性出血率0.67%,对照组迟发性出血率3.33%,2组迟发性出血率比较,差异无统计学意义。[结论]经内镜胃肠息肉电切术后加用康复新液内服,可以加快术后创面愈合,缓解术后腹痛和防治术后出血等并发症。     

Extramedullary hematopoietic growth factor and cytokine gene expression indicate endocrine regulation of hematopoiesis in patients with acute appendicitis

 To analyze the role of hematopoietic growth factors (HGFs) and other cytokines in the regulation of hematopoiesis in vivo, we investigated HGFs and cytokine gene expression in appendices obtained from patients who underwent surgery for suspected appendicitis. Concomitantly, HGF gene expression was studied in bone marrow (BM) biopsy specimens and plasma HGF levels were measured. G-CSF gene expression was detected in inflamed but not in normal appendices. With one exception, GM-CSF was detectable in all appendices whether inflamed or not, whereas IL-3, except for one case, was not expressed in appendices. None of the investigated HGFs appeared to be expressed in BM biopsy specimens concurrently obtained with the appendices. Plasma G-CSF levels were significantly elevated in patients with appendicitis compared with patients without inflamed appendices. Circulating levels of GM-CSF and IL-3 were not increased. Significant up-regulation of IL-8 and IL-6 gene expression was observed in response to inflammation, in contrast to IL-1α and IL-1β expression, which appeared not to be influenced by the inflammatory state. These data indicate that G-CSF, and not GM-CSF or IL-3, is essential for the regulation of inducible granulopoiesis in acute inflammatory conditions, and that G-CSF acts in an endocrine fashion. Received: 1 September 1997 / Accepted: 19 September 1997     

高频电圈套技术在支气管内病变中的应用

目的探讨高频电圈套技术在支气管病变中的应用。方法在局麻下经气管镜高频电圈套技术对气管内病变进行电凝。结果 31例支气管病变的患者行高频电圈套34次,10例有效,11例部分有效,7例轻度有效,3例无效,其中3人行两次高频电圈套治疗。其中良性病变:5例,恶性病变:26例。合并出血8例,感染1例。结论经气管镜高频电圈套技术消除支气管内病变安全、有效,不良反应少,在解除支气管内病变尤其是良性病变导致的阻塞或梗阻方面作用巨大。     

无痛麻醉下电圈套器联合氩气刀治疗老年中央型晚期肺癌疗效观察

目的探讨支气管镜下电圈套器联合氩气刀治疗老年中央型晚期肺癌气道狭窄的临床疗效及安全性。 方法选取2014年7月至2017年8月连云港市第二人民医院收治的老年中央型晚期肺癌患者68例（鳞癌38例,腺癌22例,小细胞肺癌8例）,均在无痛麻醉下采用支气管镜介导下联合应用电圈套器和氩气刀治疗。应用氩气刀时,调节气流速度为0.3～2.0 L/min,输出功率20～40 W,导管前端距离病灶上方约1 cm;应用高频电刀时,电凝探头须直接接触病灶进行灼烧,治疗时间一般为0.5～2.0 h/次,治疗间隔时间3～5 d/次。 结果68例患者共行电圈套器及氩等离子体凝固治疗105次,其中1例患者治疗最多达8次。治疗结束时的即刻临床疗效：完全有效38例（55.9%）,部分有效23例（33.8%）,轻度有效7例（10.3%）,即时有效率为100%。所有患者术中、术后均未出现大出血、穿孔等严重并发症,轻微并发症均经对症处理后痊愈。 结论无痛麻醉下行电圈套器联合氩气刀治疗老年中央型晚期肺癌,操作性强,患者耐受好,可明显缓解症状,疗效佳,值得临床推广。     

支气管镜下介入治疗支气管结核气道阻塞82例临床疗效分析

目的 探讨经支气管镜下介入治疗支气管结核气道阻塞的临床疗效。方法 对82例支气管结核气道阻塞的患者在全身常规抗结核治疗的同时,联用支气管镜下介入治疗,根据气道阻塞狭窄程度选择冲洗、钳夹清除、高频电凝治疗及球囊扩张术治疗,后再局部管腔内注入抗结核药物INH。结果 82例患者管腔完全通畅54例、管腔轻度狭窄26例,气道阻塞未改变2例。结论 经支气管镜下介入治疗支气管结核气道阻塞的疗效确切,能有效解除气道阻塞。     

Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data

OBJECTIVE: To examine the long-term outcome of patients with active ankylosing spondylitis (AS) clinically and by magnetic resonance imaging (MRI) after continuous treatment with the tumor necrosis factor (TNF) receptor fusion protein etanercept over 2 years. METHODS: Overall, 26 patients with active AS were treated with etanercept 25 mg twice daily subcutaneously, twice weekly with no concomitant disease-modifying antirheumatic drugs (DMARDs) or steroids. The clinical response was assessed by standardized parameters. Inflammatory spinal lesions were quantified by the ASspiMRI-a rating gadolinium-enhanced (T1-weighted gadolinium diethylenetriaminepentaacetic acid) and STIR MRI sequences. The primary outcome was a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) improvement > or =50% after 2 years of etanercept therapy compared with the baseline value of the study. RESULTS: Overall, 21 (70%) of 30 patients completed year 2. In the intent-to-treat analysis, 54% of the patients showed a 50% improvement according to the BASDAI and a 40% improvement according to the Assessment in Ankylosing Spondylitis (ASAS) criteria. In the completer analysis, 9 (43%) of 21 patients were in partial remission according to ASAS criteria. Mean +/- SD BASDAI scores, which were elevated at baseline (6.3 +/- 1.6), remained low: 2.7 +/- 2.4 after 2 years compared with 2.6 +/- 2.2 at week 54. In accordance, all other clinical parameters showed sustained improvement during year 2. The majority of patients had no disease activity flares. MRI evaluation showed a 75% improvement of active spinal lesions, but minor spinal inflammation was still present in 64% of the patients after 2 years. There were 2 serious adverse events leading to discontinuation of etanercept. CONCLUSION: The clinical efficacy and safety of etanercept in patients with active AS without simultaneous administration of DMARDs or steroids over 2 years of continuous treatment is confirmed. Spinal inflammation as depicted by MRI decreased significantly, but a few patients still had some spinal inflammation even after long-term anti-TNF therapy.     

Circulating level of hepatocyte growth factor as a useful tumor marker in patients with early‐stage gastric carcinoma

Background: Although conventional tumor markers including carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19‐9) have been used in gastric cancer patients, clinically useful markers of early gastric cancer have not been identified. The present study was designed to clarify the clinical significance of the circulating level of hepatocyte growth factor (HGF) as a tumor marker, especially in early‐stage gastric cancer patients. Methods: Preoperative serum HGF levels were measured with an enzyme‐linked immunosorbent assay in 30 early‐stage and 42 advanced‐stage gastric cancer patients. Results: The mean value of serum HGF in 72 patients was significantly higher than that in the normal subjects. There was a significant increase in serum HGF levels in both advanced‐stage and early‐stage patients compared with normal subjects. The positivity rates of HGF in early disease cases were higher than those of CEA and CA19‐9. The serum HGF level was significantly higher in patients with vessel invasion than in those without invasion. In smaller early gastric cancers, serum HGF elevation was associated with lymphatic invasion. Conclusions: The serum HGF level may be a clinically significant tumor marker in patients with early‐stage, as well as advanced‐stage, gastric cancer. HGF elevation in early‐stage patients may help us to predict the risk of lymph node metastasis of early gastric tumors, even of smaller tumor size. HGF may be a useful indicator for appropriate lymphadenectomy in early gastric cancer.     

Hematopoietic growth factors in the treatment of acquired bone marrow failure states

In severe aplastic anemia (SAA), the use of hematopoietic growth factors (HGFs) to support blood counts is of limited value, as predicted by in vitro studies and measurement of endogenous serum levels of hematopoietic growth factors (HGF), which are markedly elevated. Benefit is usually only seen in those with less severe disease who are unlikely to require HGFs in practice. HGFs administered alone play no role in the treatment of SAA. The main indication for using HGFs, most often granulocyte colony-stimulating factor (G-CSF), in SAA has been to determine whether they increase the response rate to immunosuppressive therapy (IST) and improve survival. While earlier neutrophil recovery occurs when G-CSF is administered with IST, studies to date show no significant advantage in hematologic response or overall survival. Conflicting results have been reported concerning whether G-CSF increases the known risk of myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) after IST; follow-up of at least 10 years is required, lacking in many clinical studies reported to date. In MDS, HGFs have been used to counteract the intramedullary apoptosis, which leads to ineffective hematopoiesis. In several uncontrolled and controlled studies, especially in low-risk MDS, high-dose erythropoietin (EPO) or its glycosylated derivative darbepoetin (DPO), alone or in combination with G-CSF, increased hemoglobin levels and diminished the need for red blood cell transfusions, in selected patients with prior transfusion frequency of less than 2 units per month and EPO levels below 500 IU/L. Quality-of-life measures were claimed to have improved, but the cost-effectiveness of this approach is debated, as is safety with regard to the risk of progression. G-CSF is used in supportive care of MDS to improve neutropenia during infectious complications, but to date there is no compelling evidence for a survival benefit or alteration of the course of the disease through the use of HGFs in MDS.     

Human acute stem cell leukemia with multilineage differentiation potential via cascade activation of growth factor receptors

The morphologic, immunophenotypic, genotypic, genomic, and functional features of an undifferentiated acute leukemia with stem cell features are reported. At light and electron microscopy, the leukemic population was represented by primitive progenitor cells with no evidence of differentiation. The blasts were CD34(+), AC133(+), CD71(-), HLA-DR(-), CD38(-/dim+), CD90(+), CD117(dim+), flt3(+); did not express B, T, or myeloid-associated antigens; and showed a germline configuration of the immunoglobulin and T-cell receptor. Genomic profiling documented the expression of early stem cell and myeloid-associated genes. Receptors for early-acting hemopoietic growth factors (HGFs) were detected, while receptors for unilineage HGF were not expressed. Incubation with the flt3 or Kit ligand induced the expression of unilineage HGF receptors, allowing these cells to respond to their respective ligands. Growth without differentiation was sustained only in the presence of early-acting HGF, namely flt3 ligand, while early and unilineage HGF gave rise to all types of hemopoietic colonies.