溃疡性结肠炎粘膜异型增生的X线表现

慢性溃疡性结肠炎患者属结肠癌高危人群,结肠粘膜常有异型增生发生。结肠癌切除标本中也常发现粘膜异型增生,所以异型增生被认为是慢性结肠炎的癌前病变。为此,作者对有全结肠炎7年以上病史的170例病人作了5年多的监视随访研究,着重于异型增生的X线表现。方法:第一年所有病人作结肠双对比造影和结肠镜检查以及多部位的随意活检;第二年重复结肠镜检查和活检;第三年重复结肠双对比造影和直肠、乙状结肠镜检查;第四年以后结肠镜活检和结肠双对比造影交替进行。如果发现异型增生或癌等病情,则予以严密随访、活检或作结肠切除。放射科医师回顾阅读全部病人     

溃疡性结肠炎细胞核DNA含量检测的临床意义

溃疡性结肠炎与大肠癌的关系一直为临床和病理工作者所关注,肠粘膜异型增生是否属于癌前病变,已有不少研究报道,但尚无定论 [1－ 3]。我们采用自动图像分析技术对正常肠粘膜、溃疡性结肠炎及大肠癌进行细胞核 DNA含量的定量分析,旨在探讨溃疡性结肠炎粘膜异型增生与大肠癌的关系,为溃疡性结肠炎的监测及大肠癌早期诊断提供有价值的客观依据。 一、材料与方法： 87例均为 1990年 5月～ 1999年 3月因消化道症状来我院做肠镜检查者,正常肠粘膜 21例;溃疡性结肠炎 34例,其中,伴异型增生 20例;大肠癌 32例。活检标本取自本院病理科常…     

溃疡性结肠炎癌变的回顾性分析

目的分析558例溃疡性结肠炎(UC)发生结直肠癌的风险以及危险因素,为溃疡性结肠炎相关癌(UC-CRC)的监测、筛查以及预防提供依据。方法 1997年1月至2007年12月南方医院共行结肠镜检查32926例,对其中558例UC患者以及UC-CRC患者的相关临床资料进行回顾性分析。结果在558例UC患者中,发现结直肠癌8例,均为进展期癌,总体风险为1.43%,2组病人在年龄、疾病病程、病变范围、诊断结直肠癌前活检是否有不典型增生、是否使用5-ASA类药物、激素治疗以及是否参加内镜随访等方面有显著性差别。危险因素分析提示,疾病病程、病变范围以及结肠镜检查发现不典型增生为UC-CRC的危险因素;定期内镜随访、5-ASA以及激素治疗可降低UC-RC发病的风险。结论 UC患者有较高癌变的风险,但总体风险较西方国家低;UC病程大于10年、全结肠炎以及活检发现有不典型增生是发生结肠癌的高危因素,定期内镜随访以及5-ASA和激素治疗是UC患者防止发生结直肠癌的保护因素。     

下消化道出血320例分析

[目的]探讨下消化道出血的常见病因.[方法]对2000年1月～2005年6月经电子结肠镜检查的320例下消化道出血患者进行回顾性分析.[结果]其主要病因依次为大肠癌62例、大肠息肉55例、溃疡性结肠炎46例、痔疮42例、结肠炎(未明确原因)37例等.[结论]大肠癌、大肠息肉及溃疡性结肠炎是下消化道出血最常见的三大病因,结肠镜检查是下消化道出血有效而安全的诊断方法.     

康复新联合瑞巴派特治疗溃疡性结肠炎的疗效观察

目的观察康复新联合瑞巴派特保留灌肠治疗溃疡性结肠炎的临床疗效。方法行电子结肠镜检查确诊的120例溃疡性结肠炎患者分为治疗组和对照组。治疗组用瑞巴派特+康复新+生理盐水混合后保留灌肠,每天1次;对照组用康复新+生理盐水保留灌肠,方法同治疗组。治疗12周后用结肠镜复查,观察其疗效和安全性。结果治疗组12周临床显效率、总有效率分别为71.0%和96.8%。对照组分别为44.8%和75.9%,两组有显著性差异(P<0.05)。结论康复新联合瑞巴派特保留灌肠治疗溃疡性结肠炎临床疗效显著。     

溃疡性结肠炎相关肿瘤3例诊疗报道并文献复习

目的探讨溃疡性结肠炎(ulcerative colitis, UC)相关肿瘤的临床特点、诊治、预后。方法对3例UC相关肿瘤患者的临床资料进行回顾性分析并复习相关文献。结果 3例UC相关肿瘤患者病程均超过10年;肠镜提示肿瘤性病变均为息肉样病变;2例为广泛结肠型结肠炎,1例为左半结肠型结肠炎;病理1例提示癌,2例活检组织提示中-度和重度异型增生;异型增生患者内镜下切除后经规范5-氨基水杨酸(5-aminosailcylic acid, 5-ASA)治疗及内镜下监测,病变处于黏膜愈合;1例癌变患者因未及时治疗,后期出现肿瘤多处转移。结论 UC相关肿瘤患者病程长,多见于广泛结肠受累的患者,以息肉样病变为主的肿瘤性病变可以内镜下切除,辅以规范治疗及监测,预后较好。     

比特诺尔治疗肠道疾病的临床研究

目的观察比特诺尔治疗慢性结肠炎，溃疡性结肠炎及肠易激综合征的疗效．方法应用比特诺尔共治疗门诊及住院患者112例，男女各56例；年龄47．51岁±11．21岁（20～76）．比特诺尔，每次3粒，4次／d，疗程4wk．治疗前及治疗后wk2，wk4末随访症状；治疗前后随访不良反应；检查血尿常规，肝肾功能；26例患者治疗前后随访纤维结肠镜，有异常者取活检.结果比特诺尔治疗4wk后，慢性结肠炎39例，总有效率76．92％；溃疡性结肠炎27例，总有效率81．48％；肠易激综合征46例，总有效率91．30％42例复查历镜，慢性结肠炎12例，总有效率75％；溃疡性结肠炎23例，总有效率78．26％；肠易激综合征7例，治疗前后均无明显异常．治疗期间不良反应除便秘，恶心各1次停药外，余均呈轻微一过性，能完成疗程．结论应用比特诺尔治疗肠易激综合征，慢性结肠炎，溃汤性结肠炎取得较好疗效．     

武汉地区老年人溃疡性结肠炎的临床特点

目的回顾分析武汉地区老年人群(≥60岁)溃疡性结肠炎的临床特点。方法选取武汉大学中南医院2007年至2011年住院治疗溃疡性结肠炎的患者共237例,对其临床特点、实验室检查结果及结肠镜下表现进行分析。比较老年人溃疡性结肠炎患者(≥60岁)与非老年溃疡性结肠炎患者(<60岁)间是否存在差异。结果 237例溃疡性结肠炎患者中,≥60岁患者38例(16.03%)。在老年溃疡性结肠炎患者中,腹痛、腹泻及发热等表现与非老年患者均无显著性差异(P>0.05)。老年组血便及消瘦发生率高于非老年组,差异具有统计学意义。病变发生部位上,老年患者局限于脾曲以下者94例(47.24%),与非老年组患者存在差异(P=0.036)。按Truelove和Witts UC分度,老年患者重度9例(23.68%),与非老年组差异存在统计学意义(P=0.007)。老年组使用糖皮质激素者14例(36.84%),与非老年组相比差异具有统计学意义(P=0.116)。结论老年溃疡性结肠炎患者与非老年溃疡性结肠炎患者临床表现、病变范围、病情严重程度及治疗方法等均存在一定差异。     

老年大肠广基息肉内镜黏膜切除术的临床研究

目的探讨内镜黏膜切除术（EMR）对老年广基息肉病变的治疗价值及安全性。方法采用结肠镜下大肠黏膜切除术治疗117例共157枚大肠广基息肉。病灶黏膜下注射肾上腺素生理盐水后,一次圈套整块切除或分次圈套切除病变,回收标本送病理检查,术后结肠镜随访。结果全部息肉通过EMR一次切除,切除息肉大小在1～5cm范围;腺瘤性息肉141枚,增生性息肉13枚;局灶癌变3例（病理证实）。4例出现腹痛,3例少量便血,发烧4例,不需要特殊处理。复查患者未有息肉残留者。腺瘤息肉异型增生程度与息肉大小密切相关（P〈0.05）。结论老年大肠广基息肉通过EMR切除完全,安全;腺瘤息肉的大小与异型增生密切相关,提示腺瘤息肉需要早期干预治疗。     

胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄（44.2±14.6）岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性（Kappa值和P值）,并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例 而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%（19/19）,肠道清洁度优良率达79%（15/19）,检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy: A retrospective co-operative IG-IBD study

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.     

Clinical investigation of colorectal cancer detected by follow-up colonoscopy after endoscopic polypectomy

PURPOSE: We analyzed the results of a long-term follow-up surveillance of patients with colorectal polyps after endoscopic polypectomy in terms of the cumulative incidence of subsequent colorectal cancer and the clinicopathologic characteristics of carcinomas detected by colonoscopy. METHOD: The study cohort consisted of 6,715 patients who had received endoscopic resection of single or multiple colorectal polyps and then underwent periodic colonoscopy (or a combination of sigmoidoscopy and barium x-ray examination in some cases) during an average follow-up of six years (40,622 person-years in total). RESULTS; During the follow-up, 31 cases of colorectal cancer containing 15 submucosal invasive carcinomas (T1,N0,M0) and 16 advanced carcinomas were detected. The cumulative incidence of colorectal cancer was analyzed for four subgroups of the 6,715 patients classified according to the diameter, grade of dysplasia, and histologic features of polyps. Furthermore, the depth of invasion, macroscopic configuration of submucosal invasive cancer, and site of colorectal cancer observed in the 31 cases were compared with those of a reference group of 1,497 patients with colorectal cancer treated at Takano Hospital during the same period. Submucosal invasive cancer was the most common type among the colorectal carcinomas detected during follow-up. In terms of macroscopic configuration of submucosal cancer, the superficial type was significantly more common than the protruded type. The superficial submucosal cancer showed a significantly longer interval to detection than the protruded submucosal cancer. By site of lesion, proximal colon cancer was significantly more common. CONCLUSION: Follow-up colonoscopy appears to be useful in patients with larger polyps (>5 mm). Patients with severe dysplasia and those with malignant polyps should be followed-up carefully. Because submucosal cancer detected by follow-up examination after polypectomy showed higher rates of superficial-type cancer and proximal colon cancer, careful endoscopic examination of the entire colon is important.     

早期大肠癌的内镜治疗

探讨内镜治疗对早期大肠癌的治疗价值。方法对１９７８年－１９９９年５月经病理确诊的９１例早期大肠癌的临床资料,治疗方式和随访结果进行分析。结果接受单纯镜治疗４８例（５１个癌灶）,外科手术治疗（包括内镜治疗后追加手术者）４３例（４７个癌灶）。内镜的癌灶完全切除率达９６．８％（６１／６３）,无无严重并发症产生。单纯内镜治疗组经３个月－１２年随访,除失访４例、３例死于心脏病外,患者无１例复发,存活率达１０     

Ulcerative colitis. Cancer surveillance in an unselected population

An unselected series of patients with chronic ulcerative colitis from a defined catchment area underwent endoscopic and histologic cancer surveillance from 1977 to 1985. At the end point of the study, which included a total of 93 patients, there were 38 patients with total colitis of more than 10 years' duration. There was one case of colonic carcinoma, two cases of high-grade dysplasia, and no death due to colorectal cancer. We conclude that in an unselected group of patients with ulcerative colitis, the risk for colorectal dysplasia and cancer is low and that a surveillance program is reliable and can be performed at a community hospital.     

Gastric Ulcer and Risk of Cancer

Abstract In 1976, 121 patients with benign gastric ulcer and 13 with gastric carcinoma were diagnosed in our department by endoscopy, cytology and directed biopsies. At a 5-year follow-up, 78 of these patients were re-examined with endoscopy and biopsies. None had developed gastric cancer during the observation time. Of the 78 patients who underwent endoscopy, 16 had gastric ulcer, 2 duodenal ulcer and 27 atrophic gastritis, including 3 with moderate dysplasia of the gastric mucosa. The patients with ulcer had remarkably few symptoms. Only few data are available concerning the postulated link between gastric ulcer disease and gastric malignancy. The cancer-ex-ulcere hypothesis seems to be a medical dogma. However, well planned prospective studies with endoscopic follow-up of gastric ulcers are needed to elucidate the question properly     

Most dysplasia in ulcerative colitis is visible at colonoscopy

BACKGROUND: Patients with long-standing extensive ulcerative colitis are at increased risk for colorectal carcinoma. Because most dysplasia is believed to be macroscopically invisible, recommended surveillance protocols include multiple non-targeted colonic biopsies. It was hypothesized by us that most dysplasia is actually colonoscopically visible. This study assessed the proportion of dysplasia that has been detected macroscopically in patients who underwent colonoscopy surveillance at our center. METHODS: A retrospective review was conducted of colonoscopically detected neoplasia (dysplasia or cancer) in patients with ulcerative colitis who underwent surveillance from 1988 through 2002. An established surveillance protocol was used in all cases that included random segmental biopsies every 10 cm throughout the length of the colon, in addition to targeted biopsies of macroscopic lesions. Neoplasia detection was categorized as resulting from either targeted or non-targeted ("random") biopsies. Follow-up information was obtained to the study end. RESULTS: A total of 525 patients underwent 2204 surveillance colonoscopies. A total of 110 neoplastic areas were detected in 56 patients: 85 (77.3%) were macroscopically visible at colonoscopy, and 25 (22.7%) were macroscopically invisible. Fifty patients (89.3%) had macroscopically detectable neoplasia, and 6 (10.7%) had macroscopically invisible lesions. The frequency of cancer in patients who had endoscopic resection of neoplasia did not differ from that for the surveillance population as a whole (1/40 vs. 18/525; p=1.0, Fisher exact test), irrespective of whether the lesion was thought to be an adenoma or a dysplasia-associated lesion/mass. Conversely, a high proportion of unresectable lesions harbored cancer. CONCLUSIONS: Most dysplastic lesions in ulcerative colitis are visible at colonoscopy. From a clinical perspective, the endoscopic resectability of a lesion is more important than whether it is thought to be a sporadic adenoma or a dysplasia-associated lesion/mass.     

Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease.

BACKGROUND & AIMS: Endoscopic screening and periodic surveillance for patients with Barrett's esophagus has been shown to be cost-effective in patients with esophageal dysplasia, with treatment for esophageal cancer limited to esophagectomy. Most gastroenterologists refer patients with high-grade dysplasia for esophagectomy, and effective endoscopic therapies are available for nonoperative patients with esophageal cancer. The cost-effectiveness of screening strategies that incorporate these nonsurgical treatment modalities has not been determined. METHODS: We designed a Markov model to compare lifetime costs and life expectancy for a cohort of 50-year-old men with chronic reflux symptoms. We compared 10 clinical strategies incorporating combinations of screening and surveillance protocols (no screening, screening with periodic surveillance for both dysplastic and nondysplastic Barrett's esophagus, or periodic surveillance for dysplasia only), treatment for high-grade dysplasia (esophagectomy or intensive surveillance), and treatment for cancer (esophagectomy or surgical and endoscopic treatment options). RESULTS: Screening and surveillance of patients with both dysplastic and nondysplastic Barrett's esophagus followed by esophagectomy for surgical candidates with high-grade dysplasia or esophageal cancer and endoscopic therapy for cancer patients who were not operative candidates cost $12,140 per life-year gained compared to no screening. Other screening strategies, including strategies that had no endoscopic treatment options, were either less effective at the same cost, or equally effective at a higher cost. CONCLUSIONS: The cost-effectiveness of screening and subsequent surveillance of patients with dysplastic as well as nondysplastic Barrett's esophagus followed by endoscopic or surgical therapy in patients who develop cancer compares favorably to many widely accepted screening strategies for cancer.     

Endoscopic factors in the diagnosis of colorectal dysplasia in chronic inflammatory bowel disease

BACKGROUND: Surveillance colonoscopy in inflammatory bowel diseases (IBDs) is advocated for early diagnosis of neoplasia but is imperfect because some patients develop cancer despite surveillance. We sought to determine if any endoscopic factors during surveillance colonoscopy were associated with the diagnosis of colorectal dysplasia before the development of cancer. METHODS: We reviewed the Mayo Clinic endoscopic database and medical records of patients with IBD who underwent surveillance colonoscopy between January 2002 and November 2003. Associations were sought between endoscopic factors and the diagnosis of dysplasia. Among 635 IBD patients, 24 (3.8%) had flat dysplasia and 12 (1.9%) had IBD-related polypoid dysplasia. In 28 patients (4.4%), sporadic tubular adenoma was identified. Colonoscopies in which flat dysplasia was identified varied in duration from 7 to 81 minutes (median, 24.5 min) compared with 3 to 70 minutes (median, 22 min) for those in which dysplasia was not found. RESULTS: Using logistic regression analysis, we found that every additional minute in total colonoscopy time increased the flat dysplasia diagnosis rate by 3.5% (P = 0.0157). There was a significant correlation between median surveillance colonoscopy duration per endoscopist and flat dysplasia diagnosis rate (P = 0.0066). The number of biopsies taken during the procedures with flat dysplasia ranged from 6 to 36 (median, 28) compared with 2 to 54 (median, 25) in those without flat dysplasia. There was no significant effect of biopsy number of dysplasia diagnosis. CONCLUSIONS: Our results show that the practice of surveillance colonoscopy varies greatly among endoscopists, and longer procedure duration is significantly associated with the likelihood of dysplasia diagnosis.     

Early diagnosis and treatment of pancreatic dysplasia in patients with a family history of pancreatic cancer.

BACKGROUND: Pancreatic cancer, the fourth most common cause of cancer death in the United States, is hereditary in an estimated 10% of cases. Surveillance of patients with a familial predisposition for pancreatic cancer has not been systematically evaluated. OBJECTIVE: To develop a surveillance program that can identify and treat patients who have precancerous conditions of the pancreas and a family history of pancreatic cancer. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: 14 patients from three kindreds with a history of pancreatic cancer. INTERVENTIONS: Endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP), spiral computed tomography, and serum carcinoembryonic antigen and CA19-9 analysis were performed in all patients. Four affected patients were tested for the K-ras mutation. MAIN OUTCOME MEASUREMENT: Pancreatic dysplasia was determined by histologic evaluation. RESULTS: Seven of the 14 patients were believed to have dysplasia on the basis of clinical history and abnormalities on endoscopic ultrasonography and ERCP and were referred for pancreatectomy. All 7 patients had histologic evidence of dysplasia in pancreatectomy specimens. Findings on endoscopic ultrasonography were subtle, nonspecific, and similar to those seen in patients with chronic pancreatitis. Findings on ERCP ranged from mild and focal side-branch duct irregularities and small sacculations to main-duct strictures and grapelike clusters of saccules. Some of these changes are typical of chronic pancreatitis, but others are more distinctive. Spiral computed tomography and serum tumor markers had low sensitivity in the detection of pancreatic dysplasia. Analysis for the K-ras mutation yielded positive results in 3 of 4 patients with dysplasia. CONCLUSIONS: Thorough screening of patients with a family history of pancreatic cancer is feasible. Clinical data combined with imaging studies (endoscopic ultrasonography and ERCP) can be used to identify high-risk patients who have dysplasia. The role of molecular genetic testing is uncertain at this time.     

内镜下黏膜切除术在治疗早期食管癌和重度不典型增生中的应用

目的探讨内镜下黏膜切除术（EMR）治疗早期食管癌、重度不典型增生的应用价值。方法对我院2004年2月～2009年4月经色素内镜筛查且活检证实为早期食管癌及重度不典型增生的32例患者,在静脉麻醉下进行内镜下黏膜切除术透明帽法治疗,其中早期癌8例,重度不典型增生24例。结果对早期食管癌及重度不典型增生的32例患者进行内镜下黏膜切除术透明帽法治疗,成功27例,小量出血2例,无穿孔及狭窄等严重并发症。结论严格筛选患者行内镜下黏膜切除术透明帽法治疗早期食管癌、癌前病变是安全而有效的方法。