无痛胃镜下高分辨率食管测压电极导管置入在贲门失弛缓症中的临床应用

目的探讨无痛胃镜辅助下高分辨率食管测压(HRM)电极导管置入技术在贲门失弛缓症(AC)患者中的临床应用价值,同时通过分析麻醉中及苏醒后HRM数据的变化评估其在麻醉中连续实时监测的意义。方法回顾性分析该院2014年3月-2017年3月经无痛胃镜辅助下行HRM电极置入术的AC患者10例,实时监测患者在麻醉中及苏醒后的不同状态下HRM的检测数据,使用该中心20例健康志愿者常规HRM检测结果作为正常对照组,分别比较两种状态下反应食管胃连接部(EGJ)功能的参数变化情况[食管下括约肌压力(LESP)(包括呼吸最小值及呼吸平均值)和食管胃连接部收缩积分(EGJ-CI)]。结果入组10例AC患者。其中3例无法耐受常规测压电极导管插入失败;3例测压电极导管插入后证实电极打折或未能通过EGJ;4例术前内镜见食管扩张明显或食物潴留的患者直接选择此方法进行监测。全部病例均于无痛胃镜辅助下将电极成功置入,同时HRM实时监测证实电极成功通过EGJ。苏醒后常规行HRM监测,符合芝加哥分类标准3.0(CCv3.0)ACⅠ型4例,Ⅱ型6例。麻醉状态下测压参数LESP(呼吸最小值及呼吸平均值)及EGJ-CI明显低于苏醒后,差异均有统计学意义(P 0.01);麻醉状态下测压参数LESP呼吸最小值与正常对照组无明显差异(P0.05),但LESP呼吸平均值和EGJ-CI均较正常对照组低,差异均有统计学意义(13.1vs 18.8,P=0.012;26.2 vs 42.7,P=0.005);然而在苏醒状态下EGJ-CI及LESP呼吸最小值明显高于正常对照组,差异均有统计学意义(69.1 vs 42.7,P=0.000;20.4 vs 12.6,P=0.012),全部病例完整松弛压(IRP)均大于15 mmHg,明显高于对照组(23.0 vs 8.3,P=0.000)。结论对常规放置HRM电极导管困难的AC患者,无痛胃镜辅助下置入术是安全有效的,但HRM参数如LESP和EGJ-CI在麻醉状态下的监测对诊断和评估AC患者EGJ功能作用有限。     

食管癌早期数字X射线钡剂造影影像表现分析

目的探讨食管癌早期数字X射线钡剂造影影像特征。方法 49例经手术病理证实的早期食管癌患者,均使用数字X射线机钡剂造影,以连续大口服钡法为主,正位、左右前斜位动态采集图像。结果 49例食管早期癌中,上段14例,中段23例,下段12例;主要X射线表现为:病变处食管黏膜不规则、浅小溃疡形成或局限性小充盈缺损,管壁增厚,柔弹性减低,造影剂局部流空减缓。结论使用数字X射线机,运用连续动态采集图像及图像后处理功能,采用大口服钡法,辅以低张食管双对比造影与操作技巧,获得更多的诊断信息,病变得到清楚显示。     

高分辨率固态测压系统用于研究不同黏稠度食团对健康人咽部及食道上括约肌功能的影响

目的:使用高分辨率固态测压系统检查不同黏稠度的食团对咽部推动力及食管上括约肌(UES)松弛功能的影响.方法:24个健康志愿者分别给予三种不同黏稠度(水、浓流质、糊状)的食团.吞咽过程中的咽部及UES压力与收缩/松弛持续时间的测量均由高分辨率固态测压系统完成.测量的参数包括:咽部收缩峰值压,咽部收缩持续时间,UES松弛残余压,UES松弛持续时间.使用重复测量的方差分析研究食团黏稠度对这些参数的影响.结果:吞咽3ml食团时,随食物黏稠度的增加,UES的松弛残余压进一步降低,UES松弛持续时间不断延长,咽部峰值压不断升高,咽部收缩持续时间也逐渐延长.吞咽10ml食团时,UES的松弛残余压、松弛持续时间与吞咽3ml食团时类似,但咽部峰值压及收缩持续时间变化不大.结论:随着食团黏稠度的增加,UES的松弛时间延长及残余压下降.在吞咽容积较小的食团时,依靠咽部推动及UES松弛功能均增强,克服黏稠度增加产生的阻力.而在吞咽容积较大的食团时,主要依靠UES增加松弛程度,吸引食团向下运送,克服黏稠度增加产生的阻力.     

窄带谱成像放大内镜技术对早期食管癌及其癌前病变诊断的临床应用价值*

目的探讨窄带谱成像放大内镜(NBI-ME)观察下食道病变上皮乳头内血管袢(IPCL)分型对早期食管癌(EEC)及癌前病变诊断的临床价值。方法回顾该院内镜诊治中心2013年7月-2016年12月发现的食管黏膜表面异常的102例(共132处病变)患者内镜表现和临床病理资料,分析IPCL分型对食道病变性质及浸润深度的预判作用。结果 IPCL为A型的病变中95.0%(38/40)病理诊断为食管炎,IPCL为B型的病变中96.7%(89/92)病理诊断为EEC及癌前病变;NBI-ME观察后,术前活检病理与术后完整病理一致性尚可(Kappa=0.4850.4,P 0.01);B1、B2、B3型IPCL预判食道病变浸润深度的准确率分别为68.0%(34/50)、73.3%(11/15)及100.0%(4/4)。结论 NBI-ME观察下对食道病变的IPCL进行AB分型,有助于对食管病变性质及浸润深度的预判,同时结合病理结果及超声内镜(EUS)等技术,可实现对病变病情的综合评估,从而可以为患者制定最佳的治疗策略。     

超声内镜、染色法及窄带成像技术联合使用对早期食管癌的诊断价值

目的：研究超声内镜、染色法及窄带成像技术联合使用在诊断早期食管癌中的临床价值。方法选取2012年12月至2014年11月行普通白光胃镜检查怀疑食管黏膜病变的患者为研究对象,共424例,将患者按随机数字法分为观察组和对照组,各212例,对照组采用普通白光内镜进行检查,观察组在对照组检查基础上加用超声内镜、染色法及窄带成像技术检查,比较两组检查方法的灵敏度、特异度及准确率。结果观察组检出癌69例,癌检出率为32.55%;对照组检出癌72例,癌检出率为33.96%。两组癌检出率差异无统计学意义（ P >0.05）。观察组检测灵敏度、特异度、准确率分别为93.02%、82.84%、84.91%,对照组分别为82.86%、75.71%、76.89%。观察组检测方法准确率明显高于对照组,差异有统计学意义（ P <0.05）。但两组检测方法检测灵敏度、特异度无显著差异（ P >0.05）。结论普通白光内镜检查用于筛查早期食管癌具有较高的检出率、灵敏度及特异度,但对可疑病变患者可进一步行超声内镜、染色法联合窄带成像技术检查,以提高食管癌诊断的准确率。     

窄带成像联合放大内镜对早期食管癌的诊治价值

目的探讨窄带成像技术（NBI）联合放大内镜对早期食管癌的诊断及指导治疗中的作用。方法选择2006年3月至2010年5月82例同时经普通内镜、NBI联合放大内镜、卢戈氏碘染色后发现食管黏膜可疑病变患者,并进行上皮乳头内毛细血管袢（IPCL）分型,最后取标本作病理检查。结果NBI对病变的检出率高于普通内镜,差异有统计学意义（P〈0．05）;对早期癌及高度异型增生的检出率与碘染色相同（均为100％）,对低度恶性倾向的病变的检出率低于碘染色,差异有统计学意义（P〈0．05）;早期癌及高度异型增生IPCL分型多在Ⅳ～Ⅴ2型（占92．3％）,低度恶性倾向病变多在Ⅱ-Ⅲ型（占87．5％）。结论NBI与碘染色均可以提高早期食管癌及高糜异型增生的检出率;NBI与放大内镜联合可初步判断病变的良恶性质及病变的深度,对指导治疗有着重要的作用。     

Comparison of barium swallow and left gastric angiography in the diagnosis of esophageal varices,with special reference to the management of variceal bleeding

Seventy-five patients with portal hypertension and esophageal varices were studied by means of barium swallow and selective left gastric angiography. The relative merits and limitations of these techniques in demonstrating the presence, extent, and severity of the varices are discussed, with reference to the selection of patients for prophylactic transection of the esophagus to prevent bleeding from the varices.     

Use of tunnel endoscopy for diagnosis of obscure submucosal esophageal adenocarcinoma:A case report and review of the literature with emphasis on causes of esophageal stenosis

BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.     

Extended field of view sonography: a useful tool in the diagnosis and management of abdominal pregnancy

Diagnosis of abdominal pregnancy continues to be a challenge, resulting in delays in diagnosis and decision making. We report 2 cases of abdominal pregnancy for which extended field of view sonography contributed to both diagnosis and management. The shortcomings of MRI with respect to localizing the site of placental attachment are also discussed.     

Bursitis,adventitious bursa,localized soft-tissue inflammation,and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications

OBJECTIVE: To assess the contribution of magnetic resonance imaging (MRI) in the diagnosis of tibial stump bursitis, in the establishment of differential diagnosis, and in the therapeutic management prosthetic-stump interface, mainly by adaptation of the prosthetic device. DESIGN: Two-year, prospective, consecutive series. SETTING: University-affiliated prosthetic and rehabilitation center and university department of radiology. PARTICIPANTS: A group of 17 persons with stump problems identified from a total of 139 consecutive below-knee amputees with prosthesis problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical symptoms and MRI. RESULTS: Clinical symptoms (variable stump volume, fluctuating mass at palpation with or without mechanical pain) were suggestive of bursitis in 10 patients. MRI confirmed bursitis in 9 and identified 1 in whom clinical signs suggested neuroma, giving an incidence of 10 of 139 amputees (7.2%). MRI identified 13 sites of bursitis (adventitious bursa, 11; synovial bursitis, 2) and 5 localized areas of soft tissue inflammation. MRI showed diffuse muscular edema at 1 site of clinically suspected bursitis, and bursitis at another site of suspected neuroma. Calcified bursitis was observed in 1 case. Bone abnormalities associated with bursitis (n=7) included osteophytes or fracture (n=4) or bone marrow edema (n=3). Two asymptomatic neuromas were also identified. MRI-guided modifications of the prosthetic interface led to favorable outcome in all cases. CONCLUSION: Bursitis, adventitious bursae, and areas of localized soft-tissue inflammation are different aspects of the same disorder resulting from a mechanical conflict between the stump and the prosthesis socket. Besides contributing to diagnosis, MRI provides a precise assessment necessary for correcting the prosthesis-stump interface in a way that reduces mechanical stress and subsequently cures bursitis.