Argon Plasma Coagulation with Submucosal Saline Injection for Gastric Adenoma on Outpatient Basis

Gastric adenoma with low-grade dysplasia (LGD) is a less progressive disease than with high-grade dysplasia; nevertheless, a certain portion of lesions can progress. The purpose of this study was to evaluate the effectiveness of argon plasma coagulation (APC) with submucosa saline injections (APC–SSI) for gastric adenoma with LGD on an outpatient department (OPD) basis. We included 57 patients with 64 lesions of gastric adenoma with LGD. Endoscopic type was flat elevated in 58 lesions and central depressed in 6 lesions. Normal saline was injected into the submucosa under the lesion before APC. APC was performed to the lesion and its surrounding mucosa. After treatment, patients underwent regular endoscopy follow-ups. One case each of pneumoperitoneum and Mallory–Weiss tearing occurred and could be managed with conservative care. One case of overt bleeding occurred after 2 weeks and was treated with APC. After 19.5 months of follow-up, four residual adenomas (6.3%) were found and treated with additional APC–SSI. Fourteen metachronous lesions were noted in eight patients (14.0%). Twelve lesions were adenoma with LGD and two lesions were intramucosal adenocarcinoma. APC–SSI is an effective and safe treatment modality for gastric adenoma with LGD on an OPD basis and it is recommended for patients with risk factors of endoscopic mucosal resection (EMR). After treatment of gastric adenoma, meticulous follow-up endoscopy is recommended for detection of metachronous lesions.     

氩离子凝固术对疣状胃炎疗效的临床研究

背景:疣状胃炎是一种特殊类型的慢性胃炎,目前尚无特异性治疗方法。目的:探讨氩离子凝固术(APC)治疗疣状胃炎的疗效。方法:选取2010年9月～2012年7月上海市青浦区朱家角人民医院经内镜检查确诊的疣状胃炎患者65例,随机分为治疗组和对照组。幽门螺杆菌(Hp)阳性者先行四联疗法根除Hp。治疗组患者行APC治疗后给予质子泵抑制剂(PPI)和胃黏膜保护剂治疗8周,对照组接受PPI和胃黏膜保护剂治疗8周。比较两组的治疗效果。结果:经APC治疗后,患者临床症状明显改善。治疗组的病灶数目减少程度明显高于对照组(P<0.05)。22例对照组患者药物治疗疗效不明显,转组接受APC治疗后,病灶数目显著降低(P<0.05)。结论:APC可有效治疗疣状胃炎,且安全性良好。     

氩离子凝固术治疗十二指肠息肉的临床研究

目的探讨应用氩离子凝固术(APC)治疗十二指肠息肉的疗效及安全性,并与微波治疗十二指肠息肉的效果进行比较研究。方法选择2008年12月至2013年2月经胃镜检查确诊的151例十二指肠息肉患者按治疗方式随机分为两组:APC组75例,微波治疗组76例。观察比较两组患者的息肉根除率、并发症、治疗疗程及费用。结果(1)APC组和微波治疗组的息肉根除率分别为90.6%、66.9%,差异有非常显著性(P0.01);(2)APC组治疗期间有8例出现轻度的并发症,给予对症处理后消失,微波治疗组有18例出现糜烂,7例出现上消化道出血,对症治疗后痊愈;(3)两组患者住院时间比较无统计学差异(P0.05),微波治疗组住院费用高于APC组(P0.05)。结论氩离子凝固术治疗十二指肠息肉效果明显,副作用小,安全可靠,值得临床推广应用。     

内镜下氩离子凝固术治疗疣状胃炎56例的疗效观察

目的探讨氩离子凝固术对疣状胃炎的治疗效果.方法在内镜直视下,采用氩离子凝固器,经内镜钳道插入氩气电凝导管,直至病灶上方0.3～0.5 cm处,以每次1～3 s的时间对疣状胃炎进行氩离子凝固术治疗.结果56例疣状胃炎患者临床症状明显改善,内镜复查病灶消失.结论氩离子凝固术治疗疗疣状胃炎是一种疗效确切,安全性好,副作用少的方法.     

内镜下氩离子凝固术治疗消化道病变的临床应用

目的探讨氩离子凝固术(APC)在消化道病变内镜介入治疗中的临床应用。方法2005年3月～2009年3月,采用内镜下APC单独或联合治疗509例消化道病变患者,并观察其治疗效果。结果353例胃肠道广基、扁平息肉及息肉残迹经APC治疗后3个月内复查内镜,黏膜色泽正常,原治疗部位无复发。68例成熟型疣状胃炎患者治疗后1月临床症状明显改善,内镜复查病灶好转或消失。17例Barrett食管患者6个月后内镜及病理检查示14例恢复为鳞状上皮,12个月后复查未见复发。38例消化道出血经APC治疗后均未再出血。12例食管支架植入术后再狭窄晚期食管癌患者经APC治疗后实现再通。15例食管中重度不典型增生患者经APC治疗病灶消除。6例联合黏膜切除术早期癌患者治愈。均无严重并发症。结论APC在消化道病变内镜介入治疗中效果显著,且简便易行,并发症少,有较高的临床应用价值。     

氩离子凝固术治疗胃黏膜脱垂症的临床研究

目的 探讨应用氩离子凝固术(APC)治疗胃黏膜脱垂症的疗效及安全性,并与微波治疗胃黏膜脱垂症的效果进行比较研究.方法 选择2008年12月至2010年10月经胃镜检查确诊的140例胃黏膜脱垂症患者,按治疗方式随机分为两组:APC组69例,微波治疗组71例.观察比较两组患者的有效率、并发症、治疗疗程及费用.结果 (1)...     

氩等离子体凝固在食管癌支架置入后的临床应用

目的：探讨内镜下氩等离子体凝固(APC)在食管癌金属支架置入后的临床应用。方法：对10例食管癌镍钛合金支架置入后新生物过度生长者，应用APC治疗。结果：9例患者治疗后的评价均为有效，症状明显改善，术后3～8个月复查局部没有肿瘤组织再生，支架无断裂。结论：经内镜APC治疗是解决肿瘤组织向支架内过分生长的有效手段之一。     

Reconstitution of Squamous Epithelium in Barrett's Oesophagus with Endoscopic Argon Plasma Coagulation: A Prospective Study

Background: Barrett's oesophagus is a premalignant condition. Recent reports have suggested that laser coagulation or photodynamic therapy combined with acid suppression may induce reconstitution of squamous mucosa. However, a high percentage of residual glands remain in cases treated with both techniques. Argon plasma coagulation (APC) appears to be an attractive alternative to other thermoablative techniques. The aim of this study was to investigate the reconstitution of squamous epithelium in Barrett's oesophagus after APC. Methods: Fifteen patients with histologically proven Barrett's oesophagus were included in a prospective study. After base-line documentation by videotaping and biopsies, Barrett's epithelium was treated by repeated APC at intervals of 4-6 weeks until complete squamous restoration was achieved. All patients were kept under high-dose proton pump inhibitor therapy. Results: In 13 patients complete reconstitution of squamous epithelium was achieved. Buried glands after squamous restoration were detected transiently in only one case after the first session. As side effects seven patients had mild retrosternal discomfort. One patient reported severe retrosternal pain for 1 week. He then refused further APC sessions. Another patient was excluded because of noncompliance. During the follow-up period (6-13 months) recurrence of Barrett's epithelium was observed in one patient. Conclusions: APC is a suitable technique for achieving squamous restoration in Barrett's oesophagus. The rare occurrence of remaining buried glands may result from the homogeneous coagulation achieved by the ionized argon gas beam.     

Improvement of Short-Term Outcomes for High-Risk Bleeding Peptic Ulcers With Addition of Argon Plasma Coagulation Following Endoscopic Injection Therapy: A Randomized Controlled Trial

A second endoscopic method together with injection therapy is recommended to treat high-risk bleeding peptic ulcers. This study investigated whether additional argon plasma coagulation (APC) treatment could influence hemostatic efficacy following endoscopic injection therapy to treat high-risk bleeding ulcers.From October 2010 to January 2012, eligible patients with high-risk bleeding ulcers were admitted to our hospital. They prospectively randomly underwent either APC therapy along with distilled water injection or distilled water injection alone. Episodes of rebleeding were retreated with endoscopic combination therapy. Patients in whom retreatment was ineffective underwent emergency surgery or transarterial embolization (TAE).A total of 116 enrolled patients were analyzed. The hemostatic efficacy in 58 patients treated with APC along with distilled water injection was compared with that in 58 patients treated with distilled water injection alone. The 2 treatment groups were similar with respect to all baseline characteristics. Initial hemostasis was accomplished in 56 patients treated with combined therapy, and 55 patients treated with distilled water injection therapy (97% vs 95%, P = 0.648). Bleeding recurred in 2 patients treated with combined therapy, and 9 patients treated with distilled water injection (3.6% vs 16%, P = 0.029). Treatment method was the only independent prognostic factor for recurrent bleeding (odds ratio 0.17; 95% confidence interval 0.03–0.84; P = 0.029). The 2 groups did not differ significantly in hospital stay, TAE, surgery, and mortality.Endoscopic therapy with APC following distilled water injection is more effective than distilled water injection alone for preventing rebleeding of peptic ulcer.     

内镜下氩离子凝固术与射频、高频电切术治疗胃肠道息肉疗效比较

目的 探讨内镜下氩离子凝固术、射频及高频电切术等3种治疗方式治疗胃肠道息肉的临床疗效及安全性.方法 对2007年3月至2010年2月我科收治的143例消化道息肉患者,根据治疗方法分为氩离子组(n=57)、射频组(n=45)和高频组(n=41).所有检出病例术前行病理活检,确定病理类型后治疗,观察治疗的结果及并发症,并于...     

疣状胃炎氩离子凝固术后质子泵抑制剂疗效的比较

背景：质子泵抑制剂（PPI）埃索美拉唑和奥美拉唑广泛应用于消化性溃疡和反流性食管炎的治疗中，但目前内镜下治疗术后的应用研究较少。目的：比较埃索美拉唑与奥美拉唑对疣状胃炎氩离子凝固术（APC）后腹痛缓解和溃疡愈合的疗效。方法：86例疣状胃炎APC后随机分为两组：A组46例，治疗后次日起予埃索美拉唑20mg／d口服．疗程4周；B组40例，治疗后次日起予奥美拉唑20mg／d口服，疗程4周。观察治疗前后两组患者的腹痛缓解情况和溃疡愈合情况。溃疡愈合情况通过胃镜检查来评估。结果：A组患者服药后第ld腹痛缓解率为84．8％，高于B组的55．0％（心0．001）。A组患者第7d腹痛缓解率为100，0％，高于B组的80．0％（P〈0．01）。两组间疼痛消失平均天数比较，A组显著少于B组（P〈0．001）。A组溃疡愈合率（95．7％）高于B组（92．5％），但差异无显著性（P〉0．05）。结论：埃索美拉唑和奥美拉唑在疣状胃炎APC后溃疡的愈合方面具有相同疗效，但在腹痛缓解方面埃索美拉唑优于奥美拉唑。     

Sustained Local Delivery of Dexamethasone by a Novel Intravascular Eluting Stent to Prevent Restenosis in the Porcine Coronary Injury Model

Objectives. This study sought to assess the feasibility, safety and efficacy of sustained intracoronary delivery of dexamethasone by a novel polymer-coated eluting stent.Background. Development of techniques to provide sustained local drug delivery has focused on polymers as matrices for drug incorporation and elution.Methods. A tantalum wire stent was coated with dexamethasone (0.8 mg) suspended in a matrix of either low (∼80 kD) or high (∼321 kD) molecular weight poly-l-lactic acid (PLLA [0.4 mg]). Uncoated stents, stents coated with PLLA or stents coated with dexamethasone in PLLA were overexpanded by 30% to the normal vessel diameter in the coronary arteries of juvenile farm pigs. Animals were euthanized 28 days later, and neointimal thicknesses were measured. Additional pigs underwent placement of stents coated with high molecular weight PLLA–dexamethasone for assessment of arterial tissue and serum concentrations of dexamethasone at 1 h and 1, 2, 10 and 28 days after stent implantation.Results. In vitro dexamethasone release occurred over the first 6 days. Stents coated with low molecular weight PLLA produced an intense inflammatory neointimal response. Stents utilizing the high molecular weight PLLA were well tolerated within the coronary vessel during the 28-day experiment. However, dexamethasone did not decrease neointimal hyperplasia. Dexamethasone concentrations in the arterial tissue were ∼300,000-fold higher than those in the serum 24 h after stent implantation, remaining ∼3,000-fold higher at 28 days.Conclusions. The eluting stent utilizing high molecular weight PLLA appeared to be a well tolerated and effective means of providing sustained, site-specific drug delivery to the porcine coronary artery wall for at least 28 days.(J Am Coll Cardiol 1997;29:808–16)     

Biochemical Analysis of the Stomach Wall in Normal Rats

The rat stomach wall was analysed biochemically. The biochemical extraction was carried out according to the Schneider, Schmidt-Thannhauser's method. Acid-soluble inorganic phosphate, acid-soluble organic phosphate, phospholipid phosphate, ribonucleic acidic phosphate, deoxyribonucleic acidic phosphate, phosphoproteid inorganic phosphate were measured colorimetrically according to Briggs's method. The nucleic acids were estimated by measuring the phosphate and sugar components. The biochemical analysis was made both from the total stomach, and also separately from glandular stomach and the rumen. It is concluded that these two parts of the rat's stomach differ biochemically.     

加注0.9%氯化钠溶液在MSCTU中显示输尿管的应用价值

目的探讨MSCT在泌尿系统造影中输尿管全程显示的技术与效果。方法选择无严重肾功能不全、无双侧尿路梗阻的泌尿系统螺旋CT扫描的病例60例,其中30例注射对比剂90~100m l,30例另外加注60m l 0.9%氯化钠溶液,进行CT三维重建,对输尿管全程显示进行对比。结果一组30例单纯注射对比剂,肾盂、输尿管全段及膀胱15m in全尿路显示8例（8/30）,占26.6%;22例未能显示输尿管下段（22/30）,占73.3%。二组30例注射对比剂后加注60m l 0.9%氯化钠溶液,肾盂、输尿管全段及膀胱15m in全尿路显示25例（25/30）,占83.3%,其中12例单侧输尿管梗阻未充盈,健侧肾盂输尿管全段及膀胱充盈;5例未能显示输尿管下段（5/30）,占16.6%。结论注射对比剂后加注0.9%氯化钠溶液,有助于提高泌尿系统全程显示率,并缩短全尿路充盈时间。     

Repair of the Lethal Developmental Defect in Deep Orange Embryos of Drosophila by Injection of Normal Egg Cytoplasm

The eggs produced by deep orange females (dor/dor) of Drosophila melanogaster have a defect that causes early death of the deep orange embryos derived from these eggs. Ovaries transplanted from deep orange females to normal female hosts continue to produce defective eggs, showing that the dor mutation directly affects an ovarian function. In heterozygous embryos (dor⁺/dor) derived from eggs of deep orange females, the presence of a paternal dor⁺ gene enables normal development to occur in about half of the embryos. Thus, the egg defect caused by the dor mutation is repairable after fertilization by the action of a dor⁺ gene.     

凝血酶注射封闭股动脉假性动脉瘤对机体凝血系统的影响

目的:了解超声引导下注射凝血酶(UGTI)治疗医源性股动脉假性动脉瘤(PS)对机体凝血指标的影响,评价超声引导下注射凝血酶治疗PS的可行性.方法:15例经股动脉径路选择性冠状动脉(冠脉)造影和冠脉介入术后医源性股动脉PS患者接受了超声引导下注射凝血酶治疗.男性5例,女性10例,平均年龄(68.5±12.0)岁,选择性冠脉造影1例,经皮冠脉介入14例.单腔的单纯型PS9例,2腔或3腔的复杂型PS6例.分析PS接受凝血酶治疗剂量、治疗结果以及机体凝血指标.注射凝血酶前、注射凝血酶后24小时、注射凝血酶后5～7天测定了以下指标:血小板计数、红细胞压积、血红蛋白、活化的凝血激酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原及二维超声心动图检查.结果:共注射凝血酶21次,平均每次注射凝血酶剂量,单腔为(186±120)IU,双腔或多腔为(388±150)IU.9例单纯型PS患者全部一次成功;6例双腔或多腔的复杂型PS患者4例一次成功,2例复杂型PS患者出现"再通",经重复注射凝血酶后,封闭成功.无一例出现其他部位血栓形成、感染、过敏等并发症.注射凝血酶前后,机体各项凝血指标间相比无显著差异.结论:超声引导下注射凝血酶治疗股动脉PS安全有效,PS瘤腔内局部注射凝血酶对机体凝血系统无明显影响.