内镜黏膜下剥离术治疗直肠类癌13例分析

直肠类癌的组织学表现类似恶性肿瘤,但生物学行为更趋向于良性病变,故其治疗措施及预后明显不同于直肠腺癌。尤其是对于病灶直径1.0～2.0cm的直肠类癌,选择何种治疗方法尚存争议。内镜黏膜下剥离术(ESD)是近年来开展的一项新技术,主要用于胃肠道黏膜层和黏膜下层较大、广基病变的一次性完整切除。2008年9月-2010年6月,我们采用ESD治疗直肠类癌13例,疗效满意。现分析报告如下。     

内镜超声下上消化道隆起性病变的诊断和治疗

目的：探讨内镜超声（EUS）对诊断和治疗上消化道隆起性病变的价值。方法：内镜超声诊断上消化道隆起病变779例：其中食管288例,贲门41例,胃394例,十二指肠病变43例。结果：EUS诊断上消化道隆起病变,食管以平滑肌瘤最多见,贲门和胃多见息肉,胃肠间质瘤多以固有肌层低回声为主。内镜下治疗525例,外科手术57例。结论：EUS为上消化道隆起性病变患者提供了更精确的诊断和更安全的内镜治疗。     

超声内镜诊断和指导治疗直肠类癌的价值

目的探讨超声内镜诊断及指导治疗直肠类癌的应用价值。方法收集21例结肠镜检出直肠类癌患者进行超声内镜检查,根据超声影像学特点诊断和指导内镜下粘膜切除术治疗。类癌超声特点结合术后病理。结果 21例类癌超声内镜特征为:来源于粘膜(7例)或粘膜下层(14例)的均匀低回声卵圆形肿块,边界清晰,有内镜下粘膜切除术(EMR)指征。21例内镜下粘膜切除术后病理证实类癌,切缘阴性。随访7～46个月无复发。结论超声内镜具有诊断和指导内镜下治疗直肠类癌的临床应用价值。     

小探头超声内镜对上消化道隆起病变的诊断价值

目的探讨小探头超声内镜在上消化道隆起病变诊断中的应用价值。方法利用超声内镜检查观察分析消化道隆起病变的部位分布情况。结果本文135例患者经小探头超声内镜检查发现其中病变位于食管72例,胃61例,十二指肠2例。按照病变类型进行分类其中平滑肌瘤56例,超声内镜表现为椭圆或梭形,均匀低回声,边界清,有低回声包膜;间质瘤28例,超声内镜表现为低回声,回声可不均匀;囊肿17例,超声内镜表现为无回声,均匀,边界清,压之变形;脂肪瘤9例,超声内镜表现为均质高回声,边界清;异位胰腺8例,超声内镜表现为不均匀中高回声,边界清;外压病变7例,超声内镜表现为来源壁外,胃各层结构完整;息肉5例,超声内镜表现为低回声,来源于黏膜层,管壁各层结构完整;疣状隆起4例,十二指肠布氏腺增生1例。所有患者均经EMR、ESD或手术病理证实,与病理诊断符合率达85.19%。结论小探头超声内镜检查能够显示上消化道隆起病变的起源层次及其与邻近组织结构的关系,并能提示隆起性病变的性质。     

超声内镜检查在上消化道隆起性病变中应用价值

目的分析超声内镜对上消化道黏膜下隆起性病变的诊断价值,为临床治疗方法选择提供依据。方法选取沈阳军区总医院消化科自2014年1月至2015年12月行胃镜检查发现上消化道黏膜下病变后行超声内镜检查的230例患者,根据超声内镜扫查特征大小、回声、管壁层次等特点做超声诊断。超声内镜诊断的准确率以病变切除后的病理诊断为标准。结果在230例患者中剔除壁外压迫29例,包括消化道肿瘤、胆胰疾病等,对剩余167例患者的临床资料进行回顾性分析。其中,超声内镜下病变<5 mm者69例(41.4%),5~10 mm者78例(46.7%),病变>10 mm者20例(12.0%);息肉40例,平滑肌瘤42例,脂肪瘤14例,间质瘤43例,囊肿9例,异位胰腺12例,静脉曲张2例,性质待定5例。148例病灶接受内镜或腹腔镜下切除治疗,与最后病理比较,超声内镜诊断的准确率为89.86%(133/148)。结论超声内镜对上消化道管壁隆起性病变的病灶分层判断有重要价值,对于病变性质的诊断有重要价值,有助于选择内镜或腹腔镜治疗的方法。     

超声胃镜引导下微创切除食管平滑肌瘤45例临床分析

目的探讨超声胃镜对于食管平滑肌瘤的诊断价值,以及内镜下微创治疗食管平滑肌瘤的疗效和安全性。方法对胃镜发现的食管隆起性病变进行超声胃镜检查,根据病变大小及性质,在胃镜下分别行圈套器电切、内镜下黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）等治疗。结果 45例食管隆起性病变经超声胃镜检查诊断为黏膜下平滑肌瘤,经内镜下微创治疗全部完整切除,所有病例创面愈合良好,均无出血、穿孔、食管狭窄等并发症发生。结论超声胃镜对食管平滑肌瘤有较高的诊断价值,内镜下微创切除是治疗食管黏膜下平滑肌瘤的有效方法。     

无痛苦上消化道超声内镜检查的护理配合

对于上消化道隆起性病变,普通胃镜检查常难以正确判断病变的结构层次和来源。超声内镜(endoscopic ultrasonography,EUS)兼具内镜和超声两方面影像检查的优点,能在内镜直视下对上消化道隆起性病变进行超声检查,显示病变的层次结构及与邻近脏器或组织的关系,且可判定病变有无邻近脏器浸润和淋巴结转移等,因此在上消化道隆起性病变的诊断中具有独特的价值[1,2]。     

超声微探头对食管隆起性病变的诊断价值

目的 阐明内镜超声微探头诊断食管隆起性病变的可行性。方法 122例食管隆起性病变患者均经超声微探头检查，其中，61例行胃镜下高频电刀切除或活检进行病理组织学检查，并与超声所见进行对比分析。结果 在超声诊断的122例食管隆起性病变中，食管息肉见于6例，黏膜下肿瘤84例，食管癌19例，食管静脉曲张5例，食管孤立性静脉瘤3例，食管外压性改变6例。61例高频电切除或活检进行病理组织学检查，诊断符合率96．7％。结论超声微探头不仅可对食管隆起性病变的起源作出准确判断，并可依据回声推断其病理性质（良性或恶性）。     

超声内镜对胰腺癌早期诊断价值的评估

目的 评估超声内镜对胰腺癌早期诊断的价值.方法 2007年1月-2007年6月经手术病理确诊为胰腺癌的患者126例,明确诊断前半月内均接受过超声(US)、超声内镜(EUS)及螺旋CT(SCT)检查,术后证实为小胰腺癌(癌块直径≤2cm)28例,癌块直径:2cm者98例.比较术前接受US、SCT和EUS检查的影像学异常发现率、诊断准确率及间接征象准确率等,探讨超声内镜对胰腺癌早期诊断的价值.结果 联合应用EUS及SCT检查,胰腺癌异常影像的发现率、诊断准确率大为提高,与单独应用US、EUS或SCF相比,有显著性差异(PO.05);对小胰腺癌的诊断,EUS诊断准确率显著高于US和SCY(p<0.05).结论 EUS在胰腺癌早期诊断中有重要价值,EUS联合SCT能提高胰腺癌的早期检出率.     

超声内镜弹性成像鉴别诊断胰腺占位价值研究

目的：探讨超声内镜（EUS）弹性成像在胰腺占位性病变鉴别诊断中的应用价值。方法：选择常规影像学检查发现或怀疑胰腺占位性病变23例,对相应病变进行EUS弹性成像检查,观察不同胰腺组织弹性成像特征,分析EUS弹性成像对胰腺占位性病变诊断的灵敏度、特异性及阳性预测值和阴性预测值。结果：23例均成功进行EUS弹性成像检查,并获得可用于结果分析的满意图像。弹性图像色彩模式评分中,判定为良性病变3例,难以确定、不除外恶性病变5例,恶性病变15例。确诊为胰腺癌16例,慢性胰腺炎6例,无功能性胰腺神经内分泌肿瘤1例。在胰腺占位性病变良恶性鉴别诊断中,与临床诊断符合20例,符合率89．0％;诊断的灵敏度100％,特异性57．0％,阳性预测值84．2％,阴性预测值100％。结论：EUS弹性成像在胰腺占位性病变鉴别诊断中具有较高的准确性。     

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.