消化内镜微创手术机器人系统的研发及其辅助离体猪胃内镜黏膜下剥离术的可行性评估

目的初步评估新型柔性、双臂、主从操作的消化内镜微创手术机器人——DREAMS(dual-arm robotic endoscopic assistant for minimally invasive surgery)系统辅助内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)的可行性。方法选用新鲜剥离的健康猪胃作为模型, 设计不同大小的类圆形病变10个(胃窦和胃体各5个), 由2名内镜医生(甲和乙)独自完成内镜下剥离操作, 观察DREAMS系统辅助下的剥离效果(黏膜下剥离速度)、安全性(肌层损伤、穿孔发生率)和操作性能(抓取效率:用每个病变需要夹钳夹取的次数来评估)。结果 10例机器人辅助下的ESD均顺利完成, 10个病变均实现整块切除, 病变直径(22.34±2.39)mm, 剥离时间(15.00±8.90)min, 剥离速度(141.79±79.12)mm2/min, 平均每个病变需要夹取4.2次, 共有4例(40.0%)ESD出现肌层损伤, 无一例穿孔发生。结论初步动物实验结果显示, DREAMS系统辅助ESD安全、可行。     

消化内镜切除技术中黏膜下注射液的研究进展

近十几年, 内镜切除技术不断发展普及, 在消化道癌前病变与早期癌变的治疗中应用广泛。内镜切除技术主要包括息肉切除术、内镜黏膜切除术(endoscopic muscosal resection, EMR)、内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)。其中ESD及多数EMR术中都需要黏膜下注射这一重要操作, 通过该操作使病灶与肌层分离, 这对黏膜的完整切除及预防出血穿孔等都非常重要, 同时也促进了内镜技术的推广应用。如何选择合适的黏膜下注射液值得关注, 本文就目前黏膜下注射液的研究现况进行阐述, 并展望了未来黏膜下注射液的发展方向。     

我国消化内镜领域行业现状及展望

近年来, 我国消化内镜技术与诊疗快速发展, 市场需求激增。消化内镜属于高端医疗器械, 在全球化竞争格局下, 高端医疗器械国产化是制造强国的重要标志, 也是国家发展战略需求。目前国产化消化内镜设备与技术处于追赶阶段, 部分领先。本文就消化内镜领域全球及我国市场进行分析, 探讨我国消化内镜行业现状以及存在的问题, 并提出相应发展方向。     

消化内镜人工智能：使命促进跨界合作研究

提高消化内镜技术水平是各医院、学术组织和政府职能部门等多年努力践行的工作,目前存在的一些问题,需要借助人工智能的帮助。基于深度学习的卷积神经网络已广泛应用于各种消化内镜人工智能辅助系统。《中华消化杂志》本期人工智能专题刊载的消化内镜人工智能辅助系统与设备可从部位质量控制、隆起型病变检出和息肉性质鉴别3个层面辅助消化内镜检出和甄别病变;减轻胶囊内镜医师阅片的工作负担,以便聚焦小肠出血病灶的检出。这些医工结合的研究,敦促消化病学与人工智能技术的深度融合。     

结直肠内镜黏膜下剥离术中出血的危险因素分析

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗结直肠病变并发术中出血情况, 并分析其危险因素。方法回顾分析2019年12月—2021年8月大同市第三人民医院及其合作单位南京鼓楼医院行结直肠ESD治疗的386例患者病例资料, 按术中出血情况分为出血组(n=85)和未出血组(n=301)。分析患者基本资料、病变相关因素与结直肠ESD术中出血的关系。采用单因素和多因素Logistic回归分析 ESD 术中出血的危险因素。根据筛选的危险因素构建ESD术中出血风险预测模型, 并采用ROC曲线对预测模型进行评价。结果单因素Logistic回归分析显示, 合并糖尿病(OR=2.340, P<0.05)、合并冠心病(OR=3.100, P<0.05)、病灶位于直肠(OR=3.272, P<0.05)、病灶长度越长(OR=1.093, P<0.05)、病灶宽度越宽(OR=1.057, P<0.05)、病灶面积越大(OR=1.126, P<0.05)、病灶形态为凹陷型(OR=6.128, P<0.05)、...     

止血夹预防早期胃癌内镜黏膜下剥离术后迟发性出血的疗效分析

目的评价止血夹预防早期胃癌内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)后出血的疗效。方法回顾性收集2013年6月—2020年8月就诊于北京友谊医院确诊为早期胃癌行ESD患者资料459例, 将其分为病变切除后使用止血夹预防性夹闭创面的A组162例、病变切除后未使用止血夹夹闭创面的B组297例, 观察术后2周患者是否发生出血。对患者进行单因素及亚组分析, 分析每组患者的术后出血发生率及临床病理特征。结果 A组术后出血发生率3.1%(5/162), B组术后出血发生率8.1%(24/297), 差异有统计学意义(χ2=4.418, P=0.036)。A组与B组进行亚组比较, 肿瘤长径>20 mm时, 两组术后出血率差异有统计学意义[3.5%(2/57)比15.3%(13/85), χ2=5.016, P=0.025];肿瘤位于胃下部时, 两组术后出血率差异有统计学意义[1.0%(1/97)比10.4%(20/192), χ2=8.425, P=0.004];肿瘤浸润深度为M/SM1时, 两组术后出血率差异有统计学意义[3.2%(5/15...     

共聚焦激光显微内镜在老年人食管及胃黏膜病变中的应用

老年人消化系统慢性病呈上升趋势, 重视老年群体食管及胃黏膜病变的诊断及监测, 将有助于降低上消化道恶性病变的发病率。随着消化内镜技术的不断发展, 诸多内镜设备、技术应运而生, 共聚焦激光显微内镜作为一种新型的显微成像技术, 能够在体内黏膜表面进行实时活体组织细胞学检查, 在老年人群胃食管反流病、巴雷特食管、食管高级别上皮内瘤变、早期食管鳞癌、萎缩性胃炎、胃黏膜癌前状态和癌前病变的实时诊断中具有重要价值。因此有必要了解共聚焦激光显微内镜在老年人群食管及胃黏膜病变中的应用, 为临床医生的诊疗决策提供参考。     

早期胃癌内镜下非治愈性切除患者淋巴结转移的危险因素

内镜黏膜下剥离术是早期胃癌的首选治疗方法,尽管部分患者不能达到治愈性切除标准,即非治愈性切除,存在淋巴结转移风险,需要进一步行外科手术治疗,但术后大部分患者不会发生淋巴结转移。现对早期胃癌患者非治愈性切除术后的临床结局、淋巴结转移的危险因素等进行综述,为临床决策提供参考。     

结直肠镜下结直肠腺瘤切除术后复发的影响因素

目的研究结直肠镜下结直肠腺瘤切除术后复发的影响因素。方法选择青岛市市立医院2014年1月至2016年8月行结肠镜下结直肠腺瘤切除术且在切除术后3年内有结肠镜随访结果的患者501例。分析性别、年龄、BMI、是否吸烟、是否合并非酒精性脂肪性肝病(NAFLD)、是否合并糖尿病,腺瘤最大径、数量、病理类型,以及手术方式对患者术后腺瘤复发率的影响,将差异有统计学意义的结果纳入多因素logistic回归模型,分析腺瘤复发的独立危险因素。统计学方法采用卡方检验和多因素logistic回归分析。结果 501例结肠镜下结直肠腺瘤切除术患者术后3年的腺瘤复发率为25.5%(128/501)。腺瘤复发率在不同性别和年龄的患者间的差异均无统计学意义(P均>0.05)。BMI为<25、25～29和>29 kg/m2的患者的腺瘤复发率分别为19.2%(32/167)、27.5%(44/160)和29.9%(52/174),其中BMI>29 kg/m2者的腺瘤复发率高于BMI<25 kg/m2者,差异有统计学意义(χ2=6.978,P<0.05),腺瘤复发率在BMI<25 ...     

2022年内镜微创切除领域新进展

系统盘点并总结了2022年消化内镜领域微创切除方面的进展, 包括食管、胃、结直肠、十二指肠病变的内镜治疗, 以及内镜全层切除术、经自然腔道内镜手术、隧道内镜技术、并发症处理、器械和设备革新等方面, 并在此基础上提出了未来的发展方向, 以期为广大同仁提供参考。     

丙型肝炎疫苗研究现状与方向

丙型肝炎(丙肝)病毒(hepatitis C virus,HCV)主要经血液传播,是急性和慢性肝炎、肝硬化、肝癌的重要致病因子。目前全球HCV感染者约有1.7亿,每年新增感染者达300万～400万,我国HCV感染者近4 000万。HCV感染的慢性率高达70%以上,至今尚无有确切保护作用的疫苗问世,迫切需要发展有效的疫苗预防、控制HCV的感染和传播。     

Gallstone dissolution therapy. Current status and future prospects

Findings by several groups of investigators have provided a reliable data base that supports a nonoperative approach toward the management of so-called silent gallstones. Considerable progress has been made in the medical dissolution treatment of selected patients with cholesterol gallstones. Ursodeoxycholic acid, and, more recently, a combination of ursodeoxycholic and chenodeoxycholic acids have been shown to be both effective and safe in dissolving gallstones that are predominantly composed of cholesterol. A drawback of the bile acid dissolution therapy lies in a significant recurrence rate after treatment is discontinued. Currently, several new methods of gallstone treatment are under study, which involve either the injection of a cholelitholytic solution, such as methyl tert-butyl ether, into the gallbladder or the use of mechanical means, such as excorporeally induced shock waves, to disintegrate gallstones. These treatments, however, are effective only if the stones are composed mainly of cholesterol without significant admixtures of calcium salts, pigment, or mucus. Most of the treatment failures are probably related to the presence of calcifications that are not visible on conventional radiographs. Future improvements of gallstone dissolution therapy can be expected from the following possible developments: improvement in ability to predict gallstone composition; dissolution of calcium salt-, pigment-, and mucus-containing stones; early treatment, before calcifications occur; combination of chemical and mechanical methods of treatment; stimulation of gallbladder contraction; prevention of stone recurrence after dissolution; and synthesis of new cholelitholytic agents.     

Current status and future applications of contrast-enhanced endoscopic ultrasonography

Endoscopic ultrasonography(EUS) is currently an in-tegral investigation of many gastrointestinal disorders.It has been shown to have a higher efficacy thanconventional computed tomography in detection andcharacterization of small lesions especially in the pan-creas. Much effort has been put to further improvethe sensitivity, specificity and overall accuracy of EUS.One of the major advances is the utilization of contrastagents for better delineation of the vascularity and tis-sue perfusion of the target lesion. This article describesthe basic principles of ultrasound contrast agents andthe different modalities used in contrast-enhanced EUS(CE-EUS) including contrast-enhanced Doppler EUS(CED-EUS) and contrast-enhanced harmonic EUS(CEH-EUS). In addition, the current applications of contrastenhanced EUS in different gastrointestinal conditionswere discussed. Furthermore, the future developmentof hybrid approaches combining CE-EUS with other im-aging modalities and the potential therapeutic aspectof using it as a vector for drug delivery were also dis-cussed.     

Current status and future prospects of chemotherapy for advanced hepatocellular carcinoma

Sorafenib is the only drug that demonstrates a survival benefit for advanced hepatocellular carcinoma (HCC). However, the therapeutic effect of sorafenib is limited, so development of a more effective treatment method and second-line treatments is needed. Since the advent of sorafenib, clinical studies have been conducted with a variety of drugs and treatment methods, mainly with molecular targeted therapy, but almost all trials have ended in failure. The reasons for the difficulty in the development of a novel drug or treatment method include the diversity of mechanisms in the carcinogenesis and development of HCC, as well as the presence of background liver diseases such as chronic hepatitis and cirrhosis. Trials with immune-checkpoint inhibitors, which have an entirely different anti-tumor mechanism from that of molecular targeted drugs or cytotoxic drugs, have recently begun. Based on the results to date, clinical trials are now being conducted with enriched target subjects. In the future, providing more individualized treatment approaches for patients with advanced HCC will be essential.     

Current status and future prospects of the Global Lymphatic Filariasis Programme

Lymphatic filariasis is recognized as one of the world's most disabling diseases. Adult lymphatic filarial nematodes live for several years; they infest the lymphatic and blood systems, and are transmitted via mosquito vectors. Acute and chronic disease can develop, manifesting as acute inflammation, hydrocoele, lymphoedema and elephantiasis. The development of a global programme for the elimination of lymphatic filariasis (focusing on disease caused by Wuchereria bancrofti) followed a resolution by the World Health Assembly in 1997 that endemic countries should develop programmes to eliminate lymphatic filariasis as a public health problem. This developed from an earlier recommendation by the International Task Force for Disease Eradication in 1993 that lymphatic filariasis was one of six diseases that could, in theory, be eradicated. Herein we review the current status and future prospects of the Global Lymphatic Filariasis Programme, which was launched in 2000.     

Gastric per-oral endoscopic myotomy: Current status and future directions

Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.