内镜联合药物治疗放射性胃炎并发难治性出血一例

放射性胃炎并发难治性出血是肿瘤放疗后的并发症，但关于其治疗方法的报道和研究相对较少。本文描述了1例肝癌切除术后、放射治疗引起的放射性胃炎并发难治性出血采用氩离子凝固技术联合聚桂醇硬化治疗的过程及体会。     

内窥镜下结肠息肉电凝电切治疗416例临床分析

目的探讨在内窥镜下应用高频电凝电切、联合氩离子凝固术及钛夹止血治疗结肠息肉的应用与疗效。方法对我院2009年01月-2011年12月416例患有结肠息肉的患者应用高频电凝电切、联合氩离子凝固术及钛夹止血切除息肉的治疗方法进行回顾与分析。结果 416例患者经治疗均成功切除息肉,术中出血均予以钛夹成功止血,未发生其他并发症。结论经内窥镜下应用高频电凝电切、联合氩离子凝固术及钛夹止血治疗结肠息肉是安全、有效的治疗方法。     

内镜下应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的临床研究

目的 探讨应用氩离子血浆凝固术治疗早期食管癌及其癌前病变的意义。方法1999年10月2003年1月内镜下应用氩离子血浆凝固术对13例早期食管癌及114例食管鳞状上皮异型增生进行治疗,氩离子血浆凝固术功率设定为28 W,氩气流量0.4 L／min。术后1个月、4个月及12个月进行内镜复查及治疗。结果 (1)氩离子血浆凝固术治疗早期食管癌及食管癌前病变的成功率分别为92.3％和100％,平均治疗次数分别为3次和2.2次。(2)本组127例合并症发生率为5.5％,其中早期癌与癌前病变合并症的发生率分别为30.7％和2.60％,合并症主要表现为出血、黏膜下血肿及发热等,经对症治疗后均治愈。本组无穿孔及狭窄发生。(3)4-12个月内镜复查并经病理证实3例早期癌复发,再次应用氩离子血浆凝固术治疗,2例治愈,1例病变未控改为手术治疗。癌前病变无复发。(4)本组术后平均随访时间为15.3个月,所有患者目前均无明显不适。结论 应用氩离子血浆凝固术可简便、安全、有效地治疗早期食管癌及癌前病变,具有较好的应用前景。     

药物注射联合氩离子凝固对消化性溃疡出血的疗效分析

目的 比较内镜下药物注射联合氩离子凝固治疗及单一治疗对上消化道溃疡出血的疗效.方法 将303例内镜下有活动出血的溃疡患者分为3组.157例接受内镜下药物注射止血治疗,51例接受氩离子凝固止血治疗,95例接受药物注射联合氩离子凝固治疗.结果 三种方法的即时止血率均为100%,有效止血率在药物注射组、氩离子及联合治疗组分别为为87.9%、86.3%、91.6%,三组比较无统计学差异(P>0.05).所有病例无穿孔及其它术后并发症.结论 药物注射联合氩离子凝同治疗为安全有效的止血方法,但并没有显著提高止血率.     

内镜下氩离子凝固术治疗胃癌前病变临床研究

目的探讨内镜下氩离子凝固术治疗胃黏膜癌前病变的价值及安全性。方法应用奥林巴斯260电子胃镜结合病理对108例胃黏膜癌前病变患者进行氩离子凝固术治疗,所有病例治疗6月后进行临床随访、内镜及病理组织学复查。结果 108例患者其中胃黏膜肠上皮化生43例（39.8%）及上皮内瘤变65例（60.2%）,104例患者临床症状减轻,复查胃镜示原病灶消失,复查病理组织学示胃黏膜肠上皮化生或上皮内瘤变消失,尚存慢性活动性炎症（92.6%）或萎缩性炎症（5.6%）,治疗有效率98.1%,所有病例治疗中未发生出血、穿孔等并发症。结论内镜下氩离子凝固术治疗胃黏膜癌前病变安全、有效、快捷、经济,值得在基层医院推广。     

第二代氩离子凝固疗法治疗消化系疾病患者260例

目的: 分析第二代氩离子凝固疗法(VIO APC)在各种消化系疾病内镜治疗中的安全性和有效性.方法: 2007-09-14/2008-10-22西安交通大学第二医院消化科内镜室接受VIO APC治疗的260患者, 共接受VIO APC治疗289次. 对各种不同的疾病, 均使用了VIO APC系统. 每次治疗后对VIO APC的安全性和有效性进行记录.结果: 各种疾病, 平均需要接受VIO APC 1.11±0.31次. 其中胃癌的姑息治疗, 平均需要接受2.50次; 用于止血治疗, 需要1.23次; 治疗结肠直肠息肉, 需要1.15次; 治疗上消化系息肉,需要1.03次; 治疗食管支架置入后再狭窄, 需1.17次; 用于Barrett食管的消融治疗, 需1.13次; 治疗胃不典型增生、疣状胃炎、胃黄色瘤及胃和十二指肠脂肪瘤, 均仅需1次治疗.10.1%-20%的患者轻微并发症(疼痛、吞咽困难/吞咽痛、腹胀、无症状性肠壁积气); 没有患者出现严重并发症(出血、穿孔、狭窄).结论: VIO APC可以安全、有效地用于各种消化系疾病, 并可以广泛用于内镜治疗.     

OTSC吻合夹在消化道出血治疗中的应用

消化道出血是胃肠道疾病和消化道术后常见并发症,如不及时救治,可继发失血性休克,甚至危及生命。目前消化道出血的内镜下治疗措施主要包括内镜下夹闭术、内镜下注射肾上腺素生理盐水、氩离子凝固术(APC)、电凝术和热探头凝固等。内镜下金属夹止血术主要包括传统through-the-scope clip(TTSC)止血术和新型over-the-scope clip(OTSC)闭合术。本文就OTSC吻合夹在消化道出血治疗中的应用作一综述。     

支气管镜下氩离子凝固术联合高频电刀及冷冻治疗气道狭窄的疗效观察

目的 探讨氩离子凝固术联合高频电刀及冷冻术(三联疗法)治疗气管狭窄的临床疗效.方法 本研究招募80名气管狭窄患者,随机分为观察组和对照组各40例.观察组患者予氩离子凝固术、高频电刀和冷冻术三联治疗,对照组患者仅行高频电刀治疗.观察两组患者气管再通的治疗效果,治疗前后的血气指标、呼吸困难严重程度、气管狭窄程度以及术后并发...     

氩离子凝固术治疗消化道疾病197例疗效观察

氩离子凝固术(APC)是一种新型非接触性电凝固方法,可用于组织表面的凝固,经离子化气将高频能量传至靶组织,组织表面即可凝固,达到凝血和消除病变组织的目的[1],我院从2008年7月至2010年12月采用APC法共治疗消化道疾病197例,疗效满意,现报道如下.     

氩离子凝固术在放大色素内镜下治疗胃黏膜癌前病变90例

目的:探讨放大色素内镜下氩离子凝固术对胃黏膜癌前病变的治疗效果及其临床应用价值.方法:应用Fujinon EG-590ZW型电子放大内镜,结合关蓝染色,对90例胃黏膜癌前病变患者进行氩离子凝固术治疗,观察治疗前后病灶细微结构形态学改变,并结合其病理组织学改变进行比较分析.结果:90例伴随肠上皮化生及异型增生的胃黏膜在进行氩离子凝固术治疗后6mo,胃小凹形态由治疗前的E、F型再生为C、D型(86.7%、6.7%),异常增生微血管消失,其相应病理组织学转变为慢性活动性炎症(85.6%)及萎缩性炎症(8.9%),E、F型胃黏膜及肠上皮化生、异型增生消融率分别为93.0%及94.4%.结论:氩离子凝固术是一种胃黏膜癌前病变安全、有效的治疗方法.     

胃镜下氩离子凝固术治疗Barrett食管的临床研究

目的探讨内镜下氩离子凝固术治疗Barrett食管的临床疗效。方法选择我院2006年3月-2007年4月经内镜检查及病理组织学检查诊断的Barrett食管患者87例,在内镜下行氩离子凝固术治疗,所有病例治疗后3个月及6个月时复查内镜以及病理组织学检查。结果87例Barrett食管患者3个月复查时78例（89.7％）胃镜下未见复发,9例（10.3％）由于BE黏膜长度较长,在原来部位有散在Barrett食管上皮残留,行第二次氩离子凝固术治疗,6个月复查胃镜及病理组织学检查,全部患者均未见Barrett黏膜复发。结论氩离子凝固术是经内镜非接触性治疗Barrett食管的新方法,操作方便,短期疗效较好。     

Use of argon plasma coagulation in advanced cancers of the upper digestive tract

Endoscopy being a diagnostic tool, allows also a nonsurgical treatment of upper gastrointestinal tract neoplasms, even at their advanced stage. Argon plasma coagulation (APC) is a contact-free method of monopolar coagulation, based primarily on the effects of high frequency electrical current flow in the ionized argon. The study used in 14 patients, aged 56-85 years, with advanced carcinoma of oesophagus and/or cardia. Carcinoma was diagnosed upon the results of endoscopic and microscopic examinations. The following parameters were included in the analysis: electrical current power, number of treatment sessions, stage of dysphagia, oesophagus passage, localization and type of a tumor. The analysis revealed that APC is a highly effective as well as safe method of palliative treatment of advanced oesophageal and/or cardiac cancers. Moreover, it was noted that APC is more effective in adenocarcinomas than in squamous cell carcinomas.     

Argon plasma coagulation in bronchology: a new method--alternative or complementary?

Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998, 364 patients (80 women, 284 men), 88% with a confirmed malignant tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway stenoses (186 patients). The defined therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with Nd:YAG laser, extensive bronchial tumors were treatable, in which coagulated tumor fractions were removed either with forceps or bronchoscope tip. The second indication was bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under local anesthesia was used. In 34 patients, APC was successfully used to recanalize occluded stents. Rare indications included benign endobronchial tumor, fistula conditioning before fibrin adhesion, and the treatment of scar tissue stenosis. Summarizing all complications, a rate of 3.7% "per treatment" was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic tumor ablation and hemostasis and can be used with local anaesthetic with flexible bronchoscopy or rigid bronchoscopy with general anesthesia. Compared with Nd:YAG laser, APC is an economic alternative technique offering more effective hemostasis. Furthermore, APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy.     

消化道肿瘤的免疫学指标监测

肿瘤的发生、发展及转归与机体免疫状态密切相关,当宿主免疫功能低下或受抑制时,肿瘤细胞会通过免疫逃逸来逃避宿主的免疫攻击。恶性肿瘤患者普遍存在免疫功能失调,外周血的免疫学指标可部分反映患者免疫状态,并对患者预后有一定预测意义。     

氩离子血浆凝固术治疗胃肠广基扁平息肉和出血

目的 探讨氩离子血浆凝固术（APC）对胃肠广基扁平息肉和出血的治疗作用。方法 广基扁平息肉患者13例，31枚息肉，行内镜下APC治疗；大息肉内镜切除及活检后出血5例，APC术止血治疗；对照组广基扁平息肉患者20例，28枚息肉，行内镜下热凝电极治疗。结果 APC术和张电极在广基扁平息肉治疗中疗效相同，局部疼痛的副作用相似，但APC术导管探头无粘连，明显优于热凝电极治疗组55％的发生率（P＜0．01）。APC治疗大息肉内镜切除及活检后渗血迅速有效。结论 APC术治疗胃肠广基扁平息肉及出血简便有效。     

日本血吸虫病相关胃肠道肿瘤的临床与病理特征

目的了解慢性肠道血吸虫感染与肠道肿瘤发生的关系。方法回顾分析池州市人民医院2005年1月~2013年3月慢性胃肠道血吸虫感染合并胃肠道肿瘤患者病理资料,总结慢性血吸虫胃肠道感染患者并发胃肠道肿瘤发生情况,分析慢性血吸虫胃肠道感染与胃肠道肿瘤发生的特点。结果慢性血吸虫病并发胃肠道肿瘤的比例为25.8%(88/340),其中癌发生比例为22.6%(77/340),轻度不典型增生为0.58%(2/340),中度不典型增生为1.47%(5/340),重度不典型增生为1.17%(4/340)。结论肠道慢性血吸虫感染与胃肠道肿瘤发生有关,可能为癌前病变。     

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。     

Loss of heterozygosity involving the APC and MCC genetic loci occurs in the majority of human esophageal cancers.

The tumor suppressor gene APC was recently identified, and the cDNA was cloned from chromosome 5q21. Point mutations affecting APC are seen in the hereditary syndrome familial adenomatous polyposis, and point mutations in APC and a closely linked gene, MCC, as well as loss of heterozygosity involving chromosome 5q have been reported in sporadic colon cancer. To our knowledge, loss of heterozygosity involving APC or MCC or both has not yet been described in any other human cancer besides lung cancer. We used the polymerase chain reaction and DNA content flow cytometric nuclear sorting to examine 30 primary human esophageal cancers for loss of heterozygosity of APC or MCC or both. Loss of one allele was detected in 77% of 26 informative cases. These data suggest that loss of heterozygosity of regions on 5q including the APC and MCC genetic loci is involved in the development and/or progression of most human esophageal cancers. They imply that inactivation of APC, MCC, and/or a linked gene on chromosome 5q plays a role in the pathogenesis of some cancers of the upper gastrointestinal tract, as well as in colon cancer and familial adenomatous polyposis.     

质子泵抑制剂治疗对Barrett食管APC基因启动子区甲基化的影响

背景：Barrett食管（BE）是食管腺癌的癌前病变,与食管腺癌的发生密切相关,已成为近年来的研究热点。目的：观察质子泵抑制剂（PPI）埃索美拉唑对BE患者抑癌基因APC表达及其启动子区甲基化的影响。方法：以甲基化特异性聚合酶链反应（PCR）和实时荧光定量PCR观察69例BE患者APC基因启动子区甲基化阳性率和APCmRNA表达在埃索美拉唑治疗前后的变化。分析治疗前APC基因启动子区甲基化状态与BE临床病理特征的关系。结果：埃索美拉唑治疗前,APC基因启动子区甲基化阳性率显著高于治疗后（42．0％对17．4％,P=0．007）。治疗前．长段BE的APC甲基化阳性率显著高于短段BE（46．8％对31．8％,P=0．032）;内镜下食管炎洛杉矶分类A级和B级者的APC甲基化阳性率显著低于C级和D级（19．0％对52．1％,P=0．046）;Ⅰ、Ⅱ、Ⅲ型BE间APC甲基化阳性率无明显差异（P=0．061）。埃索美拉唑治疗后,BE上皮APCmRNA表达量较治疗前显著增加（19．5±0．4对6．5±2．3,P=0．000）。结论：埃索美拉唑可抑制BE患者APC基因启动子区甲基化,增加抑癌基因APC表达。     

胆汁反流的诊断及发病机制的研究现状

胆汁反流性疾病的研究工作近年来颇为活跃。现已知胆汁反流患者多有胃肠道运动功能障碍，部分胃肠激素亦参与其发病。对胆道系统疾病及胆囊切除术后并发胆汁反流也已进行了广泛的研究，但其具体机制尚无定论。本文就胆汁反流的诊断、检测及发病机制进行综述，希望对今后的临床丁作及研究有所帮助。