内镜黏膜切除术在大肠小扁平腺瘤中的临床应用

目的探讨内镜下黏膜切除术(EMR)在大肠小扁平腺瘤中的临床应用价值。方法选择89例114个内镜下直径≤10mm,圆形或椭圆形隆起性病灶,黏膜下生理盐水注射后非提起征阴性者行黏膜切除术,全瘤病灶送病理学检查;观察手术并发症并作相应处理。对腺瘤患者术后进行6～18月随访。结果114个大肠小扁平隆起性病变中,腺瘤21个,分布于大肠各个部位,其中,以直、乙状结肠多见;其他93个为增生性息肉或炎症性息肉。21个大肠小扁平腺瘤大多伴有上皮细胞不同程度异型增生,共中轻度13个(61.9%),中度4个(19.0%),重度2个(9.5%)。89例11个病灶EMR术中,3例发生即时出血,以病灶周边渗血为主,电凝后出血停止,2例分别在第3d、第6d发生一过性出血,均因过量运动所致,保守治疗后出血停止。21个腺瘤患者随访6～18月,原发灶部位均未见病变复发。结论内镜黏膜切除术对于大肠小扁平腺瘤不仅安全、有效,而且完全彻底,对早期大肠癌的防治具有重要的意义,值得临就床推广。     

大肠小扁平腺瘤、息肉样腺瘤p53、p21表达的研究

目的:观察大肠小扁平腺瘤p53、p21基因的表达,探讨小扁平腺瘤与息肉样腺瘤生物学行为的不同及其与大肠癌的关系.方法:利用免疫组化法研究50例小扁平腺瘤(A组)和30例息肉样腺瘤(B组)以及20例正常大肠黏膜(C组)的p53、P21基因表达情况.结果:p53、p21 在A、B、C 三组中阳性率分别为58%、56%;33.3%、36.7%;5%、10%.P53阳性率三组间差异有显著性(P＜0.05).p21阳性率:A、B组分别与C组有差异显著性(P＜0.05);A组高于B组,但卡方检验P＞0.05,无统汁学差异;A组进一步与B组中直径＜1.0cm的腺瘤的p21阳性率(30%)比较,差异有显著性(P＜0.05).结论:大肠小扁平腺瘤p53、p21基因的异常表达提示小扁平腺瘤的生物学行为与息肉样腺瘤有差别,可能更易于恶变.     

大肠扁平腺瘤与息肉样腺瘤的对比研究

大肠扁平腺瘤指平坦或轻微隆起于大肠黏膜表面的腺瘤，其腺瘤成分的厚度不超过周围正常黏膜的两倍，1985年由Muto等最早报道。多项研究显示，大肠扁平腺瘤占所有大肠腺瘤患者的12％～42％，伴重度异型增生的比例超过12％，远高于息肉样腺瘤的4％，故认为扁平腺瘤是易癌变的特殊腺瘤类型。本研究通过结肠镜检查、病理检查和免疫组化染色研究大肠扁平腺瘤的特点。     

大肠腺瘤56例内镜随访资料分析

大肠腺瘤５６例内镜随访资料分析韦铮武我们对５６例大肠腺瘤内镜随访了５～９年，发现大肠腺瘤复发跟腺瘤的多少有关，跟腺瘤的部位及大小关系不大。现报告如下。临床资料用ＯｌｍｙｐｕｓＣＦＭＲ３Ｒ大肠镜，检查全部到达回盲部，５６例中男３９例，女１７例，＜３０岁...     

大肠Muto小扁平状腺瘤

大肠Ｍｕｔｏ小扁平状腺瘤赵伟东１牛海洲１张再厚２１山东胜利石油管理局中心医院山东省东营市２解放军总医院消化内科主题词腺瘤癌前状态结直肠肿瘤Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓａｄｅｎｏｍａｐｒｅｃａｎｃｅｒｏｕｓｃｏｎｄｉｔｉｏｎｓｃｏｌｏｒｅｃｔａｌ...     

大肠腺瘤与大肠癌

大肠腺瘤与大肠癌欧阳钦，欧阳雪松，马洪升大肠癌在欧美国家为最常见的恶性肿瘤之一。亚、非、拉美国家虽属低发区，但来自日本的报道表明近年的发病率逐渐上升，预计至２０００年将超过胃癌、肺癌而占居首位。我国尚无确切的统计，东南沿海部分地区与世界高发地区相近，...     

大肠腺瘤恶变研究进展

大肠息肉包括瘤性和非瘤性两大类.瘤性息肉腺瘤(adenoma),具有恶变潜能,可再分为管状(tubular)、绒毛状(villous)及混合性(tubulovillous)三种.非瘤性息肉计有炎性、幼年性、增生性、化生性、良性淋巴管性、缺陷瘤性及炎性肠病之假性息肉等等,无恶变能力.本文就腺瘤的恶变、恶性腺瘤的诊断及处理、腺瘤切除在大肠癌预防中的应用三方面国内外研究进展作一综述.     

靛胭脂染色内镜检查对大肠微小腺瘤和息肉的诊断价值

目的探讨靛胭脂染色内镜检查在诊断大肠微小腺瘤和息肉中的价值。方法将31个大肠微小息肉分别行普通内镜及靛胭脂染色内镜检杏的结果与组织学检查结果比较,并比较2种内镜检查方法对大肠微小腺瘤和息肉的诊断准确率。结果靛胭脂染色内镜对大肠微小腺瘤和息肉的诊断准确率显著高于普通内镜,D组与A组、C组比较差异有娃著性（55．2％vs12％、10％）,P〈0．05;D组与B组比较差异无显著性i55．2％（腺瘤13．8％）VS50％（腺瘤10％）],P〉0．05。结论靛胭脂染色内镜检查可提高大肠微小腺瘤和息肉的诊断准确率。     

大肠小扁平腺瘤的形态及病理组织学特征研究

目的探讨大肠小扁平腺瘤的形态学特征及p53、p21、雌激素受体（estrogen receptor，ER）、孕激素受体（progesterone receptor，PR）表达的生物学意义。方法用Olympus CF240型电子结肠镜及OlympusBX41光学显微镜观察50例大肠小扁平腺瘤形态学特征。用免疫组化二步法检测50例小扁平腺瘤及其腺瘤旁组织、26例大肠癌及其癌旁组织、15例正常人大肠黏膜中p53、p21、ER、PR的表达情况。结果小扁平腺瘤发生于大肠任何部位，其发病率依次以横结肠、乙状结肠、直肠为多见；肠镜下见病灶呈圆形或椭圆形，扁平状，基底宽，体积≤1cm。光镜下小扁平腺瘤呈管状腺瘤样图像，上皮具有不同程度的异型增生。小扁平腺瘤中p53、p21、ER、PR的表达率分别为58％（29／50）、56％（28／50）、12％（6／50）、10％（5／50）。随着小扁平腺瘤异型增生程度的增高，p53、p21、ER、PR的表达率也逐渐升高（P〈0．05）。大肠癌中的表达最高（P〈0．05）。结论大肠小扁平腺瘤有其独特的形态学特征，p53、p21、ER、PR的表达与大肠小扁平腺瘤的发生发展有密切关系。     

大肠腺瘤389例资料分析

大肠腺瘤是息肉的一种,腺瘤的外观表现往往很难与其他息肉相区分,病理诊断是必不可少的手段。早年曾有报道应用直肠镜乙状结肠镜对人群进行了大量的研究,但其缺乏整段大肠的腺瘤发生情况。我院在１０７１６例大肠镜检查中,检出３８９例大肠腺瘤,并发现了３１个腺瘤癌...     

老年人大肠息肉与大肠癌

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析。结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉、腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％；（３）多发性息肉比例较高，并以腺瘤性息肉为主，占８０．７％，且多发生于不同的肠段；（４）老年人大肠癌低恶性程度者多；（５）大肠腺瘤性息肉常与大肠癌并存，二者多发生于不同肠段。因此，我们认为便血是老年人大肠镜检查的有力指征；大肠镜检查时不应满足于远端大肠病变的诊断，应尽可能检查全大肠；对老年人大肠息肉，尤其是多发性息肉及直径大于１．０ｃｍ者应积极切除。     

下呼吸道痰痂分类及其清除术

探讨下呼吸道痰痂形态、治疗。通过支气管镜观察，探求４例开胸术后急性呼吸衰竭的病人在气管切开后，痰痂依形态可分为：扁平型和隆起型。依其与气道壁附着的牢固程度可分为：牢固型和非牢固型。纤维支气管镜直视下清除痰痂有三种方法：吸除，活检钳清除，弯止血钳取除。三种方法中以弯止血钳取除的效率最高，耗时最少。     

RELATION BETWEEN OBESITY AND ADENOMATOUS POLYPS OF THE LARGE BOWEL

Background: We compared the prevalence of colorectal adenoma (polyps) in men and women and examined the role of body mass index (BMI) on polyp risk according to patient age and gender. Methods: The risk of developing colorectal polyps was studied in 15 380 subjects (7155 men and 8225 women) who underwent colonoscopy for the first time from April 1998 to March 2006 at our ‘Human Dry Dock’, which is the check‐up service provided in Japan. Eligible subjects were 20–86 years old (mean age ± SD, 47.3 ± 8.5) and were free of invasive cancer, hyperplastic polyps and familial polyposis. Polyps were found in 1590 subjects (1062 men and 528 women). The odds ratio (OR) of detection of polyps in relation to obesity was determined in all cases by multivariate logistic regression analysis after making an adjustment for gender and age. Results: The OR of polyp detection in obese subjects (BMI ≥ 25) versus non‐obese subjects (BMI < 25, OR = 1) was 1.34 (P < 0.001) in men and 1.13 (P = 0.26) in women. As the BMI increased in increments of one, the OR in men increased significantly to 1.01 (P < 0.001), whereas the OR in women was unchanged at 1.00 (P = 0.23), which was without significance. Conclusions: We conclude that obesity in men is a risk factor for the development of polyps. These results must be confirmed by additional epidemiological studies.     

RELATIONSHIP BETWEEN ENDOSCOPIC FINDINGS OF THE POUCH AND BOWEL FREQUENCY AFTER RESTORATIVE PROCTOCOLECTOMY IN ULCERATIVE COLITIS

Background and aim: Pouchitis is one of the late complications of restorative proctocolectomy in ulcerative colitis (UC) and is associated with increased bowel frequency. The present study aimed to clarify the endoscopic findings that are associated with bowel frequency. Patients and methods: The macroscopic and microscopic features in the ileum proximal to the pouch, the pouch, and the remnant short rectum in 100 endoscopies on 63 patients were studied retrospectively. Results: Four of 28 (14%) patients had inflammatory changes in the proximal ileum. Sixty‐seven percent of patients showed an abnormal appearance of the pouch. Granularity, friability, presence of mucus, erythema, and erosions were significantly related to bowel frequency. ‘Endoscopic pouch activity index’ (EPAI), which is the number of positive findings of diffuse erythema, mucus, friability, ulcer, erosion, and granularity, was strongly associated with bowel frequency (P < 0.0001). Patients without macroscopic inflammation in the rectum had significantly lower bowel frequency than those with mild or moderately active inflammation (P = 0.0294 and 0.0183, respectively). Multivariate analysis revealed that ‘endoscopic pouch activity index’ and histological grade of pouch inflammation were significant factors (P = 0.0004 and P = 0.0429, respectively) influencing bowel frequency. Time–course study demonstrated that changes in EPAI and macroscopic grade of the rectum were significantly related to alteration in bowel frequency (P = 0.0120 and 0.0244, respectively). Conclusion: Erythema, mucus discharge and granularity were significantly related to bowel frequency. EPAI may be useful to evaluate endoscopic pouch inflammation.     

食管乳头状瘤的临床,内镜及病理学探讨

为探讨食管乳头状瘤（ＥＰ）的临床与病理特点以及病因及发病机制，回顾性总结和分析了２７例ＥＰ的临床和病理资料。结果发现：１．ＥＰ临床表现无特异性；２．内镜见病变主要位于食管中下段（２５例），且与食管炎有关，内镜易误诊为食管息肉；３．治疗后６例随访１月正常，其中４例随访２年未见复发；４．并发其它部位恶性肿瘤（４例）；５．病理学无恶变证据，但２例有轻度不典型增生。认为１．ＥＰ是否属癌前病变值得进一步研究；２．加强对ＥＰ病人邻近脏器的检查和随访十分必要；３．粘膜的慢性炎症刺激等在ＥＰ发病中起一定作用。     

LARGE HYPERPLASTIC POLYP DEVELOPING AFTER ENDOSCOPIC MUCOSAL RESECTION OF GASTRIC ADENOMA IN A PATIENT RECEIVING IMMUNOSUPPRESSIVE THERAPY

A 59‐year‐old man underwent endoscopic mucosal resection (EMR) for gastric adenoma. He had suffered from end‐stage renal disease for several years and had received renal transplantation some 5 months before EMR. Subsequently, he took immunosuppressive agents. Follow‐up gastrofiberscopy 6 months after EMR showed a sessile polyp at the resection site twice as large as the original adenoma; biopsy specimens revealed a hyperplastic nature. At the time of writing, this hyperplastic polyp has neither increased in size nor developed adenomatous or carcinomatous changes by histological examinations over the past 5 years. Therefore, this is a case of hyperplastic polyp occurring at the gastric adenoma resection site, and suggests the possible effect of immunosuppressive therapy on the post‐EMR healing process and hyperplastic polyp development.     

USEFULNESS OF ENDOSCOPIC TREATMENT FOR DUODENAL ADENOMA

In recent years, due to the increasing prevalence of upper gastrointestinal endoscopy, there have been an increasing number of reports on duodenal adenoma and early stage cancer. However, endoscopic techniques for the resection of duodenal adenomas are difficult, due to the anatomical features of the duodenum, and the long distance to the lesion. There have only been a few reports on the use of endoscopic techniques for duodenal adenomas compared to those focused on the stomach and large intestine. For duodenal adenomas, we used a conventional endoscope for lesions proximal to the major duodenal papilla, and a short‐type double balloon endoscope for lesions distal to the papilla. The en‐bloc resection rate was 93.8%. There was only one case of microperforation. Endoscopic manipulation is considered difficult in the deep areas of the duodenum, but double balloon endoscopy enabled stable manipulation and successful resection of the tumor in the majority of cases.