胃静脉曲张血流动力学分型与临床处理专家共识

胃静脉曲张(GV)是门静脉高压并发症之一, 其发生率虽较食管静脉曲张低, 但GV出血不易控制, 再出血率和病死率高。GV有着不同于食管静脉曲张的血管解剖学和血流动力学特点, 与其特点相对应, GV有特殊临床处理策略。为加深对GV血流动力学分型的认识, 指导临床医师制定GV出血的个体化治疗策略, 中华医学会消化病学分会消化微创介入协作组邀请该领域部分专家制定本共识。     

胰腺神经内分泌瘤精准诊疗困境与展望

胰腺神经内分泌瘤的发病率逐年增加, 其诊治也受到越来越多的重视。相较于常见的实体肿瘤, 胰腺神经内分泌瘤由于独特的时空异质性, 其精准诊疗仍面临困境。随着基因组学、转录组学、蛋白质组学、影像组学等多组学的快速发展, 有望为胰腺神经内分泌瘤的精准诊疗带来新方法和新思路。     

肝硬化门静脉高压食管胃静脉曲张出血的防治指南

为了规范肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理, 中华医学会肝病学分会、中华医学会消化病学分会和中华医学会消化内镜学分会组织国内有关专家, 结合近年来国内外肝硬化门静脉高压食管胃静脉曲张出血相关临床研究的最新进展, 遵循循证医学的证据, 修订了《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》, 对肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理提出了推荐意见, 旨在提高临床医生对于肝硬化门静脉高压食管胃静脉曲张出血的临床救治水平。     

肝硬化门静脉高压食管胃静脉曲张出血的防治指南

为了规范肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理, 中华医学会肝病学分会、消化病学分会和消化内镜学分会组织国内有关专家, 结合近年来国内外肝硬化门静脉高压食管胃静脉曲张出血相关临床研究的最新进展, 遵循循证医学的证据, 修定了《肝硬化门静脉高压食管胃静脉曲张出血的防治指南》, 对肝硬化门静脉高压食管胃静脉曲张出血的诊断、治疗和管理提出了推荐意见, 旨在提高临床医生对于肝硬化门静脉高压食管胃静脉曲张出血的临床救治水平。     

自身免疫性胃炎123例发生1型胃神经内分泌瘤的危险因素研究

目的探究自身免疫性胃炎(AIG)患者发生1型胃神经内分泌瘤(g-NET)的危险因素。方法回顾性收集2016年9月1日至2022年2月28日就诊于郑州大学第一附属医院的123例AIG患者, 其中37例合并1型g-NET, 86例未合并1型g-NET。分析所有患者的临床资料、血清学指标和内镜下表现, 包括确诊AIG时的年龄(以下简称确诊年龄)、胃泌素17和胃蛋白酶原Ⅰ(PGⅠ)水平、有无胃底和胃体息肉等。通过单因素与多因素logistic回归分析AIG患者发生1型g-NET的独立危险因素。绘制受试者操作特征曲线(ROC)分析独立危险因素预测AIG患者发生1型g-NET的最佳截断值、灵敏度和特异度。统计学方法采用独立样本t检验、Mann-WhitneyU检验、卡方检验。结果与未合并1型g-NET的AIG患者相比, 合并1型g-NET的AIG患者确诊年龄更低[(57.49±11.16)岁比(48.49±10.96)岁]、胃泌素17水平更高[200.21 ng/L(121.85 ng/L, 244.40 ng/L)比244.40 ng/L(182.50 ng/L, 248.02 ng/L)], ...     

原发性胃神经内分泌肿瘤的临床特点、病理及预后分析

目的 比较胃神经内分泌肿瘤(NEN)各临床分型的临床病理特征,并分析其中胃神经内分泌癌(NEC)及混合性腺-神经内分泌癌(MANEC)的预后影响因素。方法 将苏州大学附属第一医院和南京医科大学第一附属医院148例胃NEN按欧洲神经内分泌肿瘤协会(ENETS)临床分型标准分为Ⅰ型、Ⅱ型、Ⅲ型,比较各型胃NEN的临床、胃镜及病理特征,分别采用Kaplan-Meier检验、Cox回归模型对其中108例病理分级为G3级的胃NEN患者进行单因素和多因素生存分析。结果 纳入的Ⅰ型、Ⅱ型、Ⅲ型NEN患者分别为37例(25.0%)、5例(3.4%)和106例(71.6%)。Ⅰ型有28例(75.7%)为胃底/胃体病变,29例(78.4%)为隆起灶,4例(10.8%)有淋巴结受累,余均为局限性病变,26例(70.3%)内镜治疗,11例(29.7%)接受外科手术。5例Ⅱ型胃NEN的瘤体均位于胃底/胃体,4例为溃疡灶,均予内镜治疗;患者中合并胃泌素瘤3例,另2例合并多发性内分泌肿瘤Ⅰ型。Ⅲ型中56例(52.8%)为贲门病变,81例(76.4%)表现为溃疡,单发病灶为102例(96.2%),淋巴结受累或器官转移...     

颅内多发结核瘤1例

中枢神经系统结核是肺外结核病的一种少见形式, 具有较高的病死率, 包括结核性脑膜炎、颅内结核瘤和结核性蛛网膜炎。颅内结核瘤是结核病危害最大的一种类型, 它的临床及影像学表现多样, 极易误诊, 早期正确诊断对于疾病的治疗和预后有非常重要的意义。本文报道了一例青年男性结核瘤患者的诊治过程, 其临床表现及实验室检查等结果不典型, 最终通过脑组织活检确诊, 为临床对该类疾病的诊断带来一定的启示。     

结直肠神经内分泌瘤61例的临床特点分析

目的分析结直肠神经内分泌瘤(NET)的临床特点,提高临床上对该病的认识。方法收集2011年1月至2018年12月在苏州大学附属张家港医院(19例)和苏州大学附属第一医院(42例)经病理确诊的61例结直肠NET患者临床资料,回顾性分析患者一般情况、发生部位、临床表现,组织学特点和病理分级,免疫组织化学检测结果,以及治疗、随访和预后情况。统计学分析采用卡方检验。结果 61例结直肠NET患者均为单发病灶,其中男36例(59.0%),女25例(41.0%);年龄为(56.3±9.2)岁。NET发生于直肠55例(90.2%),发生于结肠6例(9.8%)。61例结直肠NET患者中无明显临床表现33例(54.1%),腹部不适10例(16.4%);55例直肠NET患者中,主要表现为无明显临床表现31例,腹部不适7例;6例结肠NET患者中,主要表现为腹部不适3例,无明显临床表现2例。61例结直肠NET患者肿瘤最大径为(0.95±1.28)cm,肿瘤最大径≤2.0 cm者占86.9%(53/61),病理学分级以G1级NET为主(93.4%,57/61);直肠NET在内镜下表现为息肉样隆起或黏膜下隆起,结肠...     

胰腺神经内分泌肿瘤计算机断层扫描增强特征对术前病理分级的预测价值

目的探讨胰腺神经内分泌肿瘤(panNEN)计算机断层扫描(CT)增强特征预测术前病理分级的价值。方法回顾性分析2009年2月至2020年8月复旦大学附属中山医院经手术和病理确诊的136例panNEN患者的CT资料。根据2019年第5版世界卫生组织消化系统肿瘤分类标准将panNEN分为G1、G2、G3级神经内分泌瘤(NET)和神经内分泌癌(NEC), 比较不同病理分级病灶实性部分CT值和相关参数的差异。采用受试者操作特征曲线下面积(AUC)评价CT值和相关参数对不同病理分级panNEN的鉴别诊断价值。统计学分析采用非参数Kruskal-Wallis检验和卡方检验。结果在136例panNEN患者中, 共检出142个肿瘤病灶, 其中G1、G2、G3级NET和NEC病灶数分别为58、73、7、4个。随着病理分级的升高, panNEN病灶实性部分的CT强化程度呈逐渐下降趋势。G2级NET患者动脉期和静脉期的CT值、CT值差值、相对密度指数均低于G1级NET患者[动脉期:105 HU (46～251 HU)比126 HU (57～195 HU)、62 HU(6～212 HU)比81 HU(23～1...     

门静脉型环形胰腺1例

门静脉型环形胰腺(PAP)是指胰腺发育过程中胰腺钩突部与胰体部融合, 并包绕门静脉或肠系膜上静脉的先天性解剖变异, 该变异极为罕见。本文报道1例PAP患者的临床表现、影像学特征以及手术过程和围术期处理等具体措施, 以提高临床医师对PAP的认识。     

肝硬化致孤立性十二指肠静脉曲张破裂出血1例报告

正孤立性胃、十二指肠静脉曲张是指不伴有食管静脉曲张,仅有胃或十二指肠静脉曲张。其中十二指肠静脉曲张(duodenal varices,DV)的临床特征包括:中年男性多见,多有肝病史,反复、大量的急性消化道出血且以大量便血为主,伴或不伴有食管静脉曲张。现将本院收治的1例孤立性十二指肠静脉曲张破裂出血患者报告如下。1病例资料患者女性,58岁,因"HBV感染10年,黑便40 d,加重伴呕     

A bleeding disorder caused by a cardiac tumor: case report

A 22-year-old female developed symptomatic thrombocytopenia. On physical examination, apart from ecchymoses, a loud holosystolic murmur was heard. Echocardiography revealed a cardiac tumor. The thrombocytopenia did not respond to corticosteroids, but after surgical removal of the intracardiac tumor, a papillary fibroelastoma, the platelet count normalised. There are no similar case reports in the literature. Our case report illustrates that thrombocytopenia may be associated with a cardiac tumor and that complete physical examination is essential in every patient presenting with easy bruising.     

Gastric variceal bleeding caused by an intrahepatic arterioportal fistula that formed after liver biopsy: a case report and review of the literature

An intrahepatic arterioportal fistula is a rare cause of portal hypertension and variceal bleeding. We report on a patient with an intrahepatic arterioportal fistula following liver biopsy who was successfully treated by hepatectomy after unsuccessful arterial embolization. We also review the literature on symptomatic intrahepatic arterioportal fistulas after liver biopsy. A 48-year-old male with bleeding gastric varices and hepatitis B virus-associated liver cirrhosis was transferred to our hospital; this patient previously underwent percutaneous liver biopsies 3 and 6 years ago. Abdominal examination revealed a bruit over the liver, tenderness in the right upper quadrant, and splenomegaly. Ultrasonographic examination, computed tomography, and angiography confirmed an arterioportal fistula between the right hepatic artery and the right portal vein with portal hypertension. After admission, the patient suffered a large hematemesis and developed shock. He was treated with emergency transarterial embolization using microcoils. Since some collateral vessels bypassed the obstructive coils and still fed the fistulous area, embolization was performed again. Despite the second embolization, the collateral vessels could not be completely controlled. Radical treatment involving resection of his right hepatic lobe was performed. For nearly 6 years postoperatively, this patient has had no further episodes of variceal bleeding.     

Obscure gastrointestinal bleeding due to duodenal infiltration of a non-functioning pancreatic neuroendocrine tumor diagnosed by capsule endoscopy: A case report

Non-functioning pancreatic neuroendocrine tumors (PNETs) are infrequent slowgrowing, clinically-silent tumors. They are incidentally detected and some of them may present in advanced stages with local involvement of surrounding structures. The diagnostic accuracy of endoscopio ultrasound (EUS) and fine needle aspiration (FNA) biopsy is significantly lower in neuroendocrine tumors (46.7%) compared with adenocarcinoma (81.4%) and other histologies (75%). Therefore, preoperative diagnosis is very difficult. Exceptionally, hey present with gastrointestinal bleeding. We present a case of a non-functioning PNET initially diagnosed as cystic serous tumor of pancreas with EUS and FNA biopsy. Two years later patient presented obscure gastrointestinal bleeding due to duodenal infiltration. Diagnosis was made by capsule endoscopy.     

肝硬化并发腹膜后静脉曲张破裂出血1例

正1病例资料患者男性,34岁,以腹胀4个月余,加重伴发热1 d为主诉于2015年6月10日收入大连医科大学附属第二医院消化科。查体:体温38℃,脉博100次/min,呼吸18次/min,血压105/70 mm Hg。贫血貌,皮肤黏膜、巩膜轻度黄染,结膜略苍白。左颈部、双腋窝3粒黄豆大小肿大淋巴结,无肝掌、蜘蛛痣。心肺阴性,腹部略膨隆,质韧,全腹部轻压痛,右上腹较重,     

Metastatic pancreatic neuroendocrine tumor presenting as a pituitary space occupying lesion: a case report

Neuroendocrine tumor metastases to the pituitary gland are very rare. There are few case reports of carcinoid tumor metastases to the pituitary, but no cases of pancreatic neuroendocrine pituitary metastases have been reported. In this report we present a 55-year-old female with a sellar mass, ophthalmoplegia and headaches initially thought to represent an invasive null cell pituitary adenoma. However a histological (trans-sphenoidal and liver biopsies) and systemic investigation proved it to be a metastasis of an undiagnosed pancreatic neuroendocrine tumor. Our patient was unique in respect to the location of the metastasis and the uncharacteristically high proliferative index of her tumor. She received conventional therapy consisting of Sandostatin, chemotherapy and radiotherapy as well as labeled somatostatin following an avid uptake on octreotide scanning. Despite a radiological improvement the patient suffered progressive clinical deterioration and died.     

Obstructive jaundice caused by secondary pancreatic tumor from malignant solitary fibrous tumor of pleura： A case report

A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining ofα-smooth muscle actin (α-SMA) or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.     

Ectopic variceal bleeding after hepatobiliary surgery: A case report

Rationale:Jejunal varices are rare in portal hypertension and are often difficult to diagnose and treat. Herein, we present a case of gastrointestinal bleeding due to jejunal varices after hepatobiliary surgery.Patient concerns:A 69-year-old man presented with recurrent massive gastrointestinal bleeding. He underwent partial right hepatectomy and cholangiojejunostomy 2 years prior to the first onset of bleeding. Two sessions of endoscopic vessel ligation for esophageal varices were performed afterwards, and hematemesis resolved completely, but massive melena still recurred during the following 5 years.Diagnosis:The patient was diagnosed with jejunal varices caused by portal venous stenosis after hepatobiliary surgery.Intervention:Portal venous angioplasty using balloon dilation and stent implantation was performed.Outcomes:After the intervention procedure, the patient did not experience any onset of gastrointestinal bleeding during follow-up.Lessons:Hepatopancreatobiliary could lead to the formation of jejunal varices. The combined use of capsule endoscopy, contrast-enhanced computed tomography, and sometimes portal venography is a promising strategy to search for jejunal varices. Transcatheter angioplasty appears to be a safe and effective method for treatment of jejunal varices in certain appropriate cases.