“雪碧零卡®”在磁控胶囊内镜胃准备方案中的应用初探

目的　探究400 mL雪碧零卡®作为磁控胶囊内镜（magnetically controlled capsule endoscopy,MCE）检查胃准备方案的可行性。方法　本随机对照研究于2019-12-16至2020-01-15在海军军医大学长海医院消化内科开展。拟行胶囊内镜的患者及健康志愿者按1∶1的比例被随机分为雪碧（S）组和纯水（W）组。W组受试者在吞咽胶囊前10 min饮用纯水800 mL,而S组受试者则用400 mL“雪碧零卡®”饮料代替纯水。本研究主要研究终点为胃充盈度评分,次要终点包括饱胀感评分、胃通过时间（gastric transit time,GTT）、小肠通过时间（small bowel transit time,SBTT）、小肠检查完成率以及诊断效能。结果　共102例受试者纳入分析（S组52例,W组50例）。S组受试者中位液体摄入量明显少于W组（500 mL比950 mL,P<0.001）的情况下,两组在吞服胶囊0~5 min、>5~10 min、>10~15 min时胃充盈中位评分均能稳定在4.0分（P>0.05）。S组饱腹感较W组显著缓解（7.0分比7.5分,P=0.030）,GTT<30 min受试者占比较W组显著增加［69.57%（16/52）比27.59%（8/29）,P=0.030］,且S组的小肠检查完成率达到了100.00%,高于W组的89.66%（P=0.245）。结论　400 mL雪碧与800 mL水相比,不仅能够充分充盈胃腔,而且具有较优的舒适性,加速胃排空,间接提高了小肠检查的完成率,作为胃准备方案具有良好可行性。     

胰性脑病研究进展

1923年Lowell首次报道急性胰腺炎患者出现精神状态异常.1941年Rothermich等报告8例胰腺炎并发意识模糊、定向力障碍、激动伴妄想及幻觉等脑神经症状,并首次称之为胰性脑病(pancreatic encephalopathy).由于其发生与胰酶对中枢神经系统的损伤有关,故又称"酶性脑病"(enzymatic encephalopathy)[1].本文就近年来对胰性脑病的发病机制以及诊治方面的进展作一综述.     

慢性胰腺炎胰腺钙化与烟酒关系初探

目的 探讨国内慢性胰腺炎(CP)患者烟酒摄入量与发生胰腺钙化间的关系.方法 按入院时有无胰腺钙化分为两组进行比较分析,再将无胰腺钙化者出院后有无新发胰腺钙化分为新发组和持续无钙化组.Logistic回归或Cox比例风险模型进行逐步回归分析胰腺钙化的风险因素.结果 1997年1月到2007年7月共收治并成功随访449例CP患者,248例有胰腺钙化;201例无胰腺钙化,其中13例出院后新发生胰腺钙化.入院时胰腺钙化者的发病年龄小、病史长、糖尿病和腹泻发生率高.首发年龄≤40岁、酒精摄入量>20 g/d、糖尿病和腹泻为胰腺钙化风险因素;过量饮酒为无胰腺钙化CP 患者新发生钙化的唯一风险因素(OR 3.2).结论 饮酒增加CP患者胰腺钙化风险,建议戒酒;吸烟的作用需进一步研究.     

十二指肠乳头癌致复发性急性胰腺炎一例并文献复习

复发性急性胰腺炎（recurrent acute pancreatitis，RAP）是指急性胰腺炎反复发作、而胰腺腺体的形态和功能正常。临床上表现为轻至中度的急性胰腺炎，腹痛伴短暂血清淀粉酶和脂肪酶升高，影像学改变为胰腺组织水肿。目前认为RAP常见病因为高脂血症、高钙血症、毒素、药物以及先天性畸形如胰腺分裂、环状胰腺、胆总管囊肿等。本文将描述由十二指肠乳头腺癌所致的复发性胰腺炎一例。     

42例青少年慢性胰腺炎的病因及临床特征分析

目的 探讨青少年慢性胰腺炎(CP)的病因及临床特征.方法 依据2002年亚太共识报告中提出的CP诊断标准,回顾分析1997年1月至2006年8月间住院治疗的42例青少年CP患者的病因、临床表现及影像学资料.结果 42例青少年CP患者占同期住院CP患者的9.84%,男、女各21例,平均住院年龄15.1岁,平均首发年龄为11.8岁;发病时间超过2年者25例(59.5%);首发到确诊时间超过2年者24例(57.1%).病因中以特发性慢性胰腺炎(ICP)为主(27例,64.3%),其次为胆道疾病和胰腺分裂等.轻、中度腹痛为主要症状,23例(54.8%)患者入院前腹痛发作4次以上,39例(92.9%)患者至少有一次"AP"发作.ERCP、CT、MRI(或MRCP)、腹部B超的阳性发现率分别为100%(37/37)、92.9%(13/14)、76.9%(20/26)和78.4%(29/37),以病理学诊断或ERCP所见为"金标准",CT、MRI(或MRCP)、腹部B超显示胰管改变的阳性率分别为74.1%、74.1%和51.4%;显示胰腺钙化或胰管结石的阳性率分别为87.5%、61.5%和45.4%.结论 青少年CP的首要病因为ICP,对反复发作的轻中度腹痛尤其是有"AP"病史者,应考虑CP的存在,辅助检查以MRI(或MRCP)和CT为优.     

慢性胰腺炎糖尿病的发生率及其风险因素分析

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.     

慢性胰腺炎糖尿病的发生率及其风险因素分析

Objective To investigate the incidence of diabetes mellitus and risk factors for the disease in chronic pancreatitis (CP) patients.Methods A historical cohort study on subjects with painful CP who were admitted to hospital from Jan.1997 to July 2007 were conducted.A life-table method was used to estimate the cumulative probability of the development of diabetes mellitus once clinical onset of abdominal pain.Cox proportional-hazards model was used for multivariate analysis of the variables including age,sex,drinking and smoking habits,etiological factor,presence of pancreatic masses,pancreatic calcifications,measure of intervention,diarrhea,weight loss and degree of pain.Results Data were obtained from 354 patients (239 males,mean age at onset of pain (38.1±17.6) years;alcoholic origin 18.1%) with painful CP.The mean follow-up period was (45.2±32.9)months.The rate of diabetes mellitus in CP patients was 16.1%.There was a high incidence (29.8%)of diabetes mellitus 1 year before the episodes of abdominal pain.The cumulative risk of diabetes mellitus in subjects 5 and 10 years after the episodes of pain was 9.3% and 20.7%,respectively.Cox proportional-hazards model selected smoking (＞10 pack years) (hazard rate (HR)= 3.3),mild abdominal pain (HR=5.2),weight loss (HR = 2.6) and pancreatic calcifications (HR = 2.2) as variables identifying subjects with diabetes mellitus in patients with painful CP before they were performed therapeutic endoscopy or surgical intervention.Smoking (＞10 pack years) (HR = 3.0),weight loss (HR= 2.8) and distal pancreatectomy (HR =7.3) were identified with an increased risk of diabetes mellitus in these cases after they received therapeutic endoscopy or surgical intervention.Conclusion The risk factors of diabetes mellitus for CP appears to be independent of smoking (＞10 pack years),mild abdominal pain,weight loss,pancreatic calcifications and distal pancreatectomy.     

胃食管反流病的内镜治疗进展

胃食管反流病是一种常见的上消化道动力障碍疾病，目前的治疗主要是抑制胃酸分泌药物和腹腔镜Nissen胃底折叠术。内镜抗反流治疗技术是近几年出现的很有前景的新方法，包括内镜下缝合术、射频治疗技术和内镜下植入治疗等，这些方法都取得较好的效果。此文就胃食管反流病的内镜治疗方面的进展作一综述。     

胶囊内镜廿年之发展:弱冠之年,而立之心

自1999年人类第1次吞下胶囊内镜开始,胶囊内镜已走过了临床应用的20个年头。20年来,从问世到成为小肠疾病一线检查方式,从技术进步到适应证拓展,从小肠到全消化道,从诊断到治疗初探,从技术应用到并发症预防,胶囊内镜为小肠疾病乃至全消化道疾病的诊疗模式带来了革命性变化。谨以此文回顾过去20年胶囊内镜的发展,并展望其将对消化系统疾病诊治带来的巨大影响。     

慢性胰腺炎癌变研究进展

近年来,有关慢性胰腺炎与胰腺癌相互关系的研究倍受瞩目.许多国内外学者从流行病学、发病机制以及肿瘤分子标记物等多方面对两者之间的关系进行了大量的实验与临床研究,以便临床早期发现发生于慢性胰腺炎基础上的胰腺癌,从而提高患者的愈后.本文就慢性胰腺炎进展为胰腺癌的癌变率、危险因素、发病机制、监查等进行综述.