中国肥胖症消化内镜治疗专家共识

消化内镜减重手术是近年来在减重领域逐渐兴起的一项新兴学科，以其创伤小、恢复快、可逆性好、并发症少、性价比高的诸多优势为肥胖患者的治疗提供了一项新的解决方案，有望成为外科减重代谢手术的并行和补充疗法。基于现有的临床循证医学依据，中华医学会消化内镜学分会微创减重治疗协作组、中国医师协会消化医师分会减重专业委员会和国家消化系统疾病临床医学研究中心（北京）组织相关专家，对其适应证、禁忌证、技术操作规范和围手术期处理策略等方面进行讨论，并达成共识，旨在为消化内镜减重技术的规范开展提供参考和指导，促进中国减重学科的健康发展。     

快速多环食管静脉结扎术并早期再发大出血

目的总结食管静脉曲张多环快速结扎的疗效及早期再发出血的原因。方法６３例门脉高压食管静脉曲张出血的患者，进行了择期内镜下结扎治疗。本组全部采用Ｗｉｌｓｏｎ－Ｃｏｏｋ或Ｍｉ－ｃｒｏｖａｓｉｖｅ多环结扎器，结扎次数每例为１～４次，平均１．９次，每次结扎橡皮圈４～１２个，每例共扎５～２１个圈，平均１０．２个圈。结果食管静脉曲张消失和基本消失４１例，占６５％，并发早期再发大出血８例，占１２．６％，分别发生于术中、术后１５小时、３６小时、３至９天。出血死亡３例，肝衰死亡１例。结论多环快速静脉结扎是一有效的治疗方法，但早期再发出血值得重视，并对早期再出血的可能原因及预防措施提出粗浅的见解。     

SHORT－TIME ANALYSIS FOR ADJUVANT CHEMOTHERAPY IN PATIENTS WITH EARLY－STAGE BULKY CERVICAL CARCINOMA

Bulky early-stage cervical cancer is defined as stage I~IIa cervical carcinoma with the diameter of enlarged cervix reaching 4 centimeters or more. These patients have higher recurrence rate and poor prognosis compared to those with smaller tumors at the same stage[1-3]. In or study, 21 patients with early-stage bulky cervical cancer were assigned to receive the addition of cisplatin-based chemotherapy for 1~2 courses followed by radical hysterectomy and the effect was analyzed. MATERIS…     

干扰素α对重症急性胰腺炎治疗作用的实验研究

目的　探讨干扰素α(interferon α,IFN α)对重症急性胰腺炎 (severeacutepancreatitis ,SAP)的治疗作用及机理。　方法　雄性SD大鼠随机分为假手术组、模型组、IFN α治疗组和生理盐水对照组 ,每组 10只。胰管内逆行注射 5 %牛磺胆酸钠建立SAP模型。治疗组大鼠 ,自制模后 0 5h开始每小时皮下注射IFN α 5× 10 5U/kg。按随机原则在制模后 4h和 12h分批处死动物 ,观察胰腺、肺和肾病变 ,测腹水量、血和腹水淀粉酶活性 (碘比色法 )、血肿瘤坏死因子α(TNFα)和白细胞介素 10 (IL 10 )浓度 (ELISA法 )。　结果　IFN α组胰腺、肺和肾病变程度减轻。血和腹水淀粉酶活性显著降低。血TNF α显著降低 ,IL 10升高。　结论　IFN α可有效减轻重症急性胰腺炎局部病变和器官损害程度 ,疗效与其对细胞因子的调控有关     

以恶性疟原虫裂殖子表面蛋白1的17区片段基因为基础的复合核酸疫苗诱导小鼠体液免疫反应的研究

目的: 检测以恶性疟原虫裂殖子表面蛋白1 的17 区片段基因为基础的复合核酸疫苗VR1012/TPA/HG-MSP1-17(分泌性)和VR1012/HG-MSP1-17(非分泌性)诱导小鼠的体液免疫反应。方法: 分别用分泌性与非分泌性核酸疫苗肌注免疫小鼠。用间接ELISA法测定小鼠血清的特异性抗体。结果: 每只小鼠经3 次100 μg/100μl非分泌性核酸疫苗免疫后, BALB/c小鼠和C57BL/6 小鼠均产生明显的抗HG和抗真菌表达的MSP1 17 区蛋白(YMSP119 )抗体。但总体抗体水平不高。BALB/c小鼠经3 次200 μg/100 μl非分泌性核酸疫苗免疫后, 产生较高的抗HG抗体, 但抗MSP1-17 的抗体无明显变化。经3 次200 μg/100 μl分泌性核酸疫苗免疫后, 只产生较低的抗HG抗体。结论: 非分泌性核酸疫苗较分泌性核酸疫苗具有更强的免疫原性     

鼻咽癌调强放疗标准流程的同质化与优化策略

放疗是鼻咽癌最主要的治疗手段,放疗技术与水平对鼻咽癌预后至关重要。由于调强放疗设备结构的复杂性以及放疗临床要求的精确性,必然对调强放疗流程提出了更高的要求。目前我国各放疗单位在设备配置、人员结构组成等方面存在差距,放疗同质化有待加强。且随着放疗信息管理系统、数字医学及人工智能技术在放疗领域的应用,原有流程已经满足不了新型精确放疗技术的应用需要。本流程旨在依据现有鼻咽癌放疗流程的基础上,结合目前放疗领域的最新进展,建立新的标准流程推荐,有力保证放疗的规范化、同质化,并实现鼻咽癌调强放疗的个体化。     

A new stage of surgical treatment: super minimally invasive surgery

<正>IntroductionThe application of video-assisted thoracoscopy, laparoscopy, and Da Vinci robotic surgery allows surgical treatment to enter the stage of minimally invasive surgery (MIS).[1,2,3] Compared     

中国ERCP诊断与治疗相关问题的探讨(一)

20世纪70年代,我国开始应用逆行胰胆管造影(ERCP)诊断及治疗技术。随着时间的推移、技术的发展与普及,操作人员的增多,操作病例量的增加,中国ERCP高层曾进行过数次高层论坛,探讨了一些与ERCP诊治相关的问题。但我们感到意犹未尽,对许多常遇到的问题仍须进一步深入探讨。特邀请中国人民解放军总医院消化疾病中心令狐恩强教授对此发表一些见解,以引发同道的讨论。来函请寄《中国实用内科杂志》编辑部“ERCP学术争鸣”组,本刊将不定期择优刊出。相信经此过程,将使问题更加明朗化而进一步达成共识。     

Preoperative arterial interventional chemotherapy on cervical cancer

Objective： To discuss the therapeutic effect of preoperative interventional chemotherapy on cervical cancer. Methods： Preoperative interventional chemotherapy by femoral intubation was performed in 25 patients with bulky cervical cancer. The patients received bleomycin 45 mg and cisplatin or oxaliplatin 80 mg/m^2. Results： 25 cases （including 8 cases with stage I and 17 cases with stage II） received one or two courses of preoperative interventional chemotherapy. The size of the focal lesions was decreased greatly and radical hysterectomy and lymphadenectomy were performed successfully in all the patients. All of the specimens were sent for pathological examination. Lymphocyte infiltration was found more obvious in the cancer tissues as compared with their counterpart before treatment. As a result, relevant vaginal bleeding was stopped completely shortly after the treatment. Conclusion： Arterial interventional chemotherapy was proved to reduce the local size of cervical cancer and thus control the hemorrhage efficiently. The patients with cervical cancer can receive radical hysterectomy therapy after the interventional chemotherapy.     

Foveal structure changes in infants treated with anti-VEGF therapy or laser therapy guided by optical coherence tomography angiography for retinopathy of prematurity

AIM: To evaluate foveal vessel density(VD) and foveal thickness using optical coherence tomography angiography(OCTA) in retinopathy of prematurity(ROP) children treated with laser photocoagulation or anti-vascular endothelial growth factor(VEGF) injection. Additionally, we assessed the relationship between foveal microvascular anomalies and different therapies in ROP children.METHODS: This was a single-center, retrospective study of patients with a diagnosis of type 1 ROP. Twenty-three eyes(14 patients) treated with anti-VEGF injection and twentynine eyes(17 patients) treated with laser coagulation were included in this study. The foveal VD, inner thickness and full thickness were measured at the central 0°, 2° to 8°, and 8° of the retina(centered on the fovea) using OCTA and cross-sectional OCT, respectively.RESULTS: Foveal VD, inner thickness and full thickness were significantly smaller within the central 8° of the retina in ROP children treated with anti-VEGF injection than in those treated with laser photocoagulation(P=0.013, 0.009, 0.036, respectively). The full thickness was also smaller in the anti-VEGF group than in the laser group at the central 0° of the retina(P=0.010). The grade of foveal hypoplasia is lower in the anti-VEGF group than in the laser group(P=0.045). Multivariable analysis did not find any risk factors associated with visual acuity in our study.CONCLUSION: In children with type 1 ROP, the better structural development of fovea in those who were treated with anti-VEGF injection compared with laser photocoagulation are identified. However, visual acuity outcomes are similar 70 mo after the treatments.