CA72-4联合AFP、CEA、CA19-9检测在胃肠道疾病中的临床应用价值研究

目的探讨糖类抗原72-4(CA72-4)联合甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)检测在胃肠道良、恶性疾病中的临床价值。方法收集2017-2018年该院就诊的胃癌(55例)、胃肠道其他癌(71例)、胃肠道良性疾病(556例)患者的临床资料与血清AFP、CEA、CA72-4、CA19-9检查结果,分析肿瘤标志物在不同疾病组间的表达差异。结果(1)血清CA72-4水平在胃癌组与良性疾病组、胃癌组与其他癌组比较,差异有统计学意义(P<0.05)。血清CA72-4在胃癌组的阳性率(30.91%)明显高于其他癌组(18.84%)及良性疾病组(17.99%)。(2)血清CA72-4在胃溃疡、胃息肉、慢性胃炎、急性胃肠炎、十二指肠溃疡、肠息肉等良性疾病的阳性率分别为15.00%、19.12%、11.02%、25.53%、24.07%、19.58%,各组间CA72-4水平及阳性率比较差异无统计学意义(P>0.05);(3)CEA单项检测用于胃癌诊断的灵敏度为23.64%,CA72-4+CEA+CA19-9联合检测用于胃癌诊断的灵敏度为47.27%;CA19-9单项检测用于胃肠道其他癌诊断的灵敏度为24.64%,AFP+CEA+CA19-9联合检测用于胃肠道其他癌诊断的灵敏度为66.20%,差异有统计学意义(P<0.05)。结论血清CA72-4联合CEA、CA19-9检测,可更好地识别胃癌;血清AFP联合CEA、CA19-9检测,可更好地识别胃肠道其他恶性肿瘤。     

Evaluation and management of lower gastrointestinal bleeding

Lower gastrointestinal bleeding (LGIB) is a common cause of presentation to the emergency department and hospital admissions. The incidence of LGIB increases with age and the most common etiologies are diverticulosis, angiodysplasia, malignancy and anorectal diseases. Foremost modality for evaluation and treatment of LGIB is colonosopy. Other diagnostic tools such as nuclear scintigraphy, computed tomography, angiography and capsule endoscopy are also frequently used in the workup of LGIB. Choice of treatment modality depends on the hemodynamic status of the patient, rate of bleeding, expertise and available resources. We present a comprehensive review of the evaluation and management of LGIB.     

内镜下金属钛夹对比药物治疗上消化道出血疗效的Meta分析

目的评价内镜下金属钛夹治疗上消化道出血的临床价值。方法通过计算机检索Pubmed、CNKI数据库、Web of Knowledge、Cochrane图书馆对照试验注册库、万方数据库从建库至2017年的有关内镜下金属钛夹对比药物注射治疗上消化道出血的相关文献,采用Cochrane协作网提供的RevMan 5.0版软件进行统计处理,对纳入资料的异质性进行分析,计算OR值和95%可信区间。结果按照入选标准,纳入了7项临床试验,共704例患者。Meta分析结果显示,钛夹治疗上消化道出血有效率更高(OR=5.74,95%CI:3.28~10.04)、72 h再出血率低(OR=0.24,95%CI:0.14~0.43)、转外科手术率低(OR=0.14,95%CI:0.05~0.37)。结论目前的研究结果显示,内镜下金属钛夹治疗上消化道出血的疗效优于单纯采用药物治疗,且该方法具有止血有效率高、72 h再出血率低和转外科手术率低等优点,具有临床推广及应用价值。     

以量化评估策略为核心的调节式护理干预对胃癌病人术后胃肠功能恢复及并发症预防的影响

目的:探讨以量化评估策略为核心的调节式护理干预对胃癌病人术后胃肠功能恢复及并发症预防的影响。方法:选取2016年7月—2018年7月收治的140例胃癌病人作为研究对象,将其以随机抽签法分为观察组及对照组。对照组给予常规护理干预,观察组给予以量化评估策略为核心的调节式护理干预。比较两组病人术后胃肠功能恢复情况、并发症发生情况,采用一般自我效能感量表(GSES)和生存质量测量量表简表评估两组病人干预前后自我效能感以及生活质量变化情况。结果:观察组病人胃肠功能恢复时间均短于对照组(均P<0.05)。观察组病人术后并发症发生率低于对照组(P<0.05)。两组病人干预后GSES评分高于干预前,且观察组高于对照组(均P<0.05)。观察组病人干预后生活质量评分高于对照组(均P<0.05)。结论:以量化评估策略为核心的调节式护理干预可有效促进胃癌病人术后胃肠道功能恢复,有利于降低术后并发症发生风险,提高病人的自我效能感以及生活质量。     

原发性胃肠道淋巴瘤的临床、内镜及组织病理学特点分析(附41例报告)

目的 探讨原发性胃肠道淋巴瘤(PGIL)的临床、内镜及组织病理学特点,以提高其诊治水平.方法 回顾性分析2008年1月-2019年12月该院经内镜或手术活组织病理检查确诊的41例PGIL患者的临床、内镜及组织病理学特点.结果 病变部位依次为胃(73.2％)、小肠(12.2％)、结肠(9.8％)和直肠(4.8％).患者临...     

Sonography of Gastrointestinal Tract Diseases

Sonographic evaluation of the gastrointestinal (GI) tract may be difficult because of overlying intraluminal bowel gas and gas‐related artifacts. However, in the absence of these factors and with the development of high‐resolution scanners and the technical experience of radiologists, sonography can become a powerful tool for GI tract assessment. This pictorial essay focuses on sonographic findings of GI tract lesions compared with endoscopic, computed tomographic, and magnetic resonance imaging findings. Neoplastic and non‐neoplastic diseases and postoperative complications are illustrated, and the distinctive sonographic characteristics of these entities are highlighted.     

静脉留置针联合真空采血器在上消化道出血急救中的应用

目的探讨静脉留置针联合真空采血器在上消化道出血急救中进行采血的优越性和可行性。方法采用便利抽样法,选择急性上消化道出血患者120例,将其按随机数字表法分为观察组和对照组,各60例。对照组按照传统方法,选择两侧肢体,一侧静脉留置针输液,另一侧肢体进行采血;观察组选择一侧肢体行外周浅静脉留置针同时联合真空抽血器抽血化验输液。比较2组在采血中的采血成功率、患者满意率、血源性污染及平均采血完成时间。结果观察组较对照组:患者满意度高,采血完成时间短,采血成功率高(均P<0.01);血源性污染发生率差异无统计学意义(P>0.05)。结论在急诊上消化道出血患者抢救中采用留置针连接真空采血针采血,可提高采血成功率和患者满意度,避免了血源性污染,同时缩短了操作时间。     

不明原因消化道出血患者实施双气囊小肠镜检查的护理

目的探讨不明原因消化道出血患者实施双气囊小肠镜检查的护理配合。方法回顾性分析2009年5月至2012年10月在沈阳军区总医院实施双气囊小肠镜检查的138例不明原因消化道出血患者的临床资料,总结其护理方法。结果所有患者均顺利完成检查,未出现并发症,检查阳性率为76.1%,其中88例小肠病变、11例上消化道出血、6例结肠病变。结论双气囊电子小肠镜检查对于不明原因消化道出血是一种安全、有效且准确率高的诊断方法,熟练的护理配合可以提高操作的成功率,降低并发症发生率。     

Effectiveness and safety of endoscopic resection for gastric GISTs: a systematic review

Aims: To evaluate the effectiveness and safety of endoscopic resection for gastric gastrointestinal stromal tumors (GISTs).

Material and methods: The effectiveness and safety of endoscopic resection were mainly assessed by complete resection rate, postoperative adverse event rate, and recurrence rate. Moreover, a comparison of endoscopic with laparoscopic resection for gastric GISTs was made through weighted mean difference by STATA 12.0 with regard to operation time, blood loss, and length of stay after including patients who underwent endoscopic or laparoscopic resection for gastric GISTs in the comparative studies.

Results: Eleven studies investigating endoscopic resection for GISTs were included. For stromal tumors <2?cm in average diameters the pooled rates of complete resection, postoperative adverse events and recurrence were 0.97, 0.08, and 0.03, respectively. Only five retrospective studies directly compared endoscopic with laparoscopic resection for gastric GISTs with average diameters from 1.1?cm to 3.8?cm, and endoscopic resection had a shorter operation time than laparoscopic resection, but there were no significant differences in intraoperative blood loss, length of stay, postoperative complications, and postoperative recurrence rates between the two approaches.

Conclusions: Endoscopic resection is predominantly tried for gastric GISTs of relatively small size. It seems effective and safe for gastric GISTs <2?cm in average diameter, with relatively short operation times.