丙泊酚复合不同阿片类药物在老年人结肠镜检查中的镇静效果

目的 探讨丙泊酚复合不同阿片类药物应用于老年人结肠镜检查镇静的效果.方法 60例老年结肠镜受检者随机分为3组,均采用靶控输注方法给予丙泊酚,其中20例单次推注芬太尼(芬太尼组),靶控输注舒芬太尼(舒芬太尼组)、瑞芬太尼(瑞芬太尼组)各20例.记录患者血流动力学改变、镇静深度和不良事件.结果 3组受检患者一般情况、血流动力学改变、镇静深度和不良事件比较差异无统计学意义(均P＞0.05).检查后恢复时间芬太尼组[(21.3±4.6)min]长于舒芬太尼组[(19.9±3.3)min]和瑞芬太尼组[(15.9±1.8)min],且与瑞芬太尼组比较差异有统计学意义(均P＜0.05).结论 丙泊酚复合3种阿片类药物均可安全有效地用于老年人结肠镜检查,但使用瑞芬太尼受检者恢复更为迅速.

Abstract：

Objective To explore the feasibility and safety of fentanyl, sufentanil or remifentanil combined with target-controlled infusion (TCI) of propofol for sedation in the elderly undergoing colonoscopy. Methods In this prospective randomized study, 60 patients undergoing colonoscopy and propofol TCI were randomly assigned to group F (fentanyl), group S (sufentanil) and group R (remifentanil)(each n=20). Patients in group F received a single bolus of fentanyl, while those in group S and group R received TCI sufentanil and remifentanil separately. The blood pressure, heart rate, blood oxygen content and Bispectral index (BIS) were monitored, and all the complications were recorded. Results All patients were adequately sedated. There were no significant differences in general conditions, hemodynamics changes, sedation depth and adverse event among the three groups (all P＞0.05). Time for recovery was longer in group F [(21.3±4.6) min] than in group S [(19.9±3.3) min] and group R [(15.9±1.8) min, P＜0.05]. Conclusions For the elderly undergoing colonoscopy, sedation with fentanyl, sufentanil or remifentanil combined with propofol TCI is feasible and safe. It is more excellent for the remifentanil group at shorter discharge time.     

Meet EBE: The Development of an Evidence-Based Endoscopy Simulator

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527例溃疡性结肠炎临床与病理分析

目的 评价临床、内镜及活检三者在溃疡性结肠炎(UC)诊断中的作用。方法 总结我院10年间经肠镜诊断为UC的病例，分析其临床、内镜表现及部分活检资料。结果 527例确诊为UC，其中误诊34例，结肠镜诊断正确率为93．9％。UC临床主要表现为腹泻(88％)、粘液脓血便(52％)。结肠镜表现以粘膜充血水肿(94％)、糜烂溃疡(75％)最多见，病变部位以直、乙结肠为主(51％)，呈弥漫性、连续性分布。活检特征性表现为炎症程度重(49％)，固有层弥漫性混合性炎细胞浸润(76％)、杯状细胞减少(71％)、隐窝扭曲(63％)、萎缩(47％)、隐窝炎(45％)、隐窝脓肿(36％)及绒毛状表面(39％)。结论 UC的诊断应强调临床、内镜及活检相结合。     

Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis.     

胃黏膜脱垂与慢性胃炎关系探讨

目的研究胃黏膜脱垂(prolapseofgastricmucosa ,GMP)与慢性胃炎的关系。方法选取二组接受胃镜检查的患者①慢性胃炎组,均符合1996年悉尼慢性胃炎诊断标准,并除外胃、十二指肠溃疡性疾病及十二指肠球部变形者。共10 3例,男5 7例,女46例。年龄2 2～74岁,平均年龄48 9岁。②对照组同期接受胃镜检查的患者,未发现胃、十二指肠存在活动性炎症、溃疡等病变表现,亦为10 3名,男60名,女43名。年龄2 0～76岁,平均年龄47 3岁。结果①共69例( 3 3 .5 % )存在GMP ,其中慢性胃炎患者及对照组中分别为43例( 4 1.7% )及2 6例( 2 5 .2 % ) ,慢性胃炎组中GMP检出率显著高于对照组(P <0 .0 5 )。②GMP在各年龄组,男女间发病率无显著性差异(P >0 .0 5 )。③GMP患者中Helicobecterpylori检测阳性率( 10 7% )显著低于GMP阴性患者H .pylori检出率( 2 6.2 % ) (P <0 .0 5 )。④43例伴GMP的慢性胃炎中胃窦条状红斑( 3 0 .2 % )、食管炎( 16.3 % )均高于60例不伴GMP中相应比例( 10 .0 % ,P <0 .0 1;3 .3 % ,P <0 .1)。结论GMP与慢性胃炎相关,胃窦条状红斑为特征性表现,GMP患者易合并食管炎;GMP发生与性别年龄无关;GMP患者H .pylori感染率较低。     

多层螺旋CT门静脉血管成像与内镜对食管、胃静脉曲张诊断的比较研究

目的对比研究多层螺旋CT门静脉血管成像(CTP)和内镜对食管、胃静脉曲张的诊断。方法采用16排多层螺旋CT门静脉血管成像,对57例临床和实验室检查提示门静脉高压的患者进行CTP,观察门静脉及其分支走形、分布,并结合横断面图像仔细观察食管和胃有无静脉曲张,并记录其部位、曲张静脉深浅、观察曲张静脉来源、有无其他部位曲张静脉或其他病理情况。同期对这些病例行胃镜检查,观察食管、胃是否存在静脉曲张及其他病变。结果CTP显示食管及胃静脉曲张病例51例,其中胃底静脉曲张合并食管静脉曲张39例,单纯胃底静脉曲张9例,胃底静脉曲张合并胃体静脉曲张3例。内镜发现食管及胃底静脉曲张46例,其中胃静脉曲张合并食管静脉曲张24例,单纯胃静脉曲张5例,单纯食管静脉曲张17例。CTP可发现内镜无法诊断的肌层或管腔外静脉曲张。结论CTP可清晰显示门静脉高压患者食管、胃底静脉曲张及主要侧支血管的走行、分布。在食管静脉曲张检查方面,CTP与内镜效果相当,CTP有几例假阳性,可作为普通内镜检查的良好补充;对于胃静脉曲张的检查,CTP效果较胃镜敏感,且CTP可清晰显示内镜无法观察的胃腔周围和食管周围静脉曲张。     

New and Recurrent Colorectal Cancers After Resection: a Systematic Review and Meta-analysis of Endoscopic Surveillance Studies

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胃出口、十二指肠和近端小肠恶性梗阻的内镜治疗

目的 探讨经内镜金属支架置入术治疗胃出口、十二指肠和近端小肠恶性梗阻的临床价值.方法 对1999年3月至2005年3月经内镜放置金属支架治疗的21例胃出口、十二指肠和近端小肠恶性梗阻患者的临床资料进行回顾性分析.结果 21例中20例放置支架成功,成功率为95.2%,其中4例采取经内镜钳道（TTS）方式释放支架,16例为经导丝直接释放支架.19例支架放置后1-3d梗阻症状得到缓解或消除,临床有效率为90.5%,平均生存期4.5个月.1例术后出血,予保守治疗而愈.1例术后1个月支架移位,1例术后2个月肿瘤向支架内浸润生长,导致梗阻复发,均予放置第2根支架后缓解.结论 经内镜放置金属支架治疗胃出口、十二指肠和近端小肠恶性梗阻是一种简单可行、安全有效的方法.