彩色能量多普勒超声在胆囊癌早期诊断中的应用价值

目的:探讨原发性胆囊癌(GBC)的超声二维声像图特点及血流动力学特征,为临床诊断与治疗提供有效依据,并以此评价彩色能量多普勤超声在胆囊癌早期诊断中的应用价值。方法:用彩色多普勒能量图(CDE)观察45例原发性胆囊癌(GBC),46例胆囊良性病变(19例慢性胆囊炎,21例胆囊息肉,6例胆囊腺瘤)。胆囊动脉、肿瘤供养动脉的血流动力学特征,采用指标为:收缩期峰值血流速度(PS)、舒张期末血流速度(MD)、阻力指数(RI)和S/D。结果:胆囊癌组的PS、MD与胆囊良性病变组没有显著性差异,胆囊癌组的RI、S/D值高于对照组。结论:二维超声结合CDE在胆囊癌早期诊断中具有较高的应用价值。     

The pathology of gastric and duodenal polyps: current concepts

The liberal use of upper endoscopy has led to an increased detection of gastric and duodenal polyps, which are identified in as many as 6 and 4.6% of patient examinations, respectively. Gastroduodenal polyps are a heterogeneous group of lesions that can be neoplastic or non‐neoplastic (e.g. hyperplastic or heterotopical). Most polyps present characteristic topographical features, as well as endoscopic appearance and size. Evaluation of the surrounding mucosa is essential in assessing the underlying pathology (e.g. Helicobacter pylori, autoimmune gastritis or inherited polyposis syndromes). Phylogenetically, gastric and duodenal polyps can be classified according to the epithelial compartment from which they derive. Polyps that arise from the surface epithelium can either be of foveolar or intestinal type, and they can develop from either the native mucosa or the metaplastic epithelium (gastric intestinal metaplasia or duodenal foveolar metaplasia). Other polyps develop from the deeper glandular component, such as pyloric/oxyntic gland derived subtypes. In this review we focus upon epithelial polyps, with an emphasis on the most common and clinically relevant lesions, and present recently described entities.     

52例结肠炎性息肉患者的中医证型分布规律

目的文章将主要针对于结肠炎性息肉患者进行中医辨证分型。方法选取2017年8月-2018年12月在本院脾胃科320例结肠息肉患者进行发病率统计。结果在320例结肠肉患者中,炎性息肉,占据16.25%;其中,男性与女性的占比分别为67.3%和32.7%,男性老年患者与女性老年患者的比例分别为51.4%和52.9%;在炎性息肉中医证型分布中,以湿热淤阻证型最高,占据比例为48.1%,其中男性比例为60.0%,年龄分布上,以青中年患者居高。结论结肠炎性息肉在人群的年龄性别分布规律上,以男性老年患者最高,中医证型中以湿热淤阻为主。而在湿热淤阻炎性息肉患者分布中,以男性青中年患者为主要发病人群。     

胆囊息肉样病变204例临床分析

目的探讨胆囊息肉样病变（PLG）的临床若干问题,提高其诊断、治疗水平。方法腹部B超检出胆囊息肉样病变患者204例,其中31例经腹腔镜或剖腹胆囊摘除术,对其临床表现与病理特点进行比较。结果31例患者中,有症状者15例,占48．38％,胆囊原位癌1例（3．2％）,真性肿瘤6例（19．35％）,息肉样病变24例（77．42％）,胆囊增厚20例（64．5％）,合并结石者6例（19．3％）。结论胆囊息肉样病变属胆囊良性肿瘤,但少数有恶变危险,建议对于下列情况之一均应手术治疗：（1）年龄〉50岁单发性胆囊息肉;（2）单发性胆囊息肉样病变直径≥10mm或多发性的直径≥12mm;（3）直径〈10mm但胆囊壁显著增厚（〉4mm）及（或）伴有结石;（4）有较明显的临床症状内科治疗治疗后症状无缓解;（5）B超动态检查息肉短期增大者应手术治疗。     

Lymphatic spread of T2 gallbladder carcinoma: Regional lymphadenectomy is required independent of tumor location

BackgroundThis study aimed to investigate the incidence and distribution of regional lymph node metastasis according to tumor location, and to clarify whether tumor location could determine the extent of regional lymphadenectomy in patients with pathological T2 (pT2) gallbladder carcinoma.MethodsIn total, 81 patients with pT2 gallbladder carcinoma (25 with pT2a tumors and 56 with pT2b tumors) who underwent radical resection were enrolled. Tumor location was determined histologically in each gallbladder specimen.ResultsSurvival after resection was significantly worse in patients with pT2b tumors than those with pT2a tumors (5-year survival, 72% vs. 96%; p = 0.027). Tumor location was an independent prognostic factor on multivariate analysis (hazard ratio, 14.162; p = 0.018). The incidence of regional lymph node metastasis was significantly higher in patients with pT2b tumors than in those with pT2a tumors (46% vs. 20%; p = 0.028). However, the number of positive nodes was similar between the two groups (median, 2 vs. 2; p = 0.910). For node-positive patients with pT2b tumors, metastasis was found in every regional node group (12%–63%), whereas even for node-positive patients with pT2a tumors, metastasis was observed in regional node groups outside the hepatoduodenal ligament.ConclusionsTumor location in patients with pT2 gallbladder carcinoma can predict the presence or absence of regional lymph node metastasis but not the number and anatomical distribution of positive regional lymph nodes. The extent of regional lymphadenectomy should not be changed even in patients with pT2a tumors, provided that they are fit enough for surgery.     

Reactivation of codogenic endogenous retroviral (ERV) envelope genes in human endometrial carcinoma and prestages: Emergence of new molecular targets

Endometrial carcinoma (EnCa) is the most common invasive gynaecologic carcinoma. Over 85% of EnCa are classified as endometrioid, expressing steroid hormone receptors and mostly involving pathological prestages. Human endogenous retroviruses (ERV) are chromosomally integrated genes, account for about 8% of the human genome and are implicated in the etiology of carcinomas. The majority of ERV envelope (env) coding genes are either not present or not consistently represented between common gene expression microarrays. The aim of this study was to analyse the absolute gene expression of all known 21 ERV env genes including 19 codogenic and two env genes with premature stop codons in EnCa, endometrium as well as in hyperplasia and polyps. For EnCa seven env genes had high expression with >200 mol/ng cDNA (e.g. envH1-3, Syncytin-1, envT), two middle >50 mol/ng cDNA (envFc2, erv-3) and 12 low <50 mol/ng cDNA (e.g. Syncytin-2, envV2). Regarding tumor parameters, Syncytin-1 and Syncytin-2 were significantly over-expressed in advanced stage pT2 compared to pT1b. In less differentiated EnCa Syncytin-1, erv-3, envT and envFc2 were significantly over-expressed. Syncytin-1, Syncytin-2 and erv-3 were specific to glandular epithelial cells of polyps, hyperplasia and EnCa using immunohistochemistry. An analysis of 10 patient-matched EnCa with endometrium revealed that the ERV-W 5'' long terminal repeat regulating Syncytin-1 was hypomethylated, including the ERE and CRE overlapping MeCP2 sites. Functional analyses showed that 10 env genes were regulated by methylation in EnCa using the RL95-2 cell line. In conclusion, over-expressed env genes could serve as indicators for pathological pre-stages and EnCa.     

Colorectal endoscopic submucosal dissection: Systematic review of mid‐term clinical outcomes

With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non‐metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid‐term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En‐bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en‐bloc resection rate was 89% (95% CI: 83–94%), R0 resection rate 76% (95% CI: 69–83%), endoscopic clearance rate 94% (95% CI: 90–97%) and recurrence rate 1% (95% CI: 0.5–2%). Studies that followed up patients for over 1 year were found to have an en‐bloc resection rate of 91% (95% CI: 86–96%), R0 resection rate of 81% (95% CI: 75–88%), endoscopic clearance rate 93% (95% CI: 90–97%) and recurrence rate of 0.8% (95% CI: 0.4–1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow‐up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.     

表面麻醉纤维喉镜与全麻显微支撑喉镜下对不同类型声带息肉摘除的临床疗效分析

目的比较表面麻醉纤维喉镜与全麻显微支撑喉镜对不同类型声带息肉(VCP)摘除的临床疗效。方法以2007年11月至2012年10月芜湖市第一人民医院收治的164例VCP患者作为研究对象,按照随机数字表法分为两组,表麻纤维喉镜组66例,采用表面麻醉纤维喉镜下VCP摘除术(广基VCP27例、带蒂VCP39例),全麻显微支撑喉镜组98例,采用全麻显微支撑喉镜下VCP摘除术(广基VCP50例、带蒂VCP48例),比较两组治疗效果及术后随访期间并发症发生情况。结果表麻纤维喉镜组手术时间显著短于全麻显微支撑喉镜组[(35.6±12.3)min vs(46.5±17.6)min,P<0.05]。全麻显微支撑喉镜组与表麻纤维喉镜组对带蒂VCP有效率差异无统计学意义(95.8%vs97.4%,P>0.05);但全麻显微支撑喉镜组对广基VCP有效率显著高于表麻纤维喉镜组(94.0%vs81.5%,P<0.05)。全麻显微支撑喉镜组不良并发症发生率与表麻纤维喉镜组比较,差异无统计学意义(7.1%vs 4.5%,P>0.05)。结论表麻纤维喉镜与全麻显微支撑喉镜下VCP摘除术各有优点及局限,临床上应综合考虑以选择最优的治疗方案。     

Lessons learnt from a case of extracorporeal shockwave lithotripsy for a residual gallbladder stone

IntroductionExtracorporeal shockwave lithotripsy (ECSWL) for gallstones is rarely used due to high recurrence rates, but has been reported to be effective in some circumstances.Presentation of caseWe describe a case of a failed attempt at laparoscopic cholecystectomy due to gallbladder contraction and complete obliteration of Calot’s triangle. Cholecystotomy was performed to remove all visible stones, and completed by a subtotal cholecystectomy and closure of the gallbladder remnant. The patient remained symptomatic due to a residual stone in the Hartmann’s pouch. ECSWL was attempted to fragment the stone; however, follow-up imaging showed persistence of the calculus.DiscussionLiterature review shows that ECSWL for multiple gallbladder stones has a low success rate. Even if a stone is successfully fragmented, a diseased gallbladder remnant seems incapable of expelling the fragments. Without completion endoscopic clearance, therefore, the treatment is considered incomplete.ConclusionOur case suggests that ECSWL is ineffective in management of residual gallbladder stones after failed cholecystectomy.