单气囊小肠镜在诊断胶囊内镜检查阴性的可疑小肠疾病患者中的应用价值

目的：探讨单气囊小肠镜（single-balloonenteroscop,SBE）在胶囊内镜检查阴性的可疑小肠疾病患者中的应用价值。方法：选取在我院行胶囊内镜检查无异常发现,后行单气囊小肠镜检查的可疑小肠疾病患者24例,分析后者对胶囊内镜检查阴性可疑小肠疾病患者的阳性发现率和病因的分布特点。结果：24例行SBE检查者有22例（91．7％）获得成功,2例失败,10例被检出阳性病变,其中间质瘤5例,小肠息肉2例,过敏性紫癜1例,血管畸形2例,SBE对胶囊内镜检查阴性的患者小肠疾病的再检出率为41．7％。结论：胶囊内镜和SBE在小肠疾病的诊断上有着各自的优缺点,对于胶囊内镜检查阴性的可疑小肠疾病患者进一步行SBE检查有助于确诊。     

行胶囊内镜检查67 例患者临床结果分析

目的:评价胶囊内镜在小肠疾病中的诊断价值,总结胶囊内镜临床应用策略。方法:回顾性分析上海市第一人民医院胃肠镜室2009年7月-2011年4月67例行胶囊内镜检查患者的检查结果,结合其中32名患者双气囊小肠镜检查结果及手术病理,分析胶囊内镜在小肠疾病的检出率,诊断率和不良事件发生率,总结胶囊内镜检查时的注意事项。结果:1例胶囊内镜操作失败,66例受检者检出率80.3%,诊断率为66.7%,发现病变中血管病变为主要诊断,占62.1%,其次为肠道占位(息肉、肿瘤)为14.6%,克罗恩病占10.9%,所有患者均未出现严重不良事件。结论:胶囊内镜在小肠疾病检查中安全,无创,诊断率较高,临床胶囊内镜检查时建议充分肠道准备,实时监控及结合双气囊小肠镜检查。     

不明原因消化道出血的外科治疗

目的:探讨不明原因消化道出血的原因及在手术过程中的诊疗策略及技术,以提高不明原因消化道出血的诊治水平。方法:对我院自2002年3月至2010年10月被诊断为不明原因消化道出血23例患者进行回顾性分析,其均经外科手术治疗。结果:本组23例患者,治愈22例,1例死于多脏器功能衰竭,1例术后出现肠瘘,2例患者出现术后切口感染。均未再次出现出血。平均住院时间14.3天。结论:手术治疗是不明原因消化道出血治疗的最后的诊治手段,掌握相应手术策略及技术,可使更多的患者受益。     

单气囊小肠镜与胶囊内镜对不明原因消化道出血的诊断价值

目的:探讨单气囊小肠镜(SBE)与胶囊内镜(CE)对不明原因消化道出血(OGffi)患者的诊断价值。方法:将在我院治疗的100例OGIB患者按照诊断方式的不同分为SBE组和CE组各50例。对两组的病灶检出率病因诊断率以及安全性进行比较。结果SBE组病因诊断率为78.0%;CE组病因诊断率为60.0%,两组病因诊断率比较差异无统计学意义(P0.05)。SBE组病灶检出率为80.0%(40/50),CE组病灶检出率为86.0%(43/50),两组病灶检出率比较差异无统计学意义(P0.05)。SBE组患者检查较顺利,CE组胶囊滞留率为4.0%。所有患者检查后均未出现不良反应及并发症。结论:息肉及粘膜糜烂渍疡病变的OGIB患者在SBE与CE检查方法中较为常见,CE病灶检出率与SBE相当,两种检查方法均较可靠,CE检查更为方便。     

原发性小肠淋巴瘤6例临床分析并文献复习

目的:探讨原发性小肠淋巴瘤临床特点,诊断及治疗方法。方法:对1997-2012年确诊的6例原发性小肠淋巴瘤患者的临床资料进行临床分析,总结其临床特点,同时复习相关文献。结果:隐性失血、脐周隐痛、腹部肿物、隐匿消瘦是原发性小肠淋巴瘤的最常见表现,而以全身症状为主的很少。推进式小肠镜及胶囊内镜的应用对该病诊断有重要价值,但阳性率较低。MSCT和MRE对本病的诊断有重要辅助作用。本组患者病理结果均为非霍奇金淋巴瘤,其中B细胞型4例,T细胞型2例,4例发生淋巴转移。6例患者中4例行手术切除治疗,2例行单纯化疗,2例死亡。结论:选择有效的检查手段,可提高小肠肿瘤的术前诊断,降低其误诊误治的发生率。手术切除是治疗该疾病的主要手段,采用手术后配合化疗及放疗的综合治疗可提高患者的生存率。     

双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血102例患者双气囊小肠镜检查,首选进镜方式分为经口或经肛2种.首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102),其中35例检查时见病变活动性出血.行内镜下止血治疗,33例止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面,双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

双气囊小肠镜在小肠出血中的应用价值

目的:观察双气囊小肠镜在小肠出血中的病变检出率、病因诊断率、耐受性和安全性,并探讨双气囊小肠镜对小肠出血的内镜下治疗情况.方法:对2006年3月至2009年11月烟台毓璜顶医院消化内科收治的可疑小肠出血患者102例行双气囊小肠镜检查,首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,日后改换进镜方式再行检查.对活动性出血病灶行内镜下止血治疗,小肠息内行息肉切除.结果:双气囊小肠镜的病变检出率为94.12%(96/102),病因诊断率为84.31%(86/102).其中35例检查时见病变活动性出血,行内镜下止血治疗,33倒止血成功,内镜止血成功率为94.30%(33/35);在耐受性方面.双气囊小肠镜的耐受性依次为:全麻下经肛进镜、全麻下经口进镜、非麻醉经肛进镜、非麻醉经口进镜.所有患者均未发生严重并发症.结论:双气囊小肠镜对小肠出血具有较高的病变检出率和病因诊断率,并且可行内镜下止血治疗,是一项安全、有效的临床诊疗方法.     

内镜下喷洒蛇毒血凝酶与金属钛夹治疗不明原因消化道出血的临床疗效比较

目的:探讨内镜下喷洒蛇毒血凝酶与金属钛夹治疗不明原因消化道出血的临床疗效。方法:选取2013年8月至2015年12月本院收治的不明原因消化道出血患者82例,随机分为对照组和实验组,每组41例。对照组给予内镜下喷洒蛇毒血凝酶治疗,实验组给予金属钛夹止血治疗。观察两组患者经止血治疗后即时止血时间、外科手术率、输血量、症状消失时间和临床疗效、再出血率和出血量。结果:实验组即时止血率明显高于对照组,输血量低于对照组(P0.05);实验组呕血消失时间、潜血转阴时间和引流液变清时间均小于对照组(P0.05);实验组痊愈率、总有效率高于对照组(P0.05);两组之间再出血率和出血量比较差异无统计学意义(P0.05)。结论:金属钛夹较内镜下喷洒蛇毒血凝酶对不明原因消化道出血具有更好的临床疗效,且再出血率较低。     

原发性小肠淋巴瘤6例临床分析并文献复习

目的：探讨原发性小肠淋巴瘤临床特点,诊断及治疗方法。方法：对1997—2012年确诊的6例原发性小肠淋巴瘤患者的临床资料进行临床分析,总结其临床特点,同时复习相关文献。结果：隐性失血、脐周隐痛、腹部肿物、隐匿消瘦是原发性小肠淋巴瘤的最常见表现,而以全身症状为主的很少。推进式小肠镜及胶囊内镜的应用对该病诊断有重要价值,但阳性率较低。MSCT和MRE对本病的诊断有重要辅助作用。本组患者病理结果均为非霍奇金淋巴瘤,其中B细胞型4例,T细胞型2例,4例发生淋巴转移。6例患者中4例行手术切除治疗,2例行单纯化疗,2例死亡。结论：选择有效的检查手段,可提高小肠肿瘤的术前诊断,降低其误诊误治的发生率。手术切除是治疗该疾病的主要手段,采用手术后配合化疗及放疗的综合治疗可提高患者的生存率。     

超声内镜对消化道隆起性病变的诊断价值

目的:探讨超声内镜(EUS)对消化道隆起性病变的诊断价值。方法:回顾性分析2013年2月到2017年6月于我院行EUS检查并经内镜下黏膜剥离术(ESD)、内镜粘膜切除术(EMR)或超声内镜引导下细针穿刺(EUS-FNA)获取诊断的293例有消化道隆起性病变的患者,分析病变的超声特点,对比病变的诊断结果。结果:在293例患者中,270例超声诊断与最终诊断相符,EUS诊断消化道隆起性病变的准确性为92.3%。在多种隆起性病变中,以平滑肌瘤(30.7%)及间质瘤(32.4%)最多见,超声对平滑肌瘤及间质瘤的诊断准确性分别为87.8%、95.8%。结论:EUS对消化道隆起性病变是一种有效的、准确的初步诊断方法。     

Epidemiology of typhoid carriers among blood donors and patients with biliary, gastrointestinal and other related diseases

Enteric fever due to Salmonella Typhi is a major public health problem. Typhoid carriers have high titres of Vi agglutinins in their sera. We worked out the baseline data for Vi agglutinins from 705 healthy blood donors (controls) by ELISA and compared it with 446 patients with biliary, gastrointestinal and other related diseases (cases). The samples were divided into five groups based on the disease condition of the patients from whom they were collected. Group A (n=196) consisted of patients with stones in the gall bladder/common bile duct and Group B (n=27) with gall bladder carcinoma. Group C (n=33) comprised patients with carcinoma of the pancreas/ampulla, obstructive jaundice and/or cholangiocarcinoma. Group D (n=112) had patients with acute/chronic pancreatitis, abdominal pain, intestinal obstruction, peritonitis, carcinoma oesophagus, chronic diarrhoea, gastrointestinal bleeding and dyspepsia. Group E (n=78) included patients with miscellaneous diseases. The mean absorbance value obtained for healthy subjects +3 standard deviations was taken as the cut-off value for a positive typhoid carrier. In Group A, 10.2% samples were positive; in Group B, 7.4%; in Group C, 12.0%; in Group D, 9.8% and in Group E, 9.0%. There was a highly significant (P <0.001) increase in the presence of Vi agglutinins in the cases compared to the controls. High prevalence of typhoid carriers occurs in patients with biliary, gastrointestinal and other related diseases. Vi serology employing highly purified Vi antigen offers a practical and cost-effective way of screening for S. Typhi carriers.     

Increased Diagnostic Yield of Capsule Endoscopy in Patients with Chronic Abdominal Pain

Background and Study Aims

Chronic abdominal pain is one of the most common chief complaints, but the underlying pathophysiology often remains unknown after routine clinical evaluation. Capsule endoscopy (CE) is a new technique for the visualization of the entire small bowel. The aim of this study was to evaluate the diagnostic efficacy of CE in patients with chronic abdominal pain of obscure origin.

Patients and Methods

Two hundred forty three patients with chronic abdominal pain with no significant lesions were enrolled in this study. CE was performed in all patients.

Results

A diagnosis was made in 23.0% of patients screened with CE. Of the 243 patients, 19 (7.8%) were diagnosed with Crohn''s disease, 15 (6.2%) with enteritis, 11 (4.5%) with idiopathic intestinal lymphangiectasia, 5 (2.1%) with uncinariasis, and a number of other diagnoses including small bowel tumor, ascariasis, and anaphylactoid purpura. Five patients had abnormal transit time, and capsule retention occurred in two patients.

Conclusions

In contrast to other previous studies, we found that CE is an effective diagnostic tool for patients with abdominal pain.     

慢性腹痛患儿C~(13)-尿素呼气试验与胃镜检查的临床意义

目的了解慢性腹痛患儿幽门螺杆菌(H.pylori)的感染状态及幽门螺杆菌感染患儿内镜下表现的特点。方法应用C13尿素呼气试验,对905例以慢性腹痛为主要症状的患儿进行检测,对C13呼气试验阳性者进行电子胃镜检查。结果905例慢性腹痛患儿中H.pylori呈阳性185例(20.44%),随年龄增长,其H.pylori阳性率升高,学年组已达高峰。对H.pylori阳性者进行胃镜检查结果显示十二指肠隆起病变47例占25.40%,结节性胃炎41例占22.1%,慢性浅表性`胃炎38例占20.5%,结节性胃炎伴十二指肠隆起病变23例占12.43%,十二指肠球部溃疡23例占12.4%。胃溃疡7例,占3.7%(其中包括1例复合性溃疡),结节性胃炎伴十二指肠炎6例,占3.2%。结论H.pylori感染为小儿慢性腹痛的主要原因之一,也是导致慢性胃炎及消化性溃疡的主要原因之一。C13尿素呼气试验方便,快速,无痛苦,无放射性,是一较好的H.pylori检测方法;对既有消化道症状同时C13呼气试验阳性者进行胃镜检查能够协助临床诊断及治疗。     

Radiology and endoscopy in acute upper gastrointestinal bleeding.

Of 112 patients admitted with acute upper gastrointestinal bleeding, the presumed bleeding site was detected in 61-5% of cases by radiology and in 57% of cases on endoscopy. Thirty-one patients who had barium-meal examination were operated on and the surgical and radiological findings agreed in 26 (84%). Twenty-three patients who had endoscopy were operated on and the surgical and endoscopic findings agreed in 15 (65%). In 10 cases radiology detected a lesion not identified on endoscopy and in nine endoscopy detected a lesion not seen at radiology. We suggest that when there are two potential sources of bleeding radiology as well as endoscopy can detect the actively bleeding lesion. The supplementary nature of radiology and endoscopy is emphasised and we conclude that both methods should be used if there is any doubt at the initial radiological or endoscopic examination about the source of the bleeding.     

In vivo imaging of intestinal helminths by capsule endoscopy

This review examines the use of digestive endoscopy to visualize intestinal helminths. The infections caused by these parasites are responsible for high levels of morbidity and mortality. These helminths can be visualized using gastroduodenal endoscopy, endoscopic retrograde cholangiopancreatography, and colonoscopy. Endoscopic examination of the small bowel is limited by its considerable length and its distance from the mouth and anus. Since capsule endoscopy (CE) was first reported in 2000, it has been established as a noninvasive modality for the investigation of the gastrointestinal tract. CE is used as a first-line tool for imaging various small-bowel diseases, mainly obscure gastrointestinal bleeding and Crohn's disease. Since the Food and Drug Administration (FDA) approved CE in 2001, the indications for its use have expanded widely. For example, CE can be used to visualize the in vivo kinetics of intestinal helminths. If the current trends in technological development continue, CE will become more widely used to facilitate the diagnosis and treatment of helminth infections in the near future.     

Long-term follow-up study on SIV intestinal proviral load in rhesus macaques

After experimental infection with simian immunodeficiency virus (SIV), intestinal endoscopy proved to be an easily tolerated, minimal invasive procedure to obtain biopsies from the gastrointestinal tract of rhesus macaques during all stages of disease. As the GI tract is affected by many opportunistic infections and immunological impairment after SIV/human immunodeficiency virus (HIV) infection, knowledge on the proviral load is an important parameter for a better understanding of disease pathogenesis. In this paper, we describe the set-up and evaluation of a quantitative competitive polymerase chain reaction (PCR) and the quantification of SIV intestinal proviral load in a long-term follow-up study of eight rhesus monkeys ( Macaca mulatta ) after two different routes of virus inoculation. A SIV-specific signal could be detected as early as day 3 after infection. Of 143 biopsies from the follow-up study, 85.3% showed a positive PCR. DNA copy numbers ranged from 300 to 15,000 molecules per 100,000 cells. No significant influence of the inoculation route could be shown on either proviral load or survival time, but higher SIV proviral load was associated with a more rapid progression to disease. Therefore, the amount of proviral load in intestinal biopsies may be an important prognostic value for the further course of the disease.     

急性肠系膜缺血性疾病36例治疗体会

摘要 目的：探讨急性肠系膜缺血(acute mesenteric ischemia,AMI)的诊断和治疗方法。方法：回顾性收集并分析36 例AMI患者的临床资料,均术前行MDT讨论,血管外科及胃肠外科联合手术治疗。所有治疗病例均行手术探查。其中3例病人术中使用荧光内镜判断肠道血供。统计诊治过程中腹部CT、白细胞计数、D-二聚体相关数据,应用SPSS软件分析其与肠道坏死的相关性。结果：腹部CT特异表现、白细胞计数升高与肠道坏死有相关性关系。治疗病例有11例行肠切除、 8例为外院行手术治疗后,在我院行术后康复治疗。术后8例发生短肠综合证。1例病人自动出院。1例死亡。1例病人术后出现肠道坏死、肠瘘,3个月后行肠瘘切除术,术后恢复良好。5例病人术后6个月行造口还纳。荧光内镜判断肠道血供及生机效果良好。结论：AMI 病情凶险,提高对疾病的认识,早期诊断,尽早重建小肠血运是提高疗效、改善预后的关键。多学科讨论后精准治疗,可提高治疗效果。术前腹部CTA对AMI的诊断及判断肠道坏死有重要意义。术中使用吲哚箐绿荧光显影剂、配合荧光导航内镜,判断肠道缺血范围,值得进一步探讨。临时性肠道双造瘘有利于及时发现肠管血运恢复情况,远端造瘘可早期进行肠内营养,值得推广。     

巴中地区上消化道出血反复发作相关性因素分析

目的：了解巴中地区上消化道出血反复发作的原因,为治疗提供临床循证医学证据。方法：通过对2011年4月~2012年11月巴中地区1134例上消化道出血中132例反复发作的患者进行调查统计,分析这上消化道出血反复发作的132例患者的年龄、生理特征、生活饮食习惯、精神状态、生活压力等多种相关因素。结果：发现饮食不当、精神紧张、腹腔感染、腹腔内压增高、输液输血过速、过量等是造成病情反复发作的主要诱因。结论：通过消除疾病的诱发因素,认真做好健康教育指导,积极治疗原发病是预防反复发作的有效措施。